[Congressional Record Volume 167, Number 206 (Tuesday, November 30, 2021)]
[House]
[Pages H6684-H6687]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         IMMUNIZATION INFRASTRUCTURE MODERNIZATION ACT OF 2021

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 550) to amend the Public Health Service Act with respect to 
immunization system data modernization and expansion, and for other 
purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 550

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Immunization Infrastructure 
     Modernization Act of 2021''.

     SEC. 2. IMMUNIZATION INFORMATION SYSTEM DATA MODERNIZATION 
                   AND EXPANSION.

       Subtitle C of title XXVIII of the Public Health Service Act 
     (42 U.S.C. 300hh-31 et seq.) is amended by adding at the end 
     the following:

     ``SEC. 2824. IMMUNIZATION INFORMATION SYSTEM DATA 
                   MODERNIZATION AND EXPANSION.

       ``(a) Expanding CDC and Public Health Department 
     Capabilities.--
       ``(1) In general.--The Secretary shall--
       ``(A) conduct activities (including with respect to 
     interoperability, population reporting, and bidirectional 
     reporting) to expand, enhance, and improve immunization 
     information systems that are administered by health 
     departments or other agencies of State, local, Tribal, and 
     territorial governments and used by health care providers; 
     and
       ``(B) award grants or cooperative agreements to the health 
     departments, or such other governmental entities as 
     administer immunization information systems, of State, local, 
     Tribal, and territorial governments, for the expansion, 
     enhancement, and improvement of immunization information 
     systems to assist public health departments in--
       ``(i) assessing current data infrastructure capabilities 
     and gaps among health care providers to improve and increase 
     consistency in patient matching, data collection, reporting, 
     bidirectional exchange, and analysis of immunization-related 
     information;
       ``(ii) providing for technical assistance and the efficient 
     enrollment and training of health care providers, including 
     at pharmacies and other settings where immunizations are 
     being provided, such as long-term care facilities, specialty 
     health care providers, community health centers, Federally 
     qualified health centers, rural health centers, organizations 
     serving adults 65 and older, and organizations serving 
     homeless and incarcerated populations;
       ``(iii) improving secure data collection, transmission, 
     bidirectional exchange, maintenance, and analysis of 
     immunization information;
       ``(iv) improving the secure bidirectional exchange of 
     immunization record data among Federal, State, local, Tribal, 
     and territorial governmental entities and non-governmental 
     entities, including by--

       ``(I) improving such exchange among public health officials 
     in multiple jurisdictions within a State, as appropriate; and
       ``(II) by simplifying and supporting electronic reporting 
     by any health care provider;

       ``(v) supporting the standardization of immunization 
     information systems to accelerate interoperability with 
     health information technology, including with health 
     information technology certified under section 3001(c)(5) or 
     with health information networks;
       ``(vi) supporting adoption of the immunization information 
     system functional standards of the Centers for Disease 
     Control and Prevention and the maintenance of security 
     standards to protect individually identifiable health 
     information;
       ``(vii) supporting and training immunization information 
     system, data science, and informatics personnel;
       ``(viii) supporting real-time immunization record data 
     exchange and reporting, to support rapid identification of 
     immunization coverage gaps;
       ``(ix) improving completeness of data by facilitating the 
     capability of immunization information systems to exchange 
     data, directly or indirectly, with immunization information 
     systems in other jurisdictions;
       ``(x) enhancing the capabilities of immunization 
     information systems to evaluate, forecast, and operationalize 
     clinical decision support tools in alignment with the 
     recommendations of the Advisory Committee on Immunization 
     Practices as approved by the Director of the Centers for 
     Disease Control and Prevention;

[[Page H6685]]

