Every time a child or adult is immunized in Georgia, health care providers are required to record details about the vaccines in a secure database at the state health department.
Georgia’s immunization registry, known by the acronym GRITS, is supposed to make it easier for schools to verify that children have required shots. And state health officials say the registry is critical to monitoring the safety of the new H1N1 flu vaccine as it becomes available this month.
Yet just 26 percent of private providers statewide are recording vaccinations in GRITS, according to state data reported to the Centers for Disease Control and Prevention — even though Georgia law has required it for years.
“We have a law, but the law doesn’t have any teeth. There’s nothing we can do to force providers to participate,” said Michelle Conner, director for infectious disease and immunizations at the Georgia Division of Public Health. Nearly all shots given by public health clinics are reported, data show.
In interviews with The Atlanta Journal Constitution, officials at pediatric practices, college health clinics, hospitals and affiliated medical groups gave a variety of reasons for routinely violating the law. Several said they believed GRITS participation is optional. Many thought only childhood vaccines had to be logged, not adult shots. Some cited glitches in technology. Others blamed the state health department’s Web site for posting conflicting and erroneous information about GRITS requirements.
But GRITS scofflaws are in for a surprise if they want to immunize their patients with the new H1N1 vaccine. Although Georgia’s immunization registry law has no enforcement provisions, the state health department is in charge of distributing the limited supplies swine flu vaccine and has made GRITS participation a requirement for any provider who wants some. It’s a condition that has prompted more providers to enroll in GRITS in recent weeks, Conner said.
“Registry use during H1N1 is so terribly important for vaccine safety monitoring and reporting back to CDC on a weekly basis,” Conner said. “Any provider that wants to administer the H1N1 vaccine must participate.”
GRITS stands for the Georgia Registry of Immunization Transactions and Services. It was created under a 1996 state law requiring mandatory reporting of vaccinations given to children and teens under age 18. In 2004, the law was expanded to mandate reporting of all vaccinations regardless of the person’s age.
Pediatricians generally do a better job of reporting than family practitioners, internal medicine specialists, ob-gyns and other providers who generally treat adult patients, Conner said. She estimates 70 to 80 percent of pediatricians record vaccinations.
Among pediatricians not using GRITS were those at the Children’s Wellness Center in Atlanta, documents obtained under the Georgia Open Records Act show. But after being contacted by the AJC, the practice had its electronic medical records firm send information to the state.
“We’re in the process of transmitting right now,” office manager Willie Ballard said Sept. 23. “In four hours, all our immunizations will be over in GRITS, and once a week, we will automatically transmit data.”
Dr. Edward Spilker at West Cobb Family Practice said he was unaware he was required to participate in GRITS. After being contacted by the AJC, he read the law. “I have now arranged to do whatever paperwork is necessary,” he said.
Lax GRITS reporting can cause hassles for busy parents, school officials said. If a child’s immunization certificate— required for school enrollment — is lost or incomplete, the parent may have to take time off work to go back to the doctor’s office. But when shots are recorded in GRITS, authorized school officials can log in and print the certificate.
“It’s easier for parents when the school can look up their records,” said Anne Coyle, nursing supervisor for the Cobb County School District.
The system is particularly helpful for families that move frequently or obtain health care from a patchwork of doctors or public health clinics, said Lynne Meadows, the Fulton County schools’ coordinator of student health services. Sometimes parents can’t remember where a child received shots, she said.
Registries also are useful for adults, who often are missing key vaccinations, experts said. Those shots, depending on the person’s age and health risks, include tetanus shots, a whooping cough booster and vaccines against pneumococcal pneumonia, shingles and hepatitis.
But in Georgia, health officials say, adults are even less likely to have their vaccinations recorded in GRITS.
None of the shots this reporter has received since moving to Georgia more than three years ago are in GRITS, registry records show. They include three seasonal flu shots provided at the AJC by a health care firm and a tetanus shot administered last year at an internist’s office affiliated with Piedmont Healthcare.
“Communication of the law has not been clear outside of the public health arena until the need arose to provide the H1N1 vaccination,” said Diana Lewis, Piedmont Healthcare spokeswoman. As recently as last month, outdated information remained on the health department’s Web site that said the law only applied to childhood vaccinations, she noted. Those Web pages have since been removed.
“No one at Piedmont views following the law as optional,” Lewis said. “We’ll review the requirements and work with GRITS and our physicians to ensure we are in compliance.”
As of late August, 32 hospitals of about 150 across the state were not enrolled in GRITS, according to state health department memos and other documents obtained under the Georgia Open Records Act. Other records indicate state concerns as far back as 2007 that many college health clinics also weren’t participating.
Both are considered key groups because of H1N1 outbreaks among college students and the need to keep hospital workers from catching and spreading the virus.
The clinic at Agnes Scott College in Decatur had been unaware of the law, but staff are now being trained to use GRITS so they can immunize students against swine flu, said spokeswoman Jennifer Owen.
Grady Memorial Hospital has long recorded childhood vaccines in GRITS, but not adult shots — until now. “While the law changed in 2004 to include adult immunization reporting, the state has not enforced that requirement,” said Grady Health System spokeswoman Denise Simpson.
Health experts began pushing for each state to develop a registry around 1991 after a resurgence of measles among unvaccinated toddlers, said Dr. Lance Rodewald, CDC’s director of immunization services. The idea was to use computers to help doctors track and send out reminders when children were due for shots. “The biggest cause for not being vaccinated is simple forgetfulness,” he said.
Over the years the childhood vaccination schedule has grown more complex. While registries could help, just 37 percent of private health providers nationwide participate, CDC data show.
Yet some states report that more than 90 percent of their private providers willingly use the registries.
In Arkansas, where 97 percent participate, state officials said they could issue a meager $25 fine for each violation, but don’t need to because the registry is embraced by local doctors as an important resource. “We’d point to physician leadership as the reason,” said Ed Barham, spokesman for the Arkansas Department of Health.
What you can do
● Check your own records: To find out whether your shots or your children’s shots are properly recorded in GRITS, you’ll need to send the registry a written request and a photocopy of state-issued identification. Call 888-223-8644 for more information.
● Ask your doctor: Find out whether your health care providers record vaccinations in GRITS. If they don’t, patients should urge them to send in the information. “I believe a lot of encouragement from patients or parents would help,” said Michelle Conner, the state health department’s director for infectious disease and immunizations.
● If you don’t want your vaccinations or a child’s vaccinations recorded in the state registry, you can opt out of the system by filling out an exemption form. It’s available at www.health.state.ga.us/pdfs/forms/grits008.03.pdf
How we got this story
While reporting earlier articles about schools not enforcing Georgia’s school vaccination law, school nurses noted that some doctors weren’t recording immunizations in GRITS.
The AJC used the Georgia Open Records Act to obtain records relating to the state health department’s enforcement of the immunization registry law. The records included some reports of physicians not using GRITS, as well as e-mails and other documents involving the state’s effort to assess GRITS participation by hospitals in preparation for the H1N1 vaccination campaign.
The AJC interviewed doctors, hospitals, medical associations and other health experts. The reporter faxed required paperwork and identification to GRITS to check whether her own immunizations had been recorded in the registry.
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Check our sources
Georgia law, O.C.G.A 31-12-3.1, requires all vaccinations administered to any person be recorded in the state’s immunization registry. To read the full text of the law and get other information about the registry, go to http://health.state.ga.us/programs/immunization/grits/
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