For years, under pressure from anti-vaccination activists, key lawmakers have failed to improve a Texas vaccination database that is incomplete and cumbersome for health care providers to use.
The long-running difficulties with the state’s immunization registry played a central role in Texas’ botched rollout of COVID-19 vaccines, according to recent reporting by the Texas Tribune. Millions of Texans are living with the consequences: Confusing discrepancies in the numbers of vaccinations that have been distributed to providers and given to patients. Conflicting advice over who can actually obtain vaccines right now. And, for health care providers, a complicated system that diverts their attention from patient care. One doctor told the Tribune his clinic could vaccinate patients at least three times faster if the state’s registry wasn’t so dysfunctional.
The problem was entirely foreseeable, and one that state Rep. Donna Howard, D-Austin, has been trying to fix for more than a decade. Lawmakers can no longer ignore the cost of their inaction. We urge them to solve the problem this session by passing House Bill 325.
The measure addresses ImmTrac2, the state registry for immunizations. The state created the registry in the mid-1990s to collect pediatric vaccination records, enabling health care providers to see if a child already had certain shots. The registry is not a public record; files are electronically secured and accessible only to approved medical professionals.
All 50 states maintain such registries. Nearly all of them automatically receive the information from the doctor’s office after a child gets vaccinated, unless the family opts out of sharing it. Texas is one of only four states that do the opposite, providing information to the database only if the family expressly opts in.
The implications are huge. Texas health care providers must collect and process opt-in consent forms for the 90-95% of vaccinated families who agree to send their information to the state, when the more efficient approach would be to gather opt-out forms from the 5-10% of families who do not want to be in the database. One estimate suggested switching to an opt-out system would cut operating costs from $2.64 per child to 29 cents per child.
Because health care software packages are designed to meet the needs of opt-out states, Texas spent “millions of dollars to retrofit (its) system to comply with Texas’ consent laws,” Anna Dragsbaek, then-president of The Immunization Partnership, told lawmakers in 2015. Likewise, clinics and doctors’ offices have to jump through extra hoops — and incur extra costs — to get their electronic health records software to communicate with the state. As a result, Dragsbaek told lawmakers, many physicians don’t participate in the database.
Fast forward to last month, when Texas started managing the complex distribution of COVID-19 vaccinations. Supplies are scarce. The state needs timely, reliable data. And with two different types of vaccines, each requiring two shots, the state needs to keep track of which patients have received which doses. But the state’s vaccine registry isn’t up to the task.
Some doctors, especially those who don’t normally handle immunizations, are suddenly learning a new system. The software used by many doctors’ offices does not communicate well with the state, forcing some practices to reenter and submit the data in other ways. The lag time in processing the records gave the false impression that unused vaccines were sitting on shelves.
Howard’s HB 325, and similar bills she has filed in previous sessions, would help address the problem by making the registry opt-out. Such a switch would still honor the rights of families who want to keep childhood immunizations out of the database, while ensuring better communication between software programs, which were designed for opt-out systems.
Howard secured House approval in 2013 for a similar bill, only to watch it stall in the Senate. Each session, the measure hits a brick wall.
“A very small, but very vocal minority” of anti-vaccination advocates “have had the ear of the leadership of the Legislature, who have been in a position of gatekeepers in terms of whether a bill can go forward,” Howard told us.
To be clear, Howard’s measure does not require anyone to get a vaccine. Texas law protects families’ rights to make those decisions. The question here pertains only to the record-keeping for those who choose to get vaccines.
The COVID-19 pandemic has cast a harsh spotlight on many aspects of our health care system that haven’t received the support they deserve. Key among them, we now see, is the state’s vaccination registry. It’s far past time for lawmakers to approve changes to ensure it functions for the benefit of Texans and their health care providers.
