delivery of vaccines and to make concrete advances in the use of health information technology (HIT) to improve health care performance and effectiveness. Although the fate of health care reform is uncertain at the time of this writing, considerable progress has been made with regard to HIT by building on the foundation set in 2004 by the President’s Executive Order 13335, establishing the Office of the National Coordinator for Health Information Technology (ONCHIT) in the Department of Health and Human Services (HHS), whose role is to lead the implementation of a nationwide HIT infrastructure that is interoperable and safeguards privacy (GAO, 2009). Changes in the ways health information is recorded, stored, and used can have enormous implications for the delivery of immunization services.

Vaccination is a cost-effective, high-value component of preventive health care and is a good indicator of how well a health care delivery system functions. Under ideal circumstances, a health information system would indicate a patient’s immunization status, remind a provider of needed vaccines for a given patient, record and facilitate the reporting of potential adverse events following immunization, help a provider obtain reimbursement for delivery of immunization services, allow public health officials and researchers to measure vaccine coverage, monitor rates of vaccine-preventable diseases, and facilitate studies of the relationship between vaccines and suspected adverse events. In reality, neither the delivery of health care nor the relevant information technology systems are constituted in ways that optimize the delivery of immunization among other preventive services.

OVERVIEW OF THE NATION’S IMMUNIZATION SERVICES

As noted in the Introduction, the terms vaccination and immunization are sometimes used interchangeably. The committee uses vaccination to refer to the delivery of the vaccine to an individual, and immunization services to refer to the range of activities (e.g., storage and management of vaccine stocks, communication) that lead to vaccine administration. The Introduction also describes the large network of federal, state, and local public health agencies that play important roles in implementing the use of vaccines routinely to prevent infectious diseases and to respond to public health emergencies such as disease outbreaks and the 2009 H1N1 influenza pandemic. Although the federal government provides advice, support, and funding, most immunization policy is made at the state level, thus stakeholders in this area include organizations such as the Association of State and Territorial Health Officials and National Conference of State Legislatures.

As described in Chapter 2, after vaccines are licensed by the Food and Drug Administration (FDA), they can be used in the population according to the recommendations of the Advisory Committee on Immunization Prac-



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