Whole of Life Immunisation Register
Statement date: 18 September 2014
Australian Immunisation Information System – a whole of life immunisation register for Australia
The Influenza Specialist Group supports the idea of a whole of life immunisation register (referred to as Australian Immunisation Information System, AIIS) as an important tool to increase and sustain high vaccination coverage by consolidating vaccination records of children and adults from multiple providers. An AIIS will be an important tool to increase and sustain high vaccination coverage by consolidating & integrating vaccination records from multiple providers, forecasting next doses past due, due, and next due to support generating reminder and recall vaccination notices for each individual, and providing official vaccination forms and vaccination coverage assessments.
The system will provide the basis for national immunisation objectives and will support the evaluation of the National Immunisation Program.
AIIS – definition:
- The Australian Immunisation Information System should be a confidential, population-based, computerized information system that attempts to collect vaccination data about all persons within Australia. It consolidates the immunisation records from multiple sources for each person living in Australia.
- A population-based system can make it easier to carry out the demonstrably effective immunisation strategies and thereby decrease the resources needed to achieve and maintain high levels of coverage. AIS will enhance adult immunisation services and coverage.
- The concept of an immunisation information system is not new. Many individual practices and services administer immunisations to their patients. Records of these immunisations often are based on computerised information systems designed for other purposes such as billing.
- Currently there is no national register for recording all vaccinations administered to adults in Australia. The Australian immunisation information landscape is characterised by many islands of information. This creates significant barriers to the effective sharing of immunisation information between health care participants. Australia’s health service boundaries and geographic distances pose an additional challenge. Currently it is difficult to assess the state of adult vaccinations in Australia – which would be the basis for managing surveillance and guiding policy, service planning, innovation and decision-making. The lack of immunisation information creates the potential for significant amount of errors and inefficiencies. It is very difficult to accurately estimate the real impact of these issues for that reason.
- A decentralised healthcare system makes it difficult to collect data.
- The design of the AIIS needs to reflect data protection regulations.
- Shared responsibilities in the process of immunisation and multiple providers form the framework for public health interventions on vaccination issues.
- Methods of data collection and available information on immunisations need to be developed on the basis of existing expertise.
- Currently only two vaccines can be recorded on disease specific registers:
- the National HPV Vaccination Program Register and
- the Australian Q Fever Register.
The objectives for an AIIS:
The Australian Immunisation Information System – should provide the following characteristics:
- Securely storing and sharing immunisation information for everybody in Australia – so that it is easily and quickly available when needed.
- Enable a safe, high quality, equitable and sustainable immunisation information system for all Australians by transforming the way immunisation information is used to plan, manage and deliver immunisation services.
- Ensure the correct immunisation information is electronically made available to the consumer and the medical practitioner at the right place and time to enable informed care and treatment decisions.
- Enable immunisation in Australia to more effectively operate as an inter-connected system overcoming the current fragmentation.
- Provide consumers with electronic access to the information needed to better manage and control their personal immunisation/protection.
- Enable various healthcare providers to electronically communicate and exchange information and provide better-coordinated immunisation advice and delivery across the continuum of care.
- Provide consumers with confidence that their personal immunisation information is managed in a secure, confidential and tightly controlled manner.
- Enable electronic access to appropriate health care services for consumers within remote, rural and disadvantaged communities.
- Facilitate continuous improvement of the immunisation information system through more effective reporting and sharing data & information.
- Support more informed policy, investment and research decisions through access to timely, accurate and comprehensive reporting on Australian health system activities and outcomes.
- Health professionals can use the AIIS to monitor immunisation coverage levels and service delivery, and to identify regions at risk during disease outbreaks.
The data of the AIIS
- Enables immunisation providers and consumers to check the individual immunisation status regardless of where the person was immunised.
- Forms the basis of an optional immunisation history statement which informs consumers of their recorded immunisation history.
- Provides a measure of coverage at a national, State/Territory and local level.
- Integrate with the existing Australian Childhood Immunisation Register (ACIR).
Create organisational structures with a mission to promote the electronic use, tracking and sharing of complete immunisation records for people of all ages in Australia.
Examples of current vaccine registers
1. Northern Territory Immunisation Register
The Northern Territory Immunisation Register (NTIR) is based at the Centre for Disease Control in Darwin, and contains details of vaccines administered to adults and children in the Northern Territory since 1991. It also contains some information about vaccines given earlier than 1991 although this data is less complete. The NTIR includes vaccines given to children as part of the National Immunisation Program, school-based vaccination programs, adult vaccines, travel vaccines and vaccines given to special groups of people in hospital.
Vaccine providers including remote and urban community care centres and clinics, hospitals, and GP surgeries are encouraged to send information about all vaccines that they have administered however not all providers participate and not all vaccines are recorded on the NTIR. Routine recording of influenza vaccine administered to adults was included on the NTIR from 2009.
The NTIR transmits vaccine information to the Australian Childhood Immunisation Register (ACIR) for all children under 8 years old, and to the National Human Papillomavirus (HPV) Vaccine Program Register for young men and women who have received this vaccine. In addition, the NTIR serves as a useful source of information for healthcare providers who need to check which vaccines a person has received, in order to ensure that people are adequately protected against vaccine-preventable diseases.
What is the Immunisation Help Desk? The NTIR Help Desk provides information about immunisation to service providers and members of the public throughout the Northern Territory. The Help Desk can be contacted by phone.
How can healthcare providers get access to immunisation records? Northern Territory immunisation records for people up to the age of 18 years can be accessed from a secure internet site by approved vaccine providers.
2. Australian immunisation registers: established foundations and opportunities for improvement
Individual privacy must be protected. However, data linkage does not pose a significant threat to privacy and has the potential to contribute efficiently and substantially to public health. One could argue that the ethical obligation, seen from a population as well as individual perspective, is to ensure routinely-collected health information is efficiently and optimally used to achieve the greatest public benefit, while protecting the individual’s privacy.
In setting up jurisdictional or national immunisation registers to achieve the greatest public benefit, we recommend thought be given to enabling easy linkage of data, in practical and legal terms, between immunisation and health outcome data.
Queensland and the Northern Territory have separate jurisdiction-level immunisation registers. These registers, which are not subject to the same privacy legislation inhibiting linkage of ACIR data, have been used to calculate effectiveness for rotavirus [4,5], pneumococcal  and pertussis-containing vaccines (unpublished data) by linking immunisation with outcome data such as hospitalisations and disease notifications.
These studies demonstrate the usefulness of linking data from immunisation registers to assess vaccine effectiveness and the importance jurisdiction-level immunisation registers have played in allowing evaluation of large publicly-funded immunisation programmes.
3. Præventis, the immunisation register of the Netherlands: a tool to evaluate the National Immunisation Programme
To monitor the vaccination coverage in the Netherlands, an electronic national immunisation register called ‘Præventis’ was implemented in 2005. Præventis has a link with the population register and can produce letters of invitation for the NIP, register and validate administered vaccinations. The database is used to monitor the vaccination process, produce reminder letters, control the stock of vaccines and provides information used for paying the fees to the different executive organisations involved. Præventis provides a crucial tool for the evaluation of the NIP by producing (sub)national vaccination coverage estimates with high accuracy and allowing additional research: identifying populations at high risk for low coverage based on existing data, conducting specific studies where individuals included in the immunisation register are approached for further research, using vaccination coverage data for the interpretation of (sero)surveillance data, and linking the immunisation register with disease registers to address vaccine safety or vaccine effectiveness. The ability to combine Præventis data with data from other databases or disease registers and the ability to approach individuals with additional research questions offers opportunities to identify areas of priority for improving the Dutch NIP.
4. American Immunisation Register Association (AIRA)
Vision & Mission: AIRA is an organization whose mission is to promote the electronic use, tracking and sharing of complete immunization records for people of all ages.