Department of Health
A Review of Management Controls at the
Department of Health's Immunization Program
Report Number 00-007
Incomplete immunization data, gaps in provider monitoring, and the inconsistent
reporting of information makes it difficult to determine if resources provided by the
State of Texas and the federal government have been efficiently and appropriately used by
the Department of Health's Immunization Program (Program). The Department of Health
(Department) has received more than $300 million in cash and vaccines for the Program over
the past four years.
Immunization rates for school age children are high, and incidence of childhood disease
is stable, which may indicate that the Program has been successful in getting children
immunized. Our main areas of concern are the underutilization of the statewide
immunization registry, the lack of information regarding performance of providers, and the
inconsistent reporting of vaccine supplies.
Key Facts and Findings
- Fewer than half of Texas' 5.5 million children are being tracked by the statewide
immunization registry. The objectives of a centralized statewide registry are to keep
track of whether a child has received immunizations, to help remind parents when
immunizations are due, and to provide a centralized immunization history for healthcare
providers to use. Because the data is so incomplete, these benefits have not been realized
to the extent intended. Texas has invested more than $10 million in this registry to date,
with annual expenditures to maintain the system exceeding $1 million.
- The Department has not adequately documented provider monitoring activities necessary to
ensure that vaccines and cash given to healthcare providers have been used as intended.
Policies, procedures, and criteria that would provide for consistent programmatic
monitoring have not been documented. Additionally, the Program has not implemented a
consistently applied risk assessment methodology to determine high-risk providers.
- Reporting of vaccine inventory information is inconsistent, increasing the risk that
decision makers do not have accurate information. The Department has not developed written
policies and procedures to direct consistent statewide reporting of immunization and
vaccine inventory information.
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