Opinion

Pediatricians: Colorado Immunization Information System is good for children, public health

Authors: Matt Daley, Matt Dorighi, Sean O’Leary - February 20, 2017 - Updated: February 19, 2017

Sean-OLeary.jpg
Sean O'Leary
Sean O’Leary, MD

We were disappointed to read the opinion column about the Colorado Immunization Information System (CIIS) by Pam Long. Her column misrepresented CIIS, which provides an enormous benefit to Colorado’s families. Vaccines save many thousands of lives in the U.S. every year, and CIIS is a vital tool to maintain high immunization coverage and protect Colorado’s children from serious diseases. As pediatricians, we hope to set the record straight regarding the benefits that CIIS offers to Colorado families.

So what is an immunization information system? At its most basic level, an immunization information system is a single place where vaccination records are stored. So clear and tangible are the benefits, that all 50 states have created similar systems. In Colorado, participation in the system by medical providers is voluntary, and parents may opt out of having records entered into the system, although few parents choose to do so. Although participation is voluntary, the vast majority of primary care providers in Colorado participate in CIIS. We will describe why CIIS is such a great benefit for Colorado, from our perspectives both as pediatricians and as parents.

Matt Daley
Matt Daley

The biggest benefit of CIIS is to parents and children. Prior to the widespread use of immunization information systems, the burden was on parents to keep track of all of their children’s vaccines. What happened when a child moved to a new pediatrician or family physician? More often than not, no one would know which vaccines the child had received. If parents kept a paper record of vaccines, what would happen if the paper record was misplaced or lost? A child may be kept out of school, or may need to be revaccinated, if old records couldn’t be found. CIIS makes life so much easier for parents in the event of lost records, or whenever parents need to provide an updated immunization record, such as when starting child care, school, summer camp or even a sports team. Having vaccine records in one place can save parents multiple phone calls and trips to old providers to track down those records.

As pediatricians, CIIS allows us to deliver better care to children. In the “old days,” before Colorado had CIIS, we would often have to track down vaccination records to determine what vaccines a child needs. Because of CIIS, we are able to find all vaccination records in one place. This helps prevent children getting more vaccines than they need. Also, the childhood vaccination schedule changes relatively frequently, and CIIS incorporates those changes as they happen, so that providers can stay up-to-date on the most recent changes. CIIS helps everyone on the health care team (doctors, other providers, nurses and staff) know what should be given and when. Giving unneeded extra vaccinations because of missing records is a waste of money, not to mention the extra time it takes away from parents and the challenge of an unnecessary vaccine for a child. The added administrative burden that it would take for providers to operate without CIIS is a cost that would ultimately be borne by all Coloradans.

Matt Dorighi
Matt Dorighi, MD

Vaccine-preventable diseases cost Colorado an estimated tens of millions of dollars every year. Controlling even one outbreak of a disease such as measles is very expensive, so systems like CIIS, which maintain high immunization rates, save Colorado money and prevent outbreaks.

The cost of a single outbreak of a vaccine-preventable disease such as measles, as happened with the California Disneyland outbreak, would be far greater than what it costs to maintain CIIS. And this isn’t even considering the pain and suffering that such an outbreak would have on families in Colorado.

In this Information Age, it is right to be cognizant of how data is used. CIIS is used to safely and securely track all vaccines a child has received, so that providers and parents know what vaccines are needed and when. Although CIIS was certainly deserving of an award, because of its long-standing commitment to improving child health in Colorado, CIIS is hardly unique. Families move; children change providers; parents occasionally lose their child’s immunization records; infectious diseases are by their very nature contagious; for these practical reasons, all states have created immunization information systems. Common sense would dictate that parents and providers would want accurate information on which vaccines children have received in the past. Going back to a “paper only” system would be a disaster for Colorado’s families.

Matt Daley

Dr. Matt Daley is a pediatric health services researcher and a practicing pediatrician for Kaiser Permanente. He was born and raised in Denver, and is a proud graduate of the Denver Public Schools system.


Matt Dorighi

Dr. Matt Dorighi graduated from the Saint Louis University School of Medicine in 1997. He works in Denver, CO and specializes in Pediatrics at Cherry Creek Pediatrics.


