Immunizations

CSTE Comment - v5

CSTE agrees with CDC and continues to strongly recommends that Vaccine Administration Date and Vaccination Event Record Type be included in USCDI v5. Both elements are required for immunization exchange and always have been. Each year, IIS respond to CDC’s annual report (IISAR). At the end of calendar year 2019, IIS records contained vaccine administration date 99.9% of the time with only 1 IIS reporting less than 100%. With these lacking from USCDI v5 draft, it would be possible to list only the immunization code a patient received, but not the date the patient received the dose or if the vaccination event originated in the source system. Vaccine Administration Date enables accurate record evaluation (e.g., were doses given at the proper age and at a proper interval) while Vaccination Event Record Type enable accurate inventory decrementing by public health and aids in vaccine matching/deduplication.

CDC's comment for USCDI Draft v5

CDC would like to reemphasize "Vaccination Administration Date" for inclusion in USCDI v5. "Vaccination Administration Date" is crucial for effective immunization management across healthcare settings. It facilitates accurate tracking of vaccination schedules, aligning with established terminology and date formats to enhance interoperability and streamline processes. Its broad relevance in public health reporting, international travel, and healthcare employment underscores the necessity for its inclusion, with strong advocacy for conformance and implementation guides to ensure consistent and accurate utilization across systems.

CDC's comment on behalf of NACCHO for USCDI v5

Support - The standardization of this data element will enhance LHDs ability to use and analyze this data. It will reduce the data preparation burden and thus enable more LHDs to use this type of data to inform decision-making.

CDC's comment on behalf of CSTE for USCDI v5

CSTE agrees with CDC and continues to strongly recommends that Vaccine Administration Date and Vaccination Event Record Type be included in USCDI v5. Both elements are required for immunization exchange and always have been. Each year, IIS respond to CDC’s annual report (IISAR). At the end of calendar year 2019, IIS records contained vaccine administration date 99.9% of the time with only 1 IIS reporting less than 100%. With these lacking from USCDI v4 it would be possible to list only the immunization code a patient received, but not the date the patient received the dose or if the vaccination event originated in the source system. Vaccine Administration Date enables accurate record evaluation (e.g., were doses given at the proper age and at a proper interval) while Vaccination Event Record Type enable accurate inventory decrementing by public health and aids in vaccine matching/deduplication.

CDC's Consolidated Comment for USCDI v5

• The "Vaccination Administration Date" is a critical data element proposed for inclusion in the USCDI v5, serving as a cornerstone for effective immunization management across various healthcare settings. This data point is integral to facilitating accurate tracking and coordination of vaccination schedules, thereby playing a vital role in ensuring timely and appropriate vaccine administration. This data element is widely captured within numerous EHR systems, making it a key component of patient care and central to immunization registry reporting. Standardizing the "Vaccination Administration Date," potentially aligned with established terminology such as HL7 or CVX codes, and specifying the date format (e.g., YYYY-MM-DD) will enhance semantic interoperability and consistency across systems. Its inclusion in USCDI v5 is poised to significantly streamline healthcare processes, supporting unified, secure, and reliable information exchange among healthcare stakeholders, including providers, public health agencies, and schools. As vaccines are pivotal in preventive health and public health responses, including epidemic control, a standardized "Vaccination Administration Date" is essential for accurate public health reporting, international travel, school enrollment, and employment in health-sensitive areas. Its broad applicability is evident as it is relevant in pediatric, adult, and geriatric care, reflecting its universality across the healthcare continuum. The inclusion of this data element in the USCDI v5 would not only ensure interoperability but also contribute to improving population health outcomes by aiding in the delivery of timely and coordinated care. We strongly advocate for its inclusion and recommend developing conformance and implementation guides that address the consistent and accurate capture and sharing of this pivotal data element across healthcare systems.

• ** ADD THIS USE CASE TO SUBMISSION **

1. "Immunizations HPV": HPV is estimated to cause 70% of oropharyngeal cancers in the United States, although it is unclear if having HPV alone is enough to cause oropharyngeal cancers, or if other factors interact with HPV to cause these cancers. Because the HPV vaccine protects against the types of HPV that can cause oropharyngeal cancers, it may also prevent oropharyngeal cancers. The United States is struggling to achieve HPV vaccination goals because HPV vaccination policies vary greatly nationwide, making it hard to implement sustainable programs. Surveillance of HPV vaccination and risk factors can help to establish associations, identify at-risk populations, and better inform clinical decision-making guidelines and interventions. These activities can increase vaccination acceptance rates and may lower HPV-associated oropharyngeal cancer prevalence and incidence.

CDC's Consolidated Comment for USCDI v4

CDC continues to recommend inclusion of this high priority data element in USCDI v4

CSTE Comment:

• CSTE agrees with CDC and continues to strongly recommends that Vaccine Administration Date and Vaccination Event Record Type be included in USCDI v4. Both elements are required for immunization exchange and always have been. Each year, IIS respond to CDC’s annual report (IISAR). At the end of calendar year 2019, IIS records contained vaccine administration date 99.9% of the time with only 1 IIS reporting less than 100%. With these lacking from USCDI v4 it would be possible to list only the immunization code a patient received, but not the date the patient received the dose or if the vaccination event originated in the source system. Vaccine Administration Date enables accurate record evaluation (e.g., were doses given at the proper age and at a proper interval) while Vaccination Event Record Type enable accurate inventory decrementing by public health and aids in vaccine matching/deduplication.

