Twenty-one years into the 21st century, Texas’ immunization registry possesses some features – and lack thereof – that leave the state’s vaccine tracking in the relative Dark Ages.
The Texas Medical Association on Wednesday asked the House Public Health Committee to help change that by advancing a bill to help modernize the state registry, ImmTrac2.
Dallas pediatrician Joseph Schneider, MD, testified for TMA in support of House Bill 4272 by Rep. Stephanie Klick (R-Fort Worth), which would improve ImmTrac2’s functionality, streamline efforts to vaccinate Texans against COVID-19, and extend retention of disaster vaccination records.
In written testimony, Dr. Schneider told the committee it’s important for electronic health records (EHRs) and ImmTrac2 to be able to send and receive data to and from each other so the systems are synchronized.
“This is not a new concept, and it is done in standard ways across the country with virtually all states and all EHRs. Except Texas,” Dr. Schneider said in his written comments. “While other states have simple ‘yes’/ ‘no’ choices for consent, which makes opting in and out easy, Texas has multiple additional steps, which, depending upon how one counts, create up to five or six possible combinations. Many of these are not supported by national electronic standards. This means EHR coding for the Texas immunization registry is very difficult, is an extra cost to the system, is done in a nonstandard fashion by each vendor, and is given a much lower priority.”
Among several improvements, HB 4272, Dr. Schneider noted, would:
- Introduce a simple yes-or-no consent option for people to have their information stored in the registry;
- Create an online portal that allows patients and parents to submit a request to withdraw immunization information from ImmTrac2; and
- Require disaster immunization records to be retained for at least seven years. The Texas Department of State Health Services (DSHS) would make multiple attempts to notify people when their records are about to be deleted from the system to give them the chance to consent to retaining the records.
A separate TMA-supported measure that would require Texans to opt out of having their vaccination records stored in ImmTrac2 – instead of opting in – is currently sitting in the same committee awaiting a hearing date. House Bill 325 by Rep. Donna Howard (D-Austin) also contains technical improvements to the registry. Its companion is Senate Bill 468 by Sen. Judith Zaffirini (D-Laredo).
Opposing a COVID-19 brochure burden
The Senate Health and Human Services Committee considered a measure Wednesday that TMA opposes for its lack of scientific basis and the burdens and liability risks it would introduce for physicians.
Senate Bill 1489 by Sen. Bob Hall (R-Edgewood) would require physicians to provide all patients who get tested for COVID-19 with printed copies of a DSHS-produced brochure that contains “information about preventative measures and treatments” for the disease. The brochure would be required to include information on how to improve immune system function, as well as the “importance of therapeutic prevention of COVID-19, including the use of nutraceuticals, the use of prescription medications, and the benefits and risks of receiving a vaccination.”
Austin pediatric infectious disease specialist Donald Murphey, MD, testified for medicine, and submitted written remarks picking apart the bill’s deficiencies on therapeutic guidance.
“Nutraceuticals, or dietary supplements, are not regulated by FDA, and [the National Institutes of Health] currently recommends against the use of any drugs for either pre- or post-exposure prophylaxis,” Dr. Murphey wrote. “There is also no fully FDA-approved cure for COVID-19. Treatments have only received emergency use authorization as researchers test a variety of options. There is a lot of misinformation circulating about ways to prevent and treat COVID-19 that is not backed by science.”
The burden on physicians to always provide the brochure is another concern for the house of medicine. Dr. Murphey asked the committee to consider what the bill would have done if it were in effect during summer 2020, when thousands of Texans were being tested every day. And he wrote that the proposed brochure encroaches on physicians’ freedom to practice medicine based on their own expertise.
“The information provided could possibly be misconstrued as government ‘practice of medicine,’ and an even bigger concern here is if the physician would be held liable should a patient still contract COVID-19 after following the brochure’s prevention recommendations. Handing a patient a brochure does not substitute for the direct care of a patient by a physician to prevent or treat COVID-19,” Dr. Murphey added.
During his appearance before the committee, Dr. Murphey withstood a barrage of questions from Senator Hall, who claimed that “at least 90% of the people we’ve allowed to die here in Texas” could have been saved if proper therapeutics had been used previously.
Studying social drivers of health
Recent research has shown that up to 80% of a person’s health has nothing to do with their doctor. Instead, the overwhelming contributors are the social determinants of health, including where people live or work and their access to nutritious food. Better health for Texans – and realizing better-value health care – means taking full stock of those social factors.
TMA testified Tuesday in support of House Bill 4365 by Rep. Tom Oliverson, MD (R-Cypress), which would establish a pilot program to address the social drivers of health. Austin pediatrician Marjan Linnell, MD, told the House Human Services Committee in written testimony that when social factors aren’t addressed, they often result in unnecessary, costly medical care.
While a physician can prescribe medications to control patients’ illnesses and educate them on healthy behavior, no amount of education or medication can overcome living in a community that doesn’t have access to healthy food, Dr. Linnell wrote. She added that in communities where health care and social services collaborate to remove barriers to food access, like by supporting mobile food pantries, patient health improves.
TMA, she added, believes that Texas Medicaid needs a sustained, systematic, and integrated approach to social determinants to address both health improvement and cost containment.
Senate Approves Bill on Medical School Clerkships
On Tuesday, the Senate passed a medicine-supported measure to ensure the availability of clerkships for Texas medical school students. Senate Bill 1490 by Sen. Brandon Creighton (R-Conroe) would introduce more stringent requirements the Texas Higher Education Coordinating Board must follow to grant authorization to private, out-of-state medical schools to operate in Texas.
Just one First Tuesdays left
This year’s final virtual First Tuesdays at the Capitol is less than two weeks away, on May 4. By then, only 27 days will remain in this session. Register for free today to get an update from TMA’s lobby team on what issues and bills are still in play, and what you can do to help in the final stretch before the legislature adjourns.
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