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Increasing Appropriate Vaccination: Immunization Information Systems

Task Force Finding

The Community Preventive Services Task Force recommends immunization information systems (IIS) on the basis of strong evidence of effectiveness in increasing vaccination rates.

Evidence is considered strong based on the findings from 108 published studies and 132 conference abstracts showing that IIS are effective in increasing vaccination rates and reducing vaccine-preventable disease through their capabilities to:

  1. Create or support effective interventions such as client reminder and recall systems, provider assessment and feedback, and provider reminders
  2. Determine client vaccination status for decisions made by clinicians, health departments, and schools
  3. Guide public health responses to outbreaks of vaccine-preventable disease
  4. Inform assessments of vaccination coverage, missed vaccination opportunities, invalid dose administration, and disparities in vaccination coverage; and
  5. Facilitate vaccine management and accountability

Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Intervention Definition

Immunization information systems are confidential, population-based, computerized databases that record all immunization doses administered by participating providers to persons residing within a given geopolitical area.

  • At the point of clinical care, an IIS can provide consolidated immunization histories for use by a vaccination provider in determining appropriate client vaccinations.
  • At the population level, an IIS provides aggregate data on vaccinations for use in surveillance and program operations, and in guiding public health action with the goals of improving vaccination rates and reducing vaccine-preventable disease.

In the United States, minimum functional standards External Web Site Icon for the operation of immunization information systems were developed in 1997 by the Centers for Disease Control and Prevention, the National Vaccination Advisory Committee, and immunization program grantees. In 2012, CDC and the IIS community updated the IIS Functional Standards for implementation during the period 2013-2017.

Immunization information systems now operate in all but one U.S. state. Most IIS serve all children, adolescents, and adults in the jurisdiction (CDC External Web Site Icon).

About the Systematic Review

The Task Force finding is based on evidence from a systematic review of 240 studies (108 published studies and 132 conference abstracts; search period January 1994 - April 2011). Included studies represented IIS-supported interventions (e.g., client reminder and recall systems) and described IIS program activities and experiences. The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing appropriate vaccination.

Results

Studies were assigned to nine categories for evidence assessment.

  • Overall evidence on effectiveness
    • A published study from Australia examined change in vaccination rates following adoption of a national IIS. Although vaccination rates steadily increased, change likely reflected increased participation rates driven by incentive payments for both families and vaccination providers.
    • A cross-sectional study conducted in the United States evaluated the association between practice use of an IIS and likelihood of children being up-to-date. Practices using an IIS did not have significantly higher coverage levels than those practices not using an IIS.
  • IIS-supported interventions to increase vaccination rates
    • Client reminder and recall systems:
      • Median absolute improvement in vaccination rates: 6 percentage points (interquartile interval: 4 to 7 percentage points; 13 studies, 16 study arms)
      • An additional 17 descriptive studies reported client reminder and recall activities using the IIS.
    • Provider assessment and feedback:
      • Median absolute improvement in vaccination rates: 9 percentage points (range of values: 5- 15 percentage points; 5 studies)
      • An additional 10 descriptive studies reported the use of IIS to support the conduct of these interventions.
        • Provider reminders (also referred to as clinical decision support for immunizations, or CDSi):
      • Absolute increase in vaccination rates: 14 percentage points (one study)
      • Many IIS in the United States have built-in reminders for vaccination providers when a client record is consulted.
  • IIS use in vaccination-related decisions by clinicians, schools, and health care systems
    • No studies evaluated the use of IIS by vaccination providers at the clinic level.
    • Ten studies described use of IIS in school settings.
    • Four studies described the use of a state IIS by a health care system. Three of the studies described using IIS data for quality measurements, including HEDIS (Healthcare Effectiveness Data and Information Set).
  • IIS use in public health response
    • Eighteen studies described use of IIS to respond to outbreaks of vaccine-preventable disease, including:
      • Targeted recalls of unvaccinated patients
      • Retrospective review of vaccine uptake to monitor provider adoption of revised vaccination recommendations
      • Guiding decisions around 2009 H1N1 influenza vaccine distribution and client management
      • Three studies described use of IIS to respond to a public health emergency situation, including two that detailed the use of IIS to screen vaccination histories of displaced persons following Hurricane Katrina in order to prevent costs associated with administering unneeded vaccines.
  • IIS use to support vaccine management
    • Fourteen studies described the use of IIS in the process of vaccine supply management, distribution, and accountability; ten involved doses distributed as part of the U.S. Vaccines for Children Program External Web Site Icon.
  • IIS to assess vaccine safety and effectiveness
    • Seventeen studies described use of IIS in assessment of, or response to, vaccine safety issues or in evaluation of vaccine effectiveness.
  • IIS as a tool for public health decision support
    • Included studies described a range of IIS surveillance capabilities including:
      • Coverage assessments for specific vaccines (51 studies)
      • Investigations of vaccination rates among high risk subsets of the population (32 studies)
      • The ability to monitor the uptake of new vaccines (16 studies)
  • IIS integrated with other child health information systems
    • Eight studies discussed integration of additional child health data (e.g. blood-lead levels, early hearing detection) into an existing IIS.
  • IIS contributing to change in documentation
    • Twenty-four studies compared the completeness of individual IIS vaccination records with some other immunization data source (e.g. medical records, parental report).

Economic Evidence

The economic review is based on evidence from 14 studies (12 published papers and 2 government reports; search period January 1994 – March 2012). Included studies evaluated the cost of IIS (9 studies; 7 assessed system costs, and 2 assessed the cost of exchanging immunization data), benefits of IIS (9 studies), and cost-benefit ratios (4 studies). All studies provided information about IIS implemented in the United States and focused on pediatric immunizations.

Of the seven studies that assessed system costs, six evaluated systems implemented from 1997 to 2002. Cost and benefit data from these studies may be less applicable today owing to changes in system technology, data exchange methods, availability of vendor support, and system functionalities. It is likely, however, that more up-to-date estimates would support the findings of cost savings in this review.

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

  • Many systems rely on voluntary participation of vaccination providers, with IIS data completeness (and subsequent utility) dependent on the extent and timeliness of provider reporting.
  • Client participation and confidentiality requirements may limit the ways in which IIS data can be entered, retrieved, or used for clinical and public health purposes.
  • Vaccination providers have expressed concerns over technological constraints, as well as time and staffing demands required to enter complete and timely reports into the system.

Supporting Materials

Publications

Groom H, Hopkins DP, Pabst LJ, Morgan JM, Patel M, Calonge Ned, et al. Immunization information systems to increase vaccination rates: a Community Guide systematic review Adobe PDF File [PDF - 441 kB]. Journal of Public Health Management and Practice 2014;00(00):1–22.

Patel M, Pabst L, Chattopadhyay S, Hopkins D, Groom H, Myerburg S, Morgan JM, the Community Preventive Services Task Force. Economic review of immunization information systems to increase vaccination rates: a Community Guide systematic review Adobe PDF File [PDF - 177 kB]. Journal of Public Health Management and Practice 2014;00(00):1–10.

Community Preventive Services Task Force. Recommendation for use of immunization information systems to increase vaccination rates Adobe PDF File [PDF - 120 kB]. Journal of Public Health Management and Practice 2014;00(00):1–4.

Novick LF. Immunization information systems (Editorial) Adobe PDF File [PDF - 49 kB]. Journal of Public Health Management and Practice 2014;00(00):1–2.

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Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Increasing appropriate vaccination: immunization information systems. www.thecommunityguide.org/vaccines/universally/imminfosystems.html. Last updated: MM/DD/YYYY.

Review completed: July 2010