Recent changes in the proceedings of the federal Advisory Committee on Immunization Practices (ACIP) do more than sow public confusion in immunization recommendations. They also upend longstanding practices designed to support clinical and public health efforts to support immunization. Navigating these changes requires a collaborative effort.
Keeping up with the latest immunization recommendations has long been a challenge. The introduction of new vaccines, and more recently, monoclonal antibody products, requires diligent attention. The changes, which could be difficult to keep up with operationally, represented carefully considered clinical best practices, based on a transparent and evidence-based approach. ACIP workgroups would meticulously study every issue across multiple domains: the scope of the problem, the benefits and harms, public values, acceptability, resource use, equity, and feasibility. This comprehensive review led to recommendations based on a clear balance of consequences. Once the CDC Director adopted new ACIP recommendations, they became official.
Technology is essential for operationalizing new recommendations. Immunization clinical decision support (CDS) software, such as the Immunization Calculation Engine (ICE), is designed to work in health IT systems to evaluate the validity of shots on a patient’s record and identify what immunizations are recommended. These systems translate complex immunization recommendations into decision support systems that provide actionable guidance for every patient. The accurate and timely translation of clinical guidelines to decision support systems helps empower patients, clinicians, and public health practitioners in recognizing and facilitating immunization in accordance with best practice recommendations.
The ICE team at HLN has relied on the detailed guidance published by ACIP and the CDC to maintain ICE in alignment with ACIP recommendations. Resources like the Morbidity and Mortality Weekly Report (MMWR) and Clinical Decision Support for Immunization (CDSi) help translate broad recommendations into the technical logic—such as minimum ages and intervals—required for an executable rules-based system.
Changes in the federal administration and ACIP mean these processes may no longer be relied on as a shared source of immunization best practices. This leaves public health jurisdictions and healthcare providers in a difficult position to determine what immunizations to recommend.
This challenge, however, also creates a powerful opportunity for collaboration. As freely available, open-source software, the ICE web service and its underlying logic are integrated into 11 electronic health record systems, 8 jurisdictional immunization information systems, and numerous other health IT systems, supporting clinical decisions for patients across the lifespan and across the country.
The ICE team at HLN is committed to working with our users and immunization stakeholders to navigate the evolving immunization landscape. Together, we can ensure that all users of ICE or similar technologies have the resources needed to continue aligning with clinical best practices and meet the needs of those on the front lines of care delivery and public health. For more information on ICE, please reach out to us at ice@hln.com.