Jared Wright

Jared Wright runs the business side of Colorado Politics, including circulation, advertising and marketing. He started as CEO and Publisher of the Statesman in 2015 and served as editor-in-chief for the journal during part of that time. He has worked in politics at both the state and federal levels, serving on a U.S. Congressman’s staff and working in government affairs in the private sector. Wright was elected to the Colorado House of Representatives in 2012 and served as member of Colorado’s 69th General Assembly from 2013-2014. He is also a writer, photographer and cartoonist.


9 comments

  • Kathy Sincere

    February 20, 2017 at 12:09 pm

    Dr. O’Leary –

    Regarding the Colorado Immunization Information System, I take exception to your statement that this is NOT an abuse of government authority but a very necessary function for the health of Coloradans.
    Below is an excerpt from the CIIS First Friday Update, February 3, 2017. I had to read this section several times to fully comprehend this egregious abuse of government power. Can you tell me what the difference is between this “report” and felony internet stalking?! The “Patients with Vaccine Refusals” report collects PII to track, control, harass, and intimidate the very small portion of the population that choses vaccine exemption.

    CDPHE/CIIS First Friday Update, February 3, 2017:

    CIIS User Quick Tip – Patients with Vaccine Refusals Report:

    “The Patients with Vaccine Refusals Report allows you to look up patients who have refused vaccinations during a specified time frame, with a variety of filtering options (e.g., type of vaccine refused, refusal reason, age at time of refusal, and refusal date range). Report results contain patient name, DOB, CIIS ID number, the type of vaccine refused, refusal reason, and the date a refusal note was added to a patient’s record. The results also display the number of patients by refusal reason (e.g., refused, deferred, or medical contraindication) and the number of patients by the type of vaccine refused. You can run this report as a PDF, or in an extract format which allows you to sort the data in a spreadsheet. For more information, please refer to our job aid.”

    I also question your statement that “Vaccines save many thousands of lives in the U.S. every year, and CIIS is a vital tool to maintain high immunization coverage and protect Colorado’s children from serious diseases.” I would like the links and data that support that statement. It is so easy to make statements as fact, with no facts to back them up. Here are some facts regarding vaccines that do NOT save thousands of lives in the U.S. every year:

    33,578 serious vaccine injuries including deaths and total disabilities are documented in the Government’s Vaccine Adverse Events System (VAERS) since 2007. As of March, 2013, more than 350,000 reports have been filed. The FDA estimates that 90 percent of doctors do NOT report reactions. Dr. David Kessler, former FDA commissioner, stated that “only about one percent of serious events (adverse drug reactions) are reported (Kessler,DA. JAMA, June 2, 1993; 269:2765-68). Most citizens, including pediatricians, are not even aware of VAERS or what purpose it serves.

    If you extrapolate the actual number of Vaccine Adverse Events using Dr. Kessler’s estimate, the number of serious vaccine injuries nationally since 2007 is 3,357,800.

    http://www.medalerts.org/vaersdb/findfield.phpTABLE=ON&GROUP1=AGE&EVENTS=ON&SERIOUS=ON&ONSET_YEAR_LOW=2007&ONSET_YEAR_HIGH=2017

    CIIS Vaccine Tracking is about data-mining PII for dollars. If it isn’t, then make CIIS an “opt-in” system. Simple!

    • Pat M.

      February 20, 2017 at 2:31 pm

      ​Re: the vaccine promotional piece by Daley, Dorighi, and O’Leary, their alternative facts do not add up to the actual data and info re: how the CDPHE, for starters, has taken it upon themselves to over-ride HB-1164 which was killed this past year.
      Rep. ​Dan ​Pabon responded to lawmakers last year at HB1164​’s hearing​ about lawmakers​’​ intent to make CIIS an ​’​opt in​’​ system with “Because no one would opt in.” ​T​his opt ​in​ system is ​strictly for ​data mining​, period, and once people’s personal and private info is in the system, it’s there for good. An ‘opt-out’ doesn’t do squat at removing their info, which is precisely the goal. Data = $$$ and is about profit and agenda, bottom line. Any marketer knows this.