       ``(xi) supporting the development and implementation of 
     policies that facilitate complete population-level capture, 
     consolidation, and access to accurate immunization 
     information;
       ``(xii) supporting the procurement and implementation of 
     updated software, hardware, and cloud storage to adequately 
     manage information volume and capabilities;
       ``(xiii) supporting expansion of capabilities within 
     immunization information systems for outbreak response;
       ``(xiv) supporting activities within the applicable 
     jurisdiction related to the management, distribution, and 
     storage of vaccine doses and ancillary supplies;
       ``(xv) developing information related to the use and 
     importance of immunization record data and disseminating such 
     information to health care providers and other persons 
     authorized under State law to access such information, 
     including payors and health care facilities; or
       ``(xvi) supporting activities to improve the scheduling and 
     administration of vaccinations.
       ``(2) Data standards.--In carrying out paragraph (1), the 
     Secretary shall--
       ``(A) designate data and technology standards that must be 
     followed by governmental entities with respect to use of 
     immunization information systems as a condition of receiving 
     an award under this section, with priority given to standards 
     developed by--
       ``(i) consensus-based organizations with input from the 
     public; and
       ``(ii) voluntary consensus-based standards bodies; and
       ``(B) support a means of independent verification of the 
     standards used in carrying out paragraph (1).
       ``(3) Public-private partnerships.--In carrying out 
     paragraph (1), the Secretary may develop and utilize 
     contracts and cooperative agreements for technical 
     assistance, training, and related implementation support.
       ``(b) Requirements.--
       ``(1) Health information technology standards.--The 
     Secretary may not award a grant or cooperative agreement 
     under subsection (a)(1)(B) unless the applicant uses and 
     agrees to use standards adopted by the Secretary under 
     section 3004.
       ``(2) Waiver.--The Secretary may waive the requirement 
     under paragraph (1) with respect to an applicant if the 
     Secretary determines that the activities under subsection 
     (a)(1)(B) cannot otherwise be carried out within the 
     applicable jurisdiction.
       ``(3) Application.--A State, local, Tribal, or territorial 
     health department applying for a grant or cooperative 
     agreement under subsection (a)(1)(B) shall submit an 
     application to the Secretary at such time and in such manner 
     as the Secretary may require. Such application shall include 
     information describing--
       ``(A) the activities that will be supported by the grant or 
     cooperative agreement; and
       ``(B) how the modernization of the immunization information 
     systems involved will support or impact the public health 
     infrastructure of the health department, including a 
     description of remaining gaps, if any, and the actions needed 
     to address such gaps.
       ``(c) Strategy and Implementation Plan.--Not later than 90 
     days after the date of enactment of this section, the 
     Secretary shall submit to the Committee on Energy and 
     Commerce of the House of Representatives and the Committee on 
     Health, Education, Labor, and Pensions of the Senate a 
     coordinated strategy and an accompanying implementation plan 
     that identifies and demonstrates the measures the Secretary 
     will utilize to--
       ``(1) update and improve immunization information systems 
     supported by the Centers for Disease Control and Prevention; 
     and
       ``(2) carry out the activities described in this section to 
     support the expansion, enhancement, and improvement of State, 
     local, Tribal, and territorial immunization information 
     systems.
       ``(d) Consultation; Technical Assistance.--
       ``(1) Consultation.--In developing the strategy and 
     implementation plan under subsection (c), the Secretary shall 
     consult with--
       ``(A) health departments, or such other governmental 
     entities as administer immunization information systems, of 
     State, local, Tribal, and territorial governments;
       ``(B) professional medical associations, public health 
     associations, and associations representing pharmacists and 
     pharmacies;
       ``(C) community health centers, long-term care facilities, 
     and other appropriate entities that provide immunizations;
       ``(D) health information technology experts; and
       ``(E) other public or private entities, as appropriate.
       ``(2) Technical assistance.--In connection with 
     consultation under paragraph (1), the Secretary may--
       ``(A) provide technical assistance, certification, and 
     training related to the exchange of information by 
     immunization information systems used by health care and 
     public health entities at the local, State, Federal, Tribal, 
     and territorial levels; and
       ``(B) develop and utilize public-private partnerships for 
     implementation support applicable to this section.
       ``(e) Report to Congress.--Not later than 1 year after the 
     date of enactment of this section, the Secretary shall submit 
     a report to the Committee on Health, Education, Labor, and 
     Pensions of the Senate and the Committee on Energy and 
     Commerce of the House of Representatives that includes--
       ``(1) a description of any barriers to--
       ``(A) public health authorities implementing interoperable 
     immunization information systems;
       ``(B) the exchange of information pursuant to immunization 
     records; or
       ``(C) reporting by any health care professional authorized 
     under State law, using such immunization information systems, 
     as appropriate, and pursuant to State law; or
       ``(2) a description of barriers that hinder the effective 
     establishment of a network to support immunization reporting 
     and monitoring, including a list of recommendations to 
     address such barriers; and
       ``(3) an assessment of immunization coverage and access to 
     immunizations services and any disparities and gaps in such 
     coverage and access for medically underserved, rural, and 
     frontier areas.
       ``(f) Definition.--In this section, the term `immunization 
     information system' means a confidential, population-based, 
     computerized database that records immunization doses 
     administered by any health care provider to persons within 
     the geographic area covered by that database.
       ``(g) Authorization of Appropriations.--To carry out this 
     section, there is authorized to be appropriated $400,000,000, 
     to remain available until expended.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Kentucky (Mr. Guthrie) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material on H.R. 550.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in strong support of H.R. 550, the Immunization 
Infrastructure Modernization Act. This bill would authorize $400 
million for grants to expand, enhance, and improve immunization 
information systems administered by health departments and used by 
healthcare providers.
  Immunization information systems, also known as IIS, or immunization 
registries, are confidential, population-based, computerized databases 
that record immunization doses administered by providers to patients. 
They are critical in our fight against COVID-19 and other public health 
threats like measles and influenza.
  Local public health officials use IIS to collect, analyze, store, and 
view aggregated vaccination information, which is kept confidential and 
separate from identifiable patient information. This information helps 
them understand overall vaccination levels so they can better guide 
public health decisions for their communities.
  IIS also helps patients and healthcare providers by allowing them to 
view a secure consolidated immunization history, helping them determine 
appropriate and necessary vaccinations, and reminding patients about 
vaccination schedules.
  IIS have been critical in the COVID-19 pandemic. They have helped us 
understand where vaccines are getting to patients, and where we need to 
do more to reach people and provide access. They provided near real-
time information sharing, allowing State officials and leadership at 
the Centers for Disease Control and Prevention to understand 
vaccination rates and where people are choosing to receive their 
vaccines.
  Like all forms of infrastructure, IIS require maintenance and 
upgrades. As I mentioned, IIS have been an important tool in the fight 
against COVID-19, but the pandemic has also tested the ability of IIS 
to keep up with the pace of our massive vaccination efforts.
  According to the American Immunization Registry Association, one 
State went from an average of 17,000 doses recorded in its IIS each day 
to over 500,000 this past spring. This dramatic increase required the 
State health department to nearly quadruple the number of digital 
servers used to host the data. These are not one-time costs. Going 
forward, these new servers and the new data collected during the 
pandemic will need to be maintained and secured.
  State and local leaders have also told us that inconsistent and 
antiquated technology, incomplete provider participation, and faltering 
interoperability are areas where we must improve to ensure that we have 
useful and quality data.
  It is important that the systems used by physicians are able to 
communicate with the State and local public health departments, and 
that these systems

