A School Nurse’s Perspective on Digital Immunization Data

School nursing is a dynamic profession that has learned to harness technology to better serve their patient population, namely the nation’s school-aged children. The education world is constantly changing and adapting new technology to benefit the students they serve, and the school nursing profession is no different.

School nurses have had to adjust and transition their practice from a pen-and-paper world to a digital one. Using electronic health records, school nurses across the country can

• document clinic visits and medication administrations,

• input hearing and vision data,

• conduct disease surveillance,

• run reports to see high level data trends, and

• communicate with a student’s parent or primary care provider.

The National Association of School Nurses (NASN) has deemed EHRs “essential” to provide “efficient and effective care in the school and monitor the health of the entire student population.” Documentation and data collection in the school clinic falls under the quality improvement pillar of the NASN Framework for 21st Century School Nurse Practice.

School nurses also leverage health information technology with an Immunization Information System (IIS), also known as an Immunization Registry.

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“Promotion of immunizations by the registered professional school nurse is central to the public health focus of school nursing practice,” according to a 2015 NASN Position Statement on Immunizations. In the not-so-distant past, a school nurse would receive paper copies of immunization records from a variety of sources: parents, other school clinics, and primary care providers, for example.

The records may be up to date, or they may be missing vital information that can help complete the picture of the student’s full immunization status. Without a complete immunization record, students can be held out of school and miss valuable instructional time.

Immunization information systems can help close this information gap and provide the up-to-date immunization data a school nurse needs to help keep a student healthy, in school and ready to learn. An excellent resource to help illustrate this concept is the 2013 article “How School Nurses Can Benefit from Immunization Information Systems” by Bobo et al.

Several states have robust immunization information systems that school nurses access frequently in their day-to-day practice. Some states provide read-only access, while other states grant access to input new data. A few examples of the many registries across the country that provide the school nurse with a digital connection to their patients’ immunization records include:

ImmTrac in Texas,

CIRT in Connecticut,

WIR in Wisconsin,

MIIC in Minnesota, and

CIR in New York City. 

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The challenge with these systems is the lack of interoperability between the IIS and the campus EHR, primary care providers, and/or hospital systems. In most cases, the school nurses still need to log into the IIS to obtain the desired immunization data, and often, they will have to enter manually that data into their campus EHR.

Direct data linkages of the immunization data to the school clinic EHR could help increase up-to-date immunization status, and decrease the problem of over-immunizing children, as this 2016 Pediatrics study from Stockwell et al concluded in a study with the New York City Department of Health and CIR. 

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The case for interoperability is clear in the benefits to the student population as a whole.


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NASN is a member of the Alliance for Nursing Informatics.