My Turn: The benefits of a robust Immunization Information System

As a 45-year resident of New Hampshire and someone who votes in every election and as a retired public health nurse with almost 40 years of community and public health experience in the Granite State, I have urged the members of the House Health, Human Services and Elderly Affairs Committee to oppose HB 1606.

The NH Immunization Information System or NHIIS (also known as New Hampshire’s vaccine “registry”) is 15 or more years behind any other state IIS in the country. As the last state to even have an IIS, many roadblocks prevented New Hampshire’s initial system from becoming the functioning tool it was meant to be, and a new vendor was contracted in 2019. As New Hampshire was getting ready to launch its first fully functioning IIS, with all of the attendant education, support and outreach required, the pandemic hit.

This not only forced a rapid rollout of certain features of the IIS required for COVID-19 vaccination efforts, but the healthcare crises occurring in hospitals and provider offices have made it extremely difficult for all parties (healthcare providers, patients and families, and public health) to realize the benefits and value of a high-quality IIS.

Making the NHIIS “opt-in” will only delay the process further and seems meant to promote its failure. And it is not necessary as patients can already opt-out if they do not want their information in the NHIIS.

These are the benefits of a robust and fully functioning IIS:

Provides consolidated records: Containing immunizations administered at a previous provider office, hospital, pharmacy or school clinic give healthcare providers the full story, preventing patients from receiving too many or too few vaccines

Manages vaccine inventory: Vaccine ordering, tracking and administration are all managed in one tool

Minimizes waste: Ensures every vaccine is accounted for and prevents the administration of unnecessary doses of vaccines

Forecasts immunizations: Alerts notify providers to assist with clinical decisions and management of the complex immunization schedule

Reminds patients of due dates: Automatic reminders promote on-time vaccinations

Spotlights areas of need: Population-level vaccine coverage data provides a clear view of communities at risk

Expedites response in an outbreak: Insights into vaccination status set the stage for effective outbreak response (including a measles or hepatitis A outbreak, not just during a pandemic.)

According to a review of state IIS policies in 2015 (Martin, Daniel W. MSPH; Lowery, N. Elaine JD, MSPH; Brand, Bill MPH; Gold, Rebecca JD; Horlick, Gail MSW, JD Immunization Information Systems, Journal of Public Health Management and Practice: May/June 2015 – Volume 21 – Issue 3), other states’ IIS policies and laws range from highly restrictive (such as immunizations only included on an opt-in basis) to mandatory inclusion with no opportunity to opt-out of the IIS.

The majority of jurisdictions either mandate reporting or use implied consent, in which the patient/parent/guardian is notified of the requirement to report and offered the opportunity to opt-out. National public health experts recommend opt-out consent policies when feasible in order to lower the barrier to comprehensive reporting to IIS. Such policies respect an individual’s right to privacy, including the right to exclude information from public health databases, while maximizing the availability of needed data for quality care and public health.

It has been suggested that switching from opt-in to opt-out could save more than $1 million per year in one state and at least one study has suggested that opt-out policies may correlate with improved immunization coverage.

Why would New Hampshire go backward and switch from opt-out to opt-in? This is bad public health policy and bad for the citizens of New Hampshire.

(Suzanne Allison, RN, BSN, lives in Barnstead.)