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Vaccine registry finds backing

Bay State lags most of US in tracking of shots

By Kay Lazar
Globe Staff / October 3, 2011

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Massachusetts, birthplace of public vaccination programs, is one of the last states without a vaccine registry, but with the resurgence of measles and whooping cough, as well as changes in the political climate, public health officials may soon have a way to track immunizations statewide.

State lawmakers, facing opposition from insurers, failed for the past two years to act on the proposal, which would assess a fee on health insurance plans to raise the estimated $1 million to $2 million a year needed to run a registry.

But now insurers have dropped their opposition, and supporters, worried that federal funding for the project will dry up, have ratcheted up their lobbying for the state’s financial support, suggesting that, for the first time, Massachusetts will join the rest of the country with a registry that physicians say is essential.

Massachusetts and New Hampshire are the only states without statewide registries to track who gets vaccinated, according to the US Centers for Disease Control and Prevention.

Physicians have long pushed for a centralized registry, saying it will make it possible for busy parents to be notified when their children are due - or overdue - for vaccines.

The need, physicians say, is especially acute for lower-income families who may not have reliable access to routine medical care. Public health officials hope to use this registry for targeting education campaigns and other programs to promote vaccination in underserved areas.

The dizzying number of shots required before children enter school, and the continual updating of the recommended doses, can make it hard for pediatricians and parents to keep track.

“Let’s say you’ve got a 10-month-old with three of one vaccine, two of another, one which can only be given until 8 months of age, and others that can’t be given until 12 months - this is a crazy, exacting, three-dimensional jigsaw puzzle,’’ said Dr. Sean Palfrey, professor of pediatrics and public health at Boston University School of Medicine, and an ardent registry supporter.

While a growing number of health care providers are switching patients’ medical charts to electronic records, most of the systems don’t talk to each other, Palfrey said, underscoring the need for one centralized, online vaccine tracking system that can transcend the confusion.

“We still don’t always know,’’ Palfrey said, “when a child has gotten a flu shot.’’

Knowing who is and is not vaccinated becomes especially important amid a disease outbreak - such as the cluster of measles reported earlier this year in Massachusetts that infected more than a dozen patients, from toddlers to seniors.

Veterinarians routinely send notices to pet owners when it is time for an animal’s shots, but it has proved challenging to design similar tracking and notification software for physician practices - underscoring the need for a statewide registry.

“I have been working in the immunization field for 18 years, and built the software, and I still cannot generate a list of patients who are due for shots,’’ said Dr. William Adams, professor of pediatrics at Boston University School of Medicine, and an architect of the state’s nascent registry.

State lawmakers last year approved legislation that established a state vaccine registry, and that law requires all licensed health care providers who administer vaccinations to report the relevant patient information to the registry, which will be run by the Department of Public Health. But the legislation contained no money to operate the system. Using federal funds, the department developed and launched a pilot registry earlier this year, and eight providers are currently testing it, including two pediatric practices in Western Massachusetts, the Attleboro Board of Health, and a community health center on Boston’s North Shore.

Dr. Robert Leavitt, a pediatrician who has been testing the system at his Longmeadow practice since the spring, said his staff made suggestions to the health department about how to simplify the data entry process.

Department spokeswoman Julia Hurley said the pilot phase is expected to be completed by the end of this year, with a statewide rollout anticipated in 2012.

Pending legislation would provide the money needed to continue running the registry through a fee on insurers. That fee would go into a vaccine trust fund, which also would be used to purchase childhood vaccines.

Massachusetts historically has used state and federal money to buy vaccines to ensure that children and many uninsured adults have access to the shots. But the state’s budget crunch prompted lawmakers for the past three years to shift the state’s costs to insurers through an assessed fee.

The pending legislation uses that formula to fund the registry and the purchase of vaccines. So did the earlier vaccine legislation proposed in January 2009 by Representative Alice Wolf, a Cambridge Democrat.

Insurers, however, were not keen on the legislation and lobbied against it. The proposal died in the Senate’s Ways and Means committee, as legislators awaited an analysis of the impact it would have on insurance costs.

That analysis, which was conducted by the Patrick administration, concluded that the assessments and related financial requirements would add between $.70 and $1.38 to the monthly costs for each insured Massachusetts resident.

A spokesman for the Massachusetts Association of Health Plans, a trade association that represents insurers, said the organization will now likely support the legislation, although with a few tweaks. “We see value and importance in vaccines, and the registry,’’ said association spokesman Eric Linzer.

The legislation, cosponsored by Senator Richard Moore, an Uxbridge Democrat, has been sitting in the legislature’s Joint Committee on Health Care Financing since it was resubmitted this session in January. Moore is cochairman of that committee.

In a statement, Moore’s office said the senator and his committee have been busy with reforming the payment system for health care providers. It said the vaccine registry “is a component of Senator Moore’s aggressive legislative agenda, and identifying a sustainable funding mechanism for the registry remains a personal priority of his.’’

Kay Lazar can be reached at klazar@globe.com. Follow her on Twitter @GlobeKayLazar.