Record of vaccine administration.

Data Element
Vaccination Event Record Type
Description

Indicates whether the vaccination event is based on a historical record (e.g., second hand knowledge of the vaccination event) or was administered at the facility submitting the data.
Submitted By: Nedra Garrett / Centers for Disease Control and Prevention
Data Element Information
Use Case Description(s)
Use Case Description Knowing whether a vaccination was administered or was a historical record is helpful when providers are evaluating a patient’s immunization status to determine when the next vaccination in a series should be given. This information helps the IIS and other health IT systems identify, prevent, and resolve duplicate vaccination events using an automated process, thus ensuring that a patient is vaccinated according to the ACIP schedule. Additionally, this information could increase vaccination rates, a Healthy People 2030 goal, by ensuring patients are vaccinated on time.
Estimate the breadth of applicability of the use case(s) for this data element "There are multiple stakeholders that would capture, access, use or exchange this data element or data class including: • Electronic Health Records
• Immunization information systems and local and state departments of public health
• Providers
• Research and academic institutions, especially those running clinical trials "
Link to use case project page https://www.cdc.gov/vaccines/programs/iis/index.html
Use Case Description Additionally, determining whether a vaccination was administered or was a historical record is helpful when performing public health analyses. Vaccine efficacy analyses use this information to determine immunization population coverage. Statistical analyses help to identify underserved populations so that resources redirected appropriately and used efficiently.
Estimate the breadth of applicability of the use case(s) for this data element "There are multiple stakeholders that would capture, access, use or exchange this data element or data class including:
• Electronic Health Records
• Immunization information systems and local and state departments of public health
• Providers
• Research and academic institutions, especially those running clinical trials "

AIRA: https://www.immregistries.org/ Immunization Action Collition: https://www.immunize.org/
Link to use case project page https://www.immunize.org/
Healthcare Aims
  • Improving the health of populations
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) LOINC:30952-6- Date and time of vaccination: https://loinc.org/30952-6/

PHINVAD Immunization Information Source
https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.114222.4.5.293
Additional Specifications This information is in various technical specifications including:
• The HL7 2.5.1 Implementation Guide for Immunization Messaging and the HL7 2.8.2 Implementation Guide: Immunization Messaging (see RXA-3)
• FHIR r4 (see immunization.occurrence)
• Clinical Decision Support for Immunizations FHIR IG
• CDC Nationally Notifiable Disease Surveillance System (NNDSS) Message Mapping Guides (MMGs) for Vaccine Preventable Diseases (VPDs)
Current Use In limited use in production environments
Supporting Artifacts Similar information has been collected in various artifacts including the HL7 v2.5.1 Implmentation Guide for Immunization Messaging, the HL7 2.8.2 Implementation Guide: Immunization Messaging, and various public heatlh reporting forms.

https://www.cdc.gov/vaccines/programs/iis/technical-guidance/hl7.html
Extent of exchange N/A
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns None
Estimate of Overall Burden The overall burden to implement this data element is low, as most healthcare IT information systems most likely have this data element stored and messaged in their system already.
Other Implementation Challenges One possible challenge for implementation is ensuring that the correct information is captured, as depending on the timing of the administration, there could be confusion about whether the vaccination was administered or reported. For example, some EHRs would consider a vaccination event given on the same day by a provider outside of their EHR system a historical record, even though they were given on the same day, even within a matter of a few hours.
ASTP Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 2 - Use cases apply to most care settings or specialties.

Comment

Submitted by Svellanky on

CMS-CCSQ Support for Vaccination Event Record Type: USCDI v4

The immunization data element provides critical information about whether a vaccination has ever been administered, planned or reported. The current immunization data element is insufficient to identify whether the vaccination is based on the historical record or was administered at the facility submitting the vaccine. By adding vaccine event record type for immunizations, ONC can also ensure data elements necessary to determine whether vaccinations are current, and whether any vaccinations need to be administered. Vaccine efficacy analyses use this information to determine immunization population coverage. Statistical analyses help to identify underserved populations so that resources are redirected appropriately and used efficiently. This should not add any substantial burden on vendors or implementers, as this metadata should already be routinely captured. As this information helps improve accuracy of vaccine reporting, it can benefit many existing CMS vaccination quality measures.

Maturity: This data element is classified as Level 2 by ONC and continues to have strong standardization and be in wide use.

Current uses, exchange, and use cases: The vaccination event record type data element provides information that is currently lacking in the USCDI on timing of the immunizations that can improve accuracy of measurement. 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. This data is particularly important for COVID-19 reporting. This data element also allows CDC to see where immunizations may be lacking and can support future CMS quality measure reporting.

Submitted by nedragarrett_CDC on

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.

Submitted by nedragarrett_CDC on

Unified Comment from CDC

  • Additional Use Case: 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.
     
  • Additional Use Cases: 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.
     
  • Estimate 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.
     
  • Healthcare Aims:
  • 1. Improving patient experience of care
  • 2. Improving health of populations
  • 3. Reducing cost of care
  • 4. Improving provider experience of care
     
  • Use of data element: Extensively used in production environments
     
  • 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

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