CDC's Consolidated Comment

• CDC would like to emphasize the inclusion of “Vaccination Administration Date” in USCDI v3. “Vaccination Administration Date” is the date the client received the vaccine. This is a core immunization data element used widely in the health community for a variety of purposes, such as:

1. To record the date this vaccination event occurred.
2. To document in the case of refusal or deferral, the date that the refusal or deferral was recorded.
3. In the context of a forecast dose, the date the forecast was made.
4. Many vaccines are aged-based, and vaccination administration date is used to evaluate before the vaccine is administered, whether a client is eligible to receive the specific vaccine product, has aged-out and no longer qualify for the vaccine or another vaccine product is recommended by ACIP.
5. Some vaccines belong to a vaccine series, and correct spacing between dose intervals is important for proper immunity.  Vaccine administration date is to evaluate before the vaccine is administered, whether the proper dose interval has been met or whether the series has been completed.

• Without “Vaccination Administration Date” physicians cannot determine when a patient was vaccinated, and thus:

1. Physicians cannot be assured that patients are fully vaccinated, nor can the physician inform their patient when their next vaccination is due.
2. Physicians are required to report some vaccination administrations to their jurisdictions which require “Vaccination Administration Date” for submission.
3. In the public health realm, “Vaccination Administration Date” is widely used for various purposes such population coverage information, especially in the context of social determinants of health and in vaccine effectiveness studies.
4.  “Vaccination Administration Date” is also used in immunization data quality assessments.

• Due the reasons stated above, and the importance of “Vaccination Administration Date”, it is included in thousands of Health IT related systems, such as EHRs and Immunization Information Systems. Additionally, there are harmonized standards for the implementation of “Vaccination Administration Date”.
• In summary, while vaccine type is extremely important in the medical and public health fields, “Vaccination Administration Date” is the second most important piece of information needed for accurate information. Without “Vaccination Administration Date”, base-level immunization functionality cannot occur.

CSTE Comment:

• CSTE agrees with AIRA and CDC and strongly recommends that Vaccine Administration Date and Vaccination Event Record Type be added to USCDI v3. Both elements are required for immunization exchange and always have been. Each year, IIS respond to CDC’s annual report (IISAR). At the end of calendar year 2019, IIS records contained vaccine administration date 99.9% of the time with only 1 IIS reporting less than 100%. With these lacking from USCDI v3 it would be possible to list only the immunization code a patient received, but not the date the patient received the dose or if the vaccination event originated in the source system. Vaccine Administration Date enables accurate record evaluation (e.g., were doses given at the proper age and at a proper interval) while Vaccination Event Record Type enable accurate inventory decrementing by public health and aids in vaccine matching/deduplication.

Unified Comment from CDC

• Additional Use Cases: Immunization information including date of administration is collected as part of case based surveillance for Hepatitis A, Acute Hepatitis B and Perinatal Hepatitis B to understand hepatitis transmission patterns and ensure appropriate interventions are prioritized within impacted communities.
   
• Immunization elements are a major piece of public health control and mitigation. When combined with case reports to a jurisdiction or notification to CDC, it allows the jurisdiction or CDC to see where immunizations may be lacking. Immunization information may not directly provide disparity information, but it is needed together with other disparity-related data (e.g., race, ethnicity, location) to identify vaccine breakthroughs or problems with vaccination access/coverage which may also speak to broader health disparities related to general access to medical care and services.
   
• Number of stakeholders who capture, access, use or exchange this data element:  All US States and DC are funded through CDC’s Division of Viral Hepatitis flagship Notice of Funding Actions to perform surveillance activities, including collection of these data for surveillance purposes.
   
• Support for healthcare aims:  Improving patient experience of care, Improving health of populations, Reducing cost of care, Improving provider experience of care
   
• Use of data element:  Extensively used in production environments
   
• Exchange of data element: CDC Message Mapping Guides (MMG) (e.g., COVID-19) ;
   
• The Multiple Chronic Conditions eCare Plan project successfully tested this element at the Sep 2020 and Jan 2021 FHIR connectathons and has implemented it at the OHSU testing site.
   
• This element is used by CMS Quality Reporting and is marked Required or MustSupport in the FHIR QI Core IG
   
•  CSTE supports inclusion of this measure into USCDI v3: supports information being shared with IIS across the country – should be captured for all IZ, not just children

There seems to be two data…

There seems to be two data elements in the Immunization Data Class in USCDI that are duplicates:

• Vaccination Administration Date
• Immunization Administered Date

Is there anyway to remove one of them? We would prefer to keep Vaccination Administration Date and have the other (Immunization Administered Date, https://www.healthit.gov/isa/uscdi-data/immunization-administered-date) removed. 

This field is for general comments on this specific data element. To submit new USCDI data classes and/or data elements, please use the USCDI ONDEC system: https://healthit.gov/ONDEC