Immunizations

Vaccination Administration Date

The inclusion of the "Vaccination Administration Date" in the USCDI v6 is paramount, as it serves as an indispensable tool for matching and deduplication processes within healthcare data management. The vaccination administration date serves as a distinct temporal identifier, which, when combined with other demographic details, helps differentiate individuals with similar identifiers. This significance is emphasized in the American Immunization Registry Association (AIRA)'s Modeling of Immunization Registry Operations Workgroup (MIROW) document titled "Consolidating Demographic Records and Vaccination Event Records". Specificity is particularly important when common names or birthdates lead to potential record confusion. Vaccination Administration Date underpins the effective coordination of immunization efforts, ensuring that individuals receive vaccines at the appropriate times. The vaccination administration date is a key identifier routinely recorded in numerous EHR systems and is essential for maintaining accurate immunization records.

By standardizing this data element and adopting a consistent date format (e.g., YYYY-MM-DD), we can achieve greater interoperability. Such standardization will facilitate more reliable exchanges of health information across various entities, including healthcare providers, public health organizations, educational institutions, and employers in sectors where health status is crucial.

The "Vaccination Administration Date" plays a pivotal role in public health initiatives, from managing preventive care to responding to epidemics. It supports precise public health surveillance and reporting, which are vital for international travel compliance, school admissions procedures, and workforce readiness in healthcare environments. Its relevance spans all age groups—from pediatrics to geriatrics—underscoring its universal application throughout the continuum of care.

Incorporating this data element into USCDI v6 would not only promote interoperability but also significantly enhance population health outcomes by facilitating timely and well-coordinated vaccination strategies. CDC strongly support its inclusion and urge the development of comprehensive conformance and implementation guidelines that ensure this critical data element's consistent capture and exchange across healthcare platforms.

CSTE Comment - v6

CSTE supports inclusion of this data element in USCDI V6. Please see previously submitted CSTE comments for additional recommendations.

APHL supports inclusion of this data element

APHL supports inclusion of this discrete data element until the design of USCDI accomodates a mechanism for each use case to define further constraints around generic data elements, as otherwise the clinical context and signifcance of when to collect this element cannot be sufficently described.
In FHIR the immunization resource is it's own resource, separate from medication administration, so should be kept separate here, too; in the base the respective element is immunization.occurence, which is 1..1 (i.e. required!!) - it has a choice of date/time or text to accomodate less precise dating, so it is already also required in US Core because of that (see 13.134.1.1 under "Each Immunization Must Have" item #4 = https://hl7.org/fhir/us/core/StructureDefinition-us-core-immunization.html#mandatory-and-must-support-data-elements)
As per CDC comment on USCDIV5 draft content: "Vaccination Administration Date" is crucial for effective immunization management across healthcare settings. It facilitates accurate tracking of vaccination schedules, aligning with established terminology and date formats to enhance interoperability and streamline processes. Its broad relevance in public health reporting, international travel, and healthcare employment underscores the necessity for its inclusion, with strong advocacy for conformance and implementation guides to ensure consistent and accurate utilization across systems.
It is unjustified to have this element in level 0, as it meets all level 2 requirements:
Represented by a terminology standard or SDO-balloted technical specification or implementation guide = in V2 = and the CDC Implementation guide called out in https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-D/part-170/subpart-B/section-170.205#p-170.205(e)(4)) , in CDA = , in FHIR = 
Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer. (immunization reporting has been in certification requirements since MU 1 and many immunization reports are being exchanged nation wide)
Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.(immunization reporting has been in certification requirements since MU 1 and many immunization reports are being exchanged nation wide)
Use cases apply to most care settings or specialties. It applies to ALL patients at some point or another (unless they refuse all vaccines)

USCoreMustSupportElements.pdf

CSTE Comment - v5

CSTE agrees with CDC and continues to strongly recommends that Vaccine Administration Date and Vaccination Event Record Type be included in USCDI v5. 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 v5 draft, 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.

CDC's comment for USCDI Draft v5

CDC would like to reemphasize "Vaccination Administration Date" for inclusion in USCDI v5. "Vaccination Administration Date" is crucial for effective immunization management across healthcare settings. It facilitates accurate tracking of vaccination schedules, aligning with established terminology and date formats to enhance interoperability and streamline processes. Its broad relevance in public health reporting, international travel, and healthcare employment underscores the necessity for its inclusion, with strong advocacy for conformance and implementation guides to ensure consistent and accurate utilization across systems.

CDC's comment on behalf of NACCHO for USCDI v5

Support - The standardization of this data element will enhance LHDs ability to use and analyze this data. It will reduce the data preparation burden and thus enable more LHDs to use this type of data to inform decision-making.

CDC's comment on behalf of CSTE for USCDI v5

CSTE agrees with CDC and continues to strongly recommends that Vaccine Administration Date and Vaccination Event Record Type be included in USCDI v5. 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.

CDC's Consolidated Comment for USCDI v5

• The "Vaccination Administration Date" is a critical data element proposed for inclusion in the USCDI v5, serving as a cornerstone for effective immunization management across various healthcare settings. This data point is integral to facilitating accurate tracking and coordination of vaccination schedules, thereby playing a vital role in ensuring timely and appropriate vaccine administration. This data element is widely captured within numerous EHR systems, making it a key component of patient care and central to immunization registry reporting. Standardizing the "Vaccination Administration Date," potentially aligned with established terminology such as HL7 or CVX codes, and specifying the date format (e.g., YYYY-MM-DD) will enhance semantic interoperability and consistency across systems. Its inclusion in USCDI v5 is poised to significantly streamline healthcare processes, supporting unified, secure, and reliable information exchange among healthcare stakeholders, including providers, public health agencies, and schools. As vaccines are pivotal in preventive health and public health responses, including epidemic control, a standardized "Vaccination Administration Date" is essential for accurate public health reporting, international travel, school enrollment, and employment in health-sensitive areas. Its broad applicability is evident as it is relevant in pediatric, adult, and geriatric care, reflecting its universality across the healthcare continuum. The inclusion of this data element in the USCDI v5 would not only ensure interoperability but also contribute to improving population health outcomes by aiding in the delivery of timely and coordinated care. We strongly advocate for its inclusion and recommend developing conformance and implementation guides that address the consistent and accurate capture and sharing of this pivotal data element across healthcare systems.

• ** ADD THIS USE CASE TO SUBMISSION **

1. "Immunizations HPV": HPV is estimated to cause 70% of oropharyngeal cancers in the United States, although it is unclear if having HPV alone is enough to cause oropharyngeal cancers, or if other factors interact with HPV to cause these cancers. Because the HPV vaccine protects against the types of HPV that can cause oropharyngeal cancers, it may also prevent oropharyngeal cancers. The United States is struggling to achieve HPV vaccination goals because HPV vaccination policies vary greatly nationwide, making it hard to implement sustainable programs. Surveillance of HPV vaccination and risk factors can help to establish associations, identify at-risk populations, and better inform clinical decision-making guidelines and interventions. These activities can increase vaccination acceptance rates and may lower HPV-associated oropharyngeal cancer prevalence and incidence.

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.

CDC's Consolidated Comment

• CDC would like to emphasize the inclusion of “Vaccination Administration Date” in USCDI v3. “Vaccination Administration Date” is the date the client received the vaccine. This is a core immunization data element used widely in the health community for a variety of purposes, such as:

1. To record the date this vaccination event occurred.
2. To document in the case of refusal or deferral, the date that the refusal or deferral was recorded.
3. In the context of a forecast dose, the date the forecast was made.
4. Many vaccines are aged-based, and vaccination administration date is used to evaluate before the vaccine is administered, whether a client is eligible to receive the specific vaccine product, has aged-out and no longer qualify for the vaccine or another vaccine product is recommended by ACIP.
5. Some vaccines belong to a vaccine series, and correct spacing between dose intervals is important for proper immunity.  Vaccine administration date is to evaluate before the vaccine is administered, whether the proper dose interval has been met or whether the series has been completed.

• Without “Vaccination Administration Date” physicians cannot determine when a patient was vaccinated, and thus:

1. Physicians cannot be assured that patients are fully vaccinated, nor can the physician inform their patient when their next vaccination is due.
2. Physicians are required to report some vaccination administrations to their jurisdictions which require “Vaccination Administration Date” for submission.
3. In the public health realm, “Vaccination Administration Date” is widely used for various purposes such population coverage information, especially in the context of social determinants of health and in vaccine effectiveness studies.
4.  “Vaccination Administration Date” is also used in immunization data quality assessments.

• Due the reasons stated above, and the importance of “Vaccination Administration Date”, it is included in thousands of Health IT related systems, such as EHRs and Immunization Information Systems. Additionally, there are harmonized standards for the implementation of “Vaccination Administration Date”.
• In summary, while vaccine type is extremely important in the medical and public health fields, “Vaccination Administration Date” is the second most important piece of information needed for accurate information. Without “Vaccination Administration Date”, base-level immunization functionality cannot occur.

CSTE Comment:

• CSTE agrees with AIRA and CDC and strongly recommends that Vaccine Administration Date and Vaccination Event Record Type be added to USCDI v3. 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 v3 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.