[[Page H6686]]

can also communicate with other States and the CDC.
  H.R. 550, the bill before us today, addresses these challenges by 
providing grants for technological upgrades, provider outreach and 
enrollment, policy development, and a skilled workforce to build and 
maintain these systems.
  The legislation also requires the Department of Health and Human 
Services to create an implementation strategy and set clear data 
standards that must be followed by all grantees. And this should help 
ensure that States are coordinated going forward.
  H.R. 550 will ensure all IIS are brought up to modern standards, help 
control disease outbreaks, and put our public health infrastructure on 
a solid foundation for years to come.
  Mr. Speaker, I thank Representatives Kuster and Bucshon for their 
bipartisan work on this bill. I urge all Members to support this 
important bipartisan legislation, and I reserve the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 550, the Immunization 
Infrastructure Modernization Act, a bill introduced by my Energy and 
Commerce Committee colleagues, Ms. Kuster and Mr. Bucshon.
  Immunization information systems, or IIS, are important tools in 
providing immunization care for patients by allowing providers to view 
a patient's comprehensive immunization history to determine the 
appropriate vaccinations throughout their life.
  The Immunization Infrastructure Modernization Act authorizes the 
Secretary of Health and Human Services to conduct activities to improve 
immunization information systems. These activities include designating 
data and technology standards, developing public-private partnerships, 
and awarding grants or cooperative agreements to health departments to 
enhance their systems.
  Modernizing our immunization infrastructure will give us a better 
understanding of our current vaccination efforts and will also help us 
determine which communities may need additional vaccination outreach--
better targeting our efforts to improve health outcomes across the 
country.
  Mr. Speaker, I urge my colleagues to support this bill, and I reserve 
the balance of my time.
  Mr. PALLONE. Mr. Speaker, I have no additional speakers at this time, 
and I reserve the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Indiana (Mr. Bucshon).
  Mr. BUCSHON. Mr. Speaker, I rise in support of H.R. 550, the 
Immunization Infrastructure Modernization Act of 2021.

  Immunization information systems serve as a vital link between public 
health officials, community providers and individuals, not only in 
cases of disease outbreak or emergencies, but also during routine 
vaccination efforts.
  The COVID-19 pandemic has made clear that our immunization 
information systems are in need of modernization.
  Decisions in response to outbreaks must be based on science, and we 
must ensure our States and localities have access to meaningful data to 
make targeted decisions that lessen the spread and quickly reopen our 
economies.
  H.R. 550 would repurpose previously appropriated funds to be spent 
through an existing grant program to improve and enhance the ability of 
immunization information systems to securely exchange real-time 
immunization record data between all public health programs.
  As a doctor, I would take my patients' medical privacy very 
seriously. Therefore, I want to make clear that the immunization 
information systems are secure, confidential, population-based 
databases, and are completely deidentified.
  Mr. Speaker, I would like to thank Representative Kuster for her 
partnership, and I urge a ``yes'' vote.
  Mr. GUTHRIE. Mr. Speaker, I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I would ask that we support this bill, and 
I yield back the balance of my time.
  Ms. JACKSON LEE. Mr. Speaker, I rise in support of H.R. 550, the 
``Immunization Infrastructure Modernization Act of 2021,'' which will 
improve our public health infrastructure and expand information-sharing 
between state and federal governments, as well as public and private 
health care providers, to ensure vaccines are being administered 
effectively and efficiently across all states and territories.
  Mr. Speaker, public health agencies work every day to prevent disease 
and viruses, promote health, and prepare for and respond to both 
emergency situations and ongoing challenges--but they cannot do so 
without the ability to access the best available data and share 
information with other experts, and the COVID-19 pandemic highlighted 
this fact.
  As the Chair of the Congressional Coronavirus Task Force, I have used 
every means possible to sound the alarm about the seriousness of the 
COVID-19 virus.
  On February 10, 2020, I held the first press conference on the issue 
of COVID-19 at Houston Intercontinental Airport.
  I then held a second press conference on February 24th to continue 
efforts to raise public knowledge of the impending threat.
  On February 26th, I wrote the Chair and Ranking Member of the 
Committee on Homeland Security requesting to be briefed by Acting 
Secretary of Homeland Security Chad Wolf regarding the preparedness of 
the Department of Homeland Security to address a possible pandemic.
  On March 19th, I announced an innovative partnership with United 
Methodist Medical Center (UMMC) to open the first drive-through 
Coronavirus Test Screening facility in the Greater Houston area, which 
proved beneficial to everyone in the Greater Houston area, as with 
UMMC's help we have opened multiple sites that are located within high-
risk communities in the Greater Houston area, to reduce the need for 
travel to get access to COVID-19 testing.
  Since the start of this pandemic, I have sought to proactively 
address the critical issues and concerns tied to the COVID-19 virus.
  As I stated at the beginning of this pandemic, We must not panic, but 
prepare.''
  I am pleased to see that this bill is not a panic-induced response, 
but a well-thought-out proposal to further protect our citizens.
  The COVID-19 pandemic revealed a number of challenges for public 
health information systems, but worst among them is the limited 
capacity of existing state Immunization Information Systems.
  The importance of these systems cannot be understated: they allow 
providers to keep vaccines and supplies in stock, prevent over--or 
under--vaccination, remind patients when they are due for a recommended 
vaccine, and identify areas with low vaccination rates to ensure 
equitable distribution of vaccines.
  However, states lack modern, comprehensive information systems that 
can meet the challenges of COVID-19 and future public health threats 
through the secure exchange of real-time immunization data.
  Consequently, many state systems struggled to accommodate additional 
demand, implement new functionalities, onboard immunization providers, 
support interoperable exchange with health care partners and enable 
timely reporting of immunization data to federal partners.
  These issues are exactly what this legislation seeks to address.
  Through H.R. 550, HHS will develop a strategy and a plan to improve 
immunization information systems and designate data and technology 
standards for use in these systems.
  Additionally, HHS will award grants to health departments and other 
government agencies to improve their systems contingent upon meeting 
designated standards.
  As the vaccine rollout continues and the time for boosters is upon 
us, immunization data systems will be a critical tool in the success of 
these efforts, and they are in need of modernization.
  That is why I rise in ardent support of H.R. 550, and that is why the 
bill has strong bipartisan backing.
  Lastly, I want to thank Congresswoman Kuster and Congressman Bucshon 
for introducing and shepherding this bill.
  Mr. Speaker, I rise in support of H.R. 550, the ``Immunization 
Infrastructure Modernization Act of 2021,'' which will improve our 
public health infrastructure and expand information-sharing between 
state and federal governments, as well as public and private health 
care providers, to ensure vaccines are being administered effectively 
and efficiently across all states and territories.


 =========================== NOTE =========================== 

  
  November 30, 2021, on page H6686, in the third column, the 
following appeared: Lastly, I want to thank Congresswoman Kuster 
and Congressman Bucshon for introducing and shepherding this bill. 
Ms. JACKSON LEE. Mr. Speaker, I rise in support of H.R. 550, the 
``Immunization Infrastructure Modernization Act of 2021,'' which
  
  The online version has been corrected to read: Lastly, I want to 
thank Congresswoman Kuster and Congressman Bucshon for introducing 
and shepherding this bill. Mr. Speaker, I rise in support of H.R. 
550, the ``Immunization Infrastructure Modernization Act of 
2021,'' which


 ========================= END NOTE ========================= 


  Mr. Speaker, public health agencies work every day to prevent disease 
and viruses, promote health, and prepare for and respond to both 
emergency situations and ongoing challenges--but they cannot do so 
without the ability to access the best available data and share 
information with other experts, and the COVID-19 pandemic highlighted 
this fact.
  As the Chair of the Congressional Coronavirus Task Force, I have used 
every mean possible to sound the alarm about the seriousness of the 
COVID-19 virus.
  On February 10th, 2020, I held the first press conference on the 
issue of COVID-19 at Houston Intercontinental Airport.

[[Page H6687]]

  I then held a second press conference on February 24th to continue 
efforts to raise public knowledge of the impending threat.
  On February 26th, I wrote the Chair and Ranking Member of the 
Committee on Homeland Security requesting to be briefed by Acting 
Secretary of Homeland Security Chad Wolf regarding the preparedness of 
the Department of Homeland Security to address a possible pandemic.
  On March 19th, I announced an innovative partnership with United 
Methodist Medical Center (UMMC) to open the first drive-through 
Coronavirus Test Screening facility in the Greater Houston area, which 
proved beneficial to everyone in the Greater Houston area, as with 
UMMC's help we have opened multiple that are located within high-risk 
communities in the Greater Houston area, to reduce the need for travel 
to get access to COVID-19 testing.
  Since the start of this pandemic, I have sought to proactively 
addressing the critical issues and concerns tied to the COVID-19 virus.
  As I stated at the beginning of this pandemic, We must not panic, but 
prepare.''
  I am pleased to see that this bill is not a panic-induced response, 
but a well-though-out proposal to further protect our citizens.
  The COVID-19 pandemic revealed a number of challenges for public 
health information systems, but worst among them is the limited 
capacity of existing state Immunization Information Systems.
  The importance of these systems cannot be understated: they allow 
providers to keep vaccines and supplies in stock, prevent over--or 
under--vaccination, remind patients when they are due for a recommended 
vaccine, and identify areas with low vaccination rates to ensure 
equitable distribution of vaccines.
  However, states lack modern, comprehensive information systems that 
can meet the challenges of COVID-19 and future public health threats 
through the secure exchange of real-time immunization data.
  Consequently, many state systems struggled to accommodate additional 
demand, implement new functionalities, onboard immunization providers, 
support interoperable exchange with health care partners and enable 
timely reporting of immunization data to federal partners.
  These issues are exactly what this legislation seeks to address.
  Through H.R. 550, HHS will develop a strategy and a plan to improve 
immunization information system and designate data and technology 
standards for use in these systems.
  Additionally, HHS will award grants to health departments and other 
government agencies to improve their systems contingent upon meeting 
designated standards.
  As the vaccine rollout continues and the time for boosters is upon 
us, immunization data systems will be a critical tool in the success of 
these efforts, and they are in need of modernization.
  That is why I rise in ardent support of H.R. 550, and that is why the 
bill has strong bipartisan backing.
  Lastly, I want to thank Congresswoman Kuster and Congressman Bucshon 
for introducing and shepherding this bill.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 550, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. ROY. Mr. Speaker, on that I demand the yeas and nays.
  The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution 
8, the yeas and nays are ordered.
  Pursuant to clause 8 of rule XX, further proceedings on this motion 
are postponed.

                          ____________________