      However, CDPHE, under Larry Wolk’s directive, over-rode the bill by prematurely having in place a new immunization form​ ostensibly to replace the original form which has been in place for some time via school districts and has worked quite well in protecting personal and private info of students and their families. Despite news media exposing Wolk’s presumptive and illegal use of his position as head of CDPHE to imply that this ‘new’ form is the ONLY form to be used by parents registering their children for school, he did not relent and instead blamed one of his staff for this egregious mis-use of power that he wields for the benefit of those agencies as in the CIIS who work in tandem w/him.

      CDPHE and CIIS’s transparent attempts at ramping up vaccination rates w/the sole purpose of obtaining continual federal funding, thanks to ​p​harma’s 1400+ lobbyists in D.C. plying their quid pro quo trade, has fallen short of its goal to intimidate and coerce parents into ‘thinking’ that this new form is required, which it is not, based on the failure of HB-1164 to launch.

      CIIS serves pediatricians, first and foremost and is a taxpayer-funded $ystem at $3 million dollars a year serving pediatricians in order to maximize their profitable sale of vaccines by ‘well-baby’ visits and vaccine clinics at public schools. Follow the money and you will see that the relentless mis-use and continual propagation of instilling fear among future and current customers, which is how patients are referred to, is a continual ‘sky is falling’ attempt at a one size fits all vaccine agenda which only benefits those invested in this ethically-compromised industry. Caveat emptor!

  • Marie Jalil

    February 20, 2017 at 1:24 pm

    Fact: My son was in the CIIS system and had THREE different records created within the system, causing him to be over vaccinated. As of today, I am told that only one of those has been deleted. FACT : I have removed my family from the system, because as a parent it is MY duty to maintain my children,s medical records and not to rely on the government to do it for me. You should really investigate, how many children in CO have the same name, especially Hispanic names, and how that causes confusion with in the system. Not only that but some also have the same birth date. Here’s another fact, I don’t want schools, colleges, any doctor having my private medical information, as these agencies are able to pull it up WITHOUT my permission. Sadly CIIS maintains the names and birth dates, even after you request they be deleted. When a child is born the hospital automatically enrolls your child, as it is an “OPT OUT” system and not an Opt IN system as it should be. Many people and parents I have known, knew nothing about CIIS. I am thankful for Pam Long’s article, and I hope that many read it and now know their right to Opt Out of a system that may sound good in theory but is open to error because human beings run it.

  • Phil Silberman

    February 20, 2017 at 2:06 pm

    I find it fascinating that it takes three pediatricians to attempt a lame response to one well informed, highly intelligent mother of a vaccine injured child.

    Where the heck do these supposed ‘experts’ get their so called ‘facts’? The numbers presented regarding fantasized savings to be realized through the use of CIIS are not even worthy of being in the category of ‘alternative’ facts now apparently growing in popularity. Their numbers are, quite frankly, simply made up. Let’s ask the authors for the source for this financial reference for so-called Vaccine Preventable Diseases (VPDs). Dr. James Todd, CCIC lobbyist for the Childen’s Hospital of Colorado, has an imagined figure for $443 million dollars saved in “hospital charges prevented” based on the conjectured figures that “8,583 hospital cases prevented” and “30,963 statewide cases prevented” from vaccines. Actual hospital cases of “VPD” in 2013 were 114, of which 40 were pertussis (most of whom were vaccinated with an ineffective vaccine), and 59 were pneumococcal. So now the authors use these imaginary figures to say VPDs “cost the Colorado tens of millions of dollars.” This is a huge logic fallacy that many people fall for, including doctors and lawmakers.

    They go one to state that “Controlling even one outbreak of a disease such as measles is very expensive”. However, they fail, of course, to mention that Measles is not a life threatening disease and is not even in the top 50 of life threatening diseases. Furthermore, remember that measles outbreak earlier this year here in Denver and Boulder? That ONE, yes one, case of what is purported to be one of the most infectious diseases known to man resulted in ZERO more cases. ZERO. The biggest expense of this epidemic was the paid fear mongering of vaccine salesmen.

