Georgia Immunization Registry (GRITS)

Frequently Asked Questions

How do I...

How do I register to become a user/partner with GRITS?

Thank you for desiring to partner with the Georgia Immunization Registry known as GRITS. TO gain access to the information contained in the GRITS system you must contact the GRITS Training Coordinator at 1-888-223-8644 or e-mail immreg@dhr.state.ga.us.

You will need to provide the GRITS Training Coordinator the following information:

1. Organization Name
2. Organization Address
3. Organization Phone Number
4. Organization Point of Contact (POC) Name
5. Organization POC Phone Number
6. Organization POC Fax Number
7. Organization POC E-Mail Address
8. Organization Administrator Name
9. Organization Administrator Phone Number
10. Organization Administrator FAX Number
11. Organization Administrator E-Mail Address

The GRITS Training Coordinator will:

1. Provide you with a series of Training Dates and Locations that you will be able to attend to receive the free training on how to utilize the GRITS system
2. Send you a Software Use Agreement that must be signed by an individual with Signature Authority for your organization.
3. Send you confirmation of the date, time, and directions to the training session that you have agreed to attend.

Once you have submitted the original signed Software Use Agreement and attended a GRITS Training Session, then you will be given an OrgCode, UserID, and Password to gain access to the information contained within the GRITS System.
 

Who must submit immunization information to the Georgia Immunization Registry?

The Georgia Code 31-12-3.1, which took effect July 1, 1996 and House Bill 1526, which took effect July 1, 2004 states:

Any person who administers a vaccine or vaccines licensed for use by the United States Food and Drug Administration to a person shall, for each such vaccination, provide to the department such data as are deemed by the department to be necessary and appropriate for purposes of the vaccination registry established pursuant to subsection (a) of this Code section, including, without limitation:

1. The name of the person;
2. The person's date and place of birth, including the name of the hospital where delivered, if applicable;
3. The names and addresses of the person's parents or guardians if the person is 18 years of age or younger;
4. The date of the vaccination and the specific type or types of vaccine or vaccines administered to the person on that date; and
5. Complications or side effects resulting from a vaccination, if any.

Vaccination data reporting requirements, including without limitation the types of data required to be reported and the time and manner of reporting such data, shall begin after the registry has established linkages to vaccine providers and shall be established by the department in consultation with the United States Centers for Disease Control and Prevention, the Georgia chapter of the American Academy of Pediatrics, and the Georgia Academy of Family Physicians.
 

Who can then receive a copy of an individual's immunization record from the Georgia Immunization registry?

The Georgia Code 31-12-3.1, which took effect July 1, 1996 and House Bill 1526, which took effect July 1, 2004 state:

Individually identifiable vaccination information regarding a person may be provided to the department by, or released by the department to, a local health department, hospital, physician, or other provider of medical services to the person or to a school or child care facility in which the person is enrolled if the person is 18 years of age or younger, without the consent of the person or the persons parents or guardians. All children shall be enrolled unless a specific exemption is requested by the person or person's parent or guardian if the person is 18 years of age or younger. A person or person's parent or guardian if the person is 18 years of age or younger may obtain, and upon request to the department, shall be provided with all individually identifiable vaccination registry information regarding his or her child or ward. Except as provided otherwise by this Code section, individually identifiable vaccination registry information shall be treated as confidential and shall not be released to a third party without consent of the person or person's parent or guardian if the person is 18 years of age or younger.

Nothing in this Code section shall:
(1) Prohibit the department from providing or publishing registry information in aggregate form for scientific, educational, or public health purposes, provided that such information is published without releasing or identifying individual names contained in the registry;
(2) Prohibit the department or any medical services provider from notifying the person or person's parent or guardian if the person is 18 years of age or younger, of the person's vaccination status or of a vaccination that is due or overdue according to recommended vaccination schedules; or
(3) Diminish a parent or guardian's responsibility for having a child vaccinated properly.
 

Can I be held liable for the information that I release to or receive from the Georgia Immunization Registry?

The Georgia Code 31-12-3.1, which took effect July 1, 1996 and House Bill 1526, which took effect July 1, 2004 state:

Any person, including but not limited to, practitioners of the healing arts, submitting or obtaining in good faith vaccination reports or data to or from the department in compliance with the provisions of this Code section and any rules or regulations promulgated pursuant to this Code section shall not be liable for any civil damages therefore.
 

I am a developer of an Electronic Medical Records System used by Immunization Providers in the State of Georgia. How do I interface my system with the Georgia Immunization Registry so that my clients can submit their mandatory information electronically?

The Georgia Immunization Registry has numerous methods for sharing data electronically with Electronic Medical Records System and other Practice Management Systems. The preferred method is utilizing the industry standard HL7 Protocol. We support HL7 in both a batch and real time mode. For more information please contact the GRITS Technical Office at 404-657-4607 or e-mail immreg@dhr.state.ga.us.
 

How do I request to have someone from the Georgia Immunization Registry make a presentation to my organization concerning the history, benefits, and future of immunization registries in the State of Georgia or the nation?

Contact the Georgia Immunization Registry Office at 404-463-0810 or e-mail immreg@dhr.state.ga.us.

General Questions

What are immunization registries?

Immunization registries are confidential, computerized information systems that contain information about immunizations and clients of all ages. Children typically are entered into a registry at birth (often through a linkage with electronic birth records) or at first contact with the health-care system. If a registry includes all children in a given geographical area and all providers are reporting immunization information, a registry can provide a single data source for all community immunization partners. Such a population-based immunization registry can make it easier to carry out the demonstrably effective immunization strategies (e.g., reminder/recall, AFIX, and WIC linkages) and thereby decrease the resources needed to achieve and maintain high levels of coverage. Immunization registries also can be used to enhance adult immunization services and coverage.

The concept of immunization registries is not new. Many individual practices and health plans have developed information systems to keep track of immunizations given to their