Legislative Hotline Feb. 11, 2021: TMA, Lawmakers Seek to Strengthen State Immunization Registry
By Joey Berlin


The time is now to transform Texas’ immunization registry and make it an “opt-out” system in which patient participation is otherwise automatic – just like nearly every other state.

That’s what the Texas Medical Association, the Texas Hospital Association (THA), and several state lawmakers said Wednesday at a news conference to promote legislation that would fix technological issues with the state’s registry, ImmTrac2, and make entry of a patient’s vaccination data the default. Normally, physicians must get patients’ consent before submitting their vaccine data to ImmTrac2.

“If we are able to transform this from an opt-in to an opt-out registry, we will not have any of the problems that we currently are experiencing,” said Fort Worth-area pediatrician Jason V. Terk, MD, who represented the Texas Public Health Coalition, which includes TMA, at Wednesday’s virtual news conference.

Because of the COVID-19 public health emergency, ImmTrac2 is currently operating as an opt-out system, just like the immunization registries of 46 other states in normal times. But once the public health emergency is over, ImmTrac2 would revert to an opt-in.

The companion bills House Bill 325 by Rep. Donna Howard (D-Austin), and Senate Bill 468 by Sens. Judith Zaffirini (D-Laredo) and Kel Seliger (R-Amarillo), would introduce “a simple way to permanently opt out of the immunization registry: easy in, easy out,” Representative Howard said at Wednesday’s news conference.

She said the bill also would fix electronic health record (EHR) interoperability problems, which have prevented Texas physicians from easily reporting data on vaccines administered through their EHRs.

“This one statutory change removes a key barrier unique to our opt-in registry that continues to contribute to the issues with data on vaccines administered – a barrier that we’ve known has existed for years and has always had the potential to bring us to where we are   today, where data on the distribution of a lifesaving vaccine is faulty,” Representative Howard said.

Dr. Terk expressed TMA’s approval of the bill “to improve this vital component of our health care system and [as] a defense against other kinds of disease outbreaks.”

He also noted TMA supports incorporating a process into the ImmTrac2 system to honor patient preference on whether to have their vaccine data included in the registry regardless of the setting in which the patient receives vaccines.

Medicine values patient privacy, and the legislation will not dilute Texas’ privacy laws, already among the strongest in the nation, TMA staff said.

Vaccine data entered in ImmTrac2 helps physicians, health departments and other vaccine administrators know which diseases a patient is protected against, and ensures that the proper vaccination schedule is followed. Not only is that important during a vaccine-preventable outbreak, but it’s also important during conditions like the current pandemic, Dr. Terk said.

While only pediatricians and physicians who regularly give vaccines are typically registered with ImmTrac2, state law requires that the registry contain a record of vaccines distributed because of natural disasters or public health emergencies. That means all physicians qualified to administer COVID-19 vaccines are required to sign up. 

On the interoperability issue, Dr. Terk noted he can’t access the immunization registry through his own EHR. If he has a new patient who didn’t bring an immunization record to an appointment, Dr. Terk may have to ask his staff to log in to ImmTrac2 outside the EHR. If he does get his hands on the correct immunization record, “more often than I would like, it does not have the information that I’m looking for. So the functionality of it is not ideal.

“We’re here in the 21st century, and we need an electronic ability to be able to query an immunization registry so that we can provide the correct vaccinations for our patients. And we want to make sure that our patients who graduate from our pediatric practices are permitted to have that information follow them as adults.”

THA President Marc Boom, MD, also spoke Wednesday in support of HB 325/SB 468.

“The business community is united in its support of this very important bill,” said Dr. Boom, who also represented the Greater Houston Partnership, the Houston area’s largest chamber of commerce. “This is the right thing to do during a pandemic, and we saw if this is something that we put in place during a disaster, then of course it is something that should be in place at other times. It is, in our simple parlance, a no-brainer. This must happen.”

The bills are the latest in a long line of attempts to strengthen ImmTrac2. Senator Zaffirini noted that she’s filed “opt-out” legislation for the past 12 years, or six sessions, of the Texas Legislature, and Representative Howard first tried in the 2007 session.

“To protect the public against COVID-19 today – and meningitis, measles, tuberculosis, or a new disease tomorrow – Texas needs an immunization registry it can trust,” Senator Zaffirini said.

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Last Updated On

July 17, 2023

Originally Published On

February 11, 2021

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