    Let’s be honest. Vaccines are a for profit business. Vaccine companies’ primary responsibility is to generate a high return on their shareholders’ investments. They should pay for their own record keeping system like all other for-profit industries. The vaccine industry’s Immunization Information Systems should not be paid for with taxpayer dollars and should exclusively and clearly opt in programs. But, as Rep. Dan Pabon responded to lawmakers during public testimony at HB16-1164, asking to make CIIS opt-in for parents wouldn’t work, “Because no one would opt in.” When lawmakers in the House voted to amend HB1164 to change CIIS to an opt-in system in 2016, Pabon and the medical community stopped advancing the bill asking for online vaccine exemption forms loaded with PII directly submitted to CIIS, and they let the bill die but implemented the online forms anyways.

    Stop this waste of tax dollars. Defund and remove state support of CIIS. The pharmaceutical industry is one of the most profitable industries in the world. Let them pay for their own inventory control and customer record keeping.

  • Pat M.

    February 20, 2017 at 2:19 pm

    ​Re: the vaccine promotional piece by Daley, Dorighi, and O’Leary, their alternative facts do not add up to the actual data and info re: how CDPHE, for starters, has taken it upon themselves to over-ride HB-1164 which was killed this past year.

    Rep. ​Dan ​Pabon responded to lawmakers last year at HB1164​’s hearing​ about lawmakers​ intent to make CIIS an ​’​opt in​’​ system with “Because no one would opt in.” ​T​his opt ​in​ system is ​strictly for ​data mining​, period, and once people’s personal and private info is in the system, it’s there for good. An ‘opt-out’ doesn’t do squat at removing their info, which is precisely the goal. Data = $$$ and is about profit and agenda, bottom line. Any marketer knows this.

    However, CDPHE, under Larry Wolk’s directive, over-rode the bill by prematurely having in place a new immunization form​ ostensibly to replace the original form which has been in place for some time via school districts and has worked quite well in protecting personal and private info of students and their families.

    Despite news media exposing Wolk’s presumptive and illegal use of his position as head of CDPHE to imply that this ‘new’ form is the ONLY form to be used by parents registering their children for school, he did not relent and instead blamed one of his staff for this egregious mis-use of power that he wields for the benefit of those agencies as in the CIIS who work in tandem w/him.

    CDPHE and CIIS’s transparent attempts at ramping up vaccination rates w/the sole purpose of obtaining continual federal funding, thanks to pharma’s 1400+ lobbyists in D.C. plying their quid pro quo trade, has fallen short of its goal to intimidate and coerce parents into ‘thinking’ that this new form is required, which it is not, based on the failure of HB-1164 to launch.

    CIIS serves pediatricians, first and foremost and is a taxpayer-funded $ystem at $3 million dollars a year serving pediatricians in order to maximize their profitable sale of vaccines by ‘well-baby’ visits and vaccine clinics at public schools. Follow the money and you will see that the relentless mis-use and continual propagation of instilling fear among future and current customers, which is how patients are referred to, is a continual ‘sky is falling’ attempt at a one size fits all vaccine agenda which only benefits those invested in this ethically-compromised industry. Caveat emptor!

  • Pam Long

    February 20, 2017 at 3:10 pm

    The argument that the Colorado Immunization Information Systems (CIIS) is the fail safe centralized back-up of vaccine records and therefore justified in a $3 million dollar annual taxpayer expense and data mining the unknowing public for the profit of vaccine provider operations is a self-serving argument of pediatricians. Parents have the most accurate information, and it not an inconvenience or burden for parents to keep copies of vital records. Consumers should also have the freedom to choose which health records they would like to share with their many doctors and specialists over their lifetime, because doctors do not get a free pass on respecting privacy, even in the pretense of aiming to provide the best services and the most convenience. The public cannot expect a system that works in secrecy to have the best data, nor good intentions. Let’s not forget how profitable medicine is when we talk about public health. Maybe consumers need some protections in this area when profit can interfere with ethical practices.

