The Immunization Registry

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• What is a Registry?
• Who are the participants?
• How do I join and what is needed?
• What are the benefits?
• What are the legal issues?
• Regional Participants?
• What's Happening?

Contact us at (209)558-4816 or E-mail us

• It is a computerized record of all the vaccinations that children in our community have received.
• It includes an option to provide automatic notification when children are behind schedule.
• It is populated with Stanislaus County birth certificate data.
• It will be linked to the Statewide Registry.
• It is easy and convenient to use.

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The registry provides:

• Easily attainable immunization records for school, camp, day care enrollment, and personal records
• Information on immunizations due
• Current recommendations by the Advisory Committee on Immunization Practices (ACIP)
• Various reports
• Less hassle locating records of mobile families

• Providers overestimate how many of their patients are fully immunized.
• Parents often do not know the immunization status of their children.
• Most providers do not have systems which recall patients for missed immunization appointments.
• Registries will reduce the burden of paperwork in a provider's practice.
• Immunization coverage rates on a community level can be institutionalized.
• Registries help to prevent the "peaks and valleys" of disease outbreaks by managing more efficiently the information about the immunizations that children receive.
• Registries consolidate a child's immunizations from all doctors into one record so the child has a reliable immunization history when a family moves or switches health care providers.

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Assembly Bill (AB) 254:

The Legislature and Governor enacted Health & Safety Code Section 3396 (AB 254, Chapter 314, Statutes of 1995). Under this legislation, unless patients or their parents refuse to permit this, physicians can share patients' immunization records with health departments operating immunization registries without having to obtain and send a written "record release" authorization from the patient or parent each time. The health departments, in turn, can share these records directly with other physicians and clinics providing immunizations to the same patients.

This law has been hailed by privacy rights groups as model legislation because it literally "bristles" with confidentiality and privacy rights protection provisions:

• Physicians must inform their patients of immunization record sharing and of their right to refuse to permit it.
• Patients have the right to examine the records and correct any errors, as well as the right to learn precisely with whom their information is shared.
• The records can be shared by patients' physicians only with health departments operating immunization registries, and these health departments in turn can share this information only with other physicians, clinics, or hospitals who need it to provide further immunization services to the patients.
• These health care providers can obtain from health department immunization registries only the records of patients with whom they specifically identify in advance; that is, they cannot simply "browse" through the records of any and all patients who may be in the registry.
• Only immunization histories and accompanying patient identification information can be shared in this manner; no other information can be transferred.
• Physicians, clinics, and hospitals requesting and receiving this information must treat it with the same legal confidentiality requirements as other patient medical records and can use the information only to provide immunization services to their patients.
• Individuals misusing this shared information and violating any of the requirements outlined above are subject to civil penalties under Section 56.35 and 1798.57 of the California Civil Code.

Senate Bill (SB) 2222:

SB 2222 was in effect January 1, 1999. It modifies Health and Safety Code Section 120440 and allows community-wide immunization registries operated by local health departments in California to share immunization records of individual, identified clients with authorized schools, child care facilities, WIC agencies, health care facilities, and health care plans, if the clients or their parents/guardians have received the appropriate AB 254 disclosure and have assented.

Authorized means the requesting agency (i.e., one of those listed above) has made an agreement with the registry, to the registry's satisfaction, that it will maintain confidentiality of information on the clients whose records they have requested and use it only for limited, specified purposes:

• Schools & child care facilities: To help families provide documentation of receipt of immunizations required for their children to be admitted.
• WIC agencies: To provide immunization status assessments for clients and advise those due for immunizations currently or in the near future to see their health care providers.
• Health care facilities & health care plans: To provide immunization services to clients/patients, including immunization reminder/recall services, and to facilitate third-party payer payments for these services.
• The difference between AB 254 and SB 2222 is that AB 254 (enacted in 1995) only allowed professionally-licensed health care PROVIDERS (i.e., physicians, nurses, etc.) to:
  
  (a) Share patient immunization histories with registries, and
  (b) Obtain patient immunization histories from registries. Sometimes the health care facility or its chief administrator or owner is the legal custodian of the patient records, rather than the physicians and nurses who work at the facility.

Agencies like schools, child care facilities, and WIC agencies will have to sign some sort of memorandum of understanding (MOU) with their local registry in order to obtain immunization information. The State Immunization Information System (SIIS) Confidentiality Committee will develop guidelines on this, to be added to California's existing SIIS "Registry Development Guidelines."

Registries do not have to share patient immunization information with these agencies. The legislation is permissive in this regard, so that registries retain the right to refuse to share this information.

The "AB 254 disclosure" is somewhat like the "Miranda Rule" in criminal law. Before a health care provider can share a patient's immunization history- currently or in the future- with a local registry, he/she must disclose to the patient or parent/guardian just what information will be shared, with whom, and for what purposes, as well as that the patient or parent/guardian has the right, currently or any time in the future, to inspect the information and/or refuse to allow this information to be shared, and/or to refuse to receive immunization reminder or recall notifications based on this shared information. And, of course, the patient or parent/guardian must agree to have the information shared. Health care providers do not need to obtain signed consent from the patient or parent/guardian, but they must indicate to the registry that the patient or parent/guardian has so agreed when they share the information with the registry.

Assembly Bill (AB) 1748: AB 1748 modifies Health and Safety Code Section 120440 and allows community-wide immunization registries operated by local health departments in California to share immunization records of individual, identified clients with CALWorks, if the clients or their parents/guardians have received the appropriate AB 254 disclosure and have assented.

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What's Happening?

Healthy people 2010 established a goal of enrolling 95% of children from birth through age 5 in a fully functioning immunization registry. Immunization registries are being developed or are operational in all 50 states.

Registry Success Stories

From Snapshots

Arizona:
By identifying under-immunized children (with the assistance of a registry) and administering the missing shots, cases of measles, pertussis, and varicella at those institutions were reduced to zero, despite county-wide outbreaks of those diseases during the same timeframe. In addition, children's school attendance increased and parents' lost time at work decreased. (Source: Margaret McChesney, Health Links, Phoenix, AZ, June 1999).

Arkansas:
The Arkansas immunization registry has helped detect errors in vaccine administration and recall children to ensure they are adequately immunized. (Source: Karen Fowler, November 1999).

California:
When a lot of a vaccine was recalled by its manufacturer, the Southern California Kaiser Permanente registry determined that over 15,000 of its enrolled children had received the vaccine during the time period that the vaccine was available. However, the registry also was able to determine that only four children had received an immunization from the recalled vaccine lot. By identifying the children who had received the vaccine, the registry saved the children and their parents time and pain by preventing unnecessary immunization. (Source: John Fontanesi, UCSD, March 1999).

Minnesota:
The Southwestern Minnesota Immunization Information System (SIIS) was instrumental in controlling a pertussis outbreak at a public school in a small rural community. Registry information helped to identify those children at risk (including families with philosophical exemptions for immunizations or whose last immunization was more than three years previous), thereby controlling the size of the outbreak and preventing disease.

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Stanislaus County Joins with Neighbors:

• Click Here to Visit the Regional Immunization Registry
  

• Alpine County
• Amador County
• Calaveras County
• Mariposa County
• Merced County
• San Joaquin County
• Stanislaus County
• Tuolumne County

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