Dubuque County health care professionals are calling for a fix to apparent discrepancies between data reported via the state immunization record system and the actual local immunization rate.
Iowa’s Immunization Registration Information System, or IRIS, tracks the rate at which children are immunized against various diseases, which immunizations they have had and if they have an exemption from receiving vaccines. The data is broken down by county, age and other filters.
On a fairly regular basis, the Iowa Department of Public Health reports the data. But members of the immunization subcommittee of the Dubuque County Board of Health said this week that the information often is unreliable.
“We were approached by the (county) Board of Supervisors saying, ‘Why do we have such a low immunization rate?’ when we actually don’t,” said committee leader Diane Pape-Freiburger. “The data being used and published is not a total data. It is only through IRIS, and not everyone enters the data into IRIS.”
In Iowa, health care providers are not required to update IRIS when they immunize a patient, according to Don Callaghan, bureau chief of immunization for the Iowa Department of Public Health. But, according to Callaghan, most do.
For example, he compared the number of records of 2-year-olds in the state registry with the number of 2-year-olds in U.S. Census data and found that 96% were accounted for.
“That data is only as good as those maintained by the health care providers,” Callaghan said. “But we have very good representation.”
Pape-Freiburger, though, said that in the past, the state has reported numbers that were off by as much as 33 percentage points for Dubuque County.
“If you take a look at last year’s data alone, (the immunization rate in the county) was reported at 61%, when it was actually at 94%,” she said.
Dubuque County contracts the UnityPoint Health-Visiting Nurse Association to audit immunization records at schools in the county. That is how the committee members know the discrepancies exist.
And, according to the group, that reporting gap could negatively impact the area in several ways.
“Our biggest concern is, when you publish these reports saying, ‘This is what’s in IRIS,’ no one knows what that is,” said VNA Executive Director Stacey Killian. “If you don’t directly work with it, you’re not going to know what IRIS is. So, as a parent in the community, they’re going to see this newspaper article or this news story that says, ‘Only 61% of Dubuque County’s up to date (on vaccines).’
“So, if I’m one of those people who is on the fence on whether or not to vaccinate my child, I will look at it and go, ‘Well, 39% don’t. If they’re OK, I’m OK.’”
The flawed reporting also could lead to children receiving double doses of vaccinations, especially because in Iowa, students must be fully immunized to attend licensed child care centers and public and private schools unless they have medical or religious exemptions.
“That happens a lot,” Killian said. “We have had to re-immunize many times because the document never floats its way back, or you don’t know who the doctor is, or they can’t find it, or there’s no release. There’s a lot of barriers to getting that document.”
The group members contend that these problems will not be solved unless all health care providers report in the state system. So they started meeting with local lawmakers to find a state-level fix.
“Why should VNA have to go around and manually do every school when all it takes is for you guys to write a bill and say, ‘Everyone has to enter into the same database?’” Pape-Freiburger asked Iowa Rep. Chuck Isenhart, D-Dubuque, who attended the meeting.
Isenhart, though, said mandates like this regularly hit roadblocks in the statehouse. Members of the committee said ideally IRIS could be made to interface with providers’ electronic medical records systems, since duplicating input work is one reason that they have heard for why providers ignore IRIS.
“That’s usually one of the pushbacks when we try to mandate — ‘It will be time-consuming. It will be expensive. We don’t want to spend money to fix our system to talk to yours,’” Isenhart said.
Instead, Isenhart recommended starting with the Iowa Boards of Medicine, Pharmacy and Nursing, members of which might not be aware of the problem.
“When I called the Board of Medicine ... this had never occurred to them before,” said Diane Heiken, a member of the committee.
She also said she thought the fix would take more than pressure on the state boards.
Committee members plan to continue to meet with lawmakers. They met with Iowa Rep. Lindsay James, D-Dubuque, later in the same day.
Pape-Freiburger said they have plans to meet in the coming weeks with other lawmakers representing Dubuque County.