    The CIIS data is incomplete because not all vaccine providers participate in CIIS, and states do not share data (yet) so how can CIIS be reliable for any medical decision making? For example, CIIS does not have any data on my children because all of their shots were administered in another state. So according to CIIS, my kids are missing all vaccines. This error could also result in my school nurse concluding that my kids are “out of compliance” and sending me a threatening letter of intent to expel. So does the CIIS database have more authority than my real medical records that I chose not to share with state and federal agencies? A nurse contacted me today explaining how her doctor will not upload her child’s shot records to the databse because he gets pressure from the AAP to revoke his accreditation and pressure from his insurance network to drop his practice if he hits an arbitrary threshold of not fully-vaccinated patients. Her son could not finish the DTaP four-shot series because he had an allergic reaction. She found herself trying to convince the health department that the database was incorrect for her son’s school attendance. Fortunately, she had kept her office visit summaries. Otherwise, she could have been pressured to over-vaccinate her child who had a documented adverse vaccine reaction. Again, where are the consumer protections?

    But I personally did not fully understand the level of unauthorized data sharing until 2014, when I received a “reminder” post card in the mail from my Colorado health insurance informing me my son was missing a shot. I called my insurance to see where they obtained their incorrect information about my son. After many attempts from insurance employees to try to dodge my question, and after my third “let me talk to your supervisor” demand resulted in this answer: CIIS. I had taken my son for strep infection testing, not shared any shot records with the pediatrician, and subsequently a CIIS profile was created for my son that showed he had no vaccines in his record. So CIIS, actually works to over-vaccinate children in this example too. And given that even the CDPHE has acknowledged that over-vaccination is something that should be avoided (CDPHE 2017 immunizations budget proposal) because over vaccination adversely affects an individual’s health, then we should all be taking pause at the current supersized 70 dose schedule which has no research showing that it is safe in cumulative effect for children. Again, parents have had to become their own consumer watchdogs because the system is rigged towards maximizing vaccine profit, not health. No person who has had all 70 vaccine doses has good health. Furthermore, not one pediatrician has had all 70 doses on the current vaccine schedule. Think about that.

    The solution on CIIS is easy: make pediatricians pay for their own record keeping and inventory system like all other for-profit businesses, and make it an opt-in system with transparency and informed consent, which is required in medical ethics.

    • Y

      February 23, 2017 at 10:16 pm

      Pam,

      It seems to me that you are making many statements that could be construed as facts but are rather your own opinion.

      “Parents have the most accurate information, and it not an inconvenience or burden for parents to keep copies of vital records.” Yes, you seem very informed and responsible, so I have no doubt that you would have the most accurate information for your child. However, everyday I see new patients whose families have no recollection of where they went for their last check-up, much less have a record of their vaccines. Should they be more responsible? Of course. But this is the reality.

      “The CIIS data is incomplete because not all vaccine providers participate in CIIS, and states do not share data (yet) so how can CIIS be reliable for any medical decision making?” When the aforementioned new patient comes to my clinic without vaccine records, I may be able to look them up in CIIS. If there is a record of them being fully vaccinated, then I don’t have to give any more vaccines. Voila!

      “No person who has had all 70 vaccine doses has good health.” Really? Can you actually find me a person who has had all 70 vaccine doses? The most recent major change to the vaccine schedule occurred in 2007 with the reintroduction of the Rota vaccine and addition of HPV vaccine. They would definitely be over-vaccinated if those babies born in 2007 had all 70 doses of their vaccines by age 10 (including the annual flu vaccine for their future ages 11-18). Perhaps it happened because their parents didn’t keep track of their vaccine records, and we didn’t have a record of them in CIIS.

      “Make pediatricians pay for their own record keeping and inventory system like all other for-profit businesses.” I work at a Federally Qualified Health Center. I’m not a financial guru, but I’m pretty sure that means we are not for profit. So do I still have to pay for it myself?

      I fully support your right to your own opinion. However, please stop overstating your opinions as facts.

  • Heather L.

    February 20, 2017 at 8:09 pm

    Are we really to the point where pediatricians cannot keep accurate patient records and parents cannot keep track of important medical procedures their children have received without help from the state? Are we really concerned that both of these parties will loose this important information at the same time? When did the doctors and the populace loose the ability to do their jobs? Perhaps an opt-in CIIS program for those incapable of doing their jobs properly would be the answer.

    Because I believe the majority of pediatricians can keep proper records and have been doing so since the inception of their profession, and the majority of parents are capable of raising their children without oversight from the state, we would save millions of tax payer dollars by implementing this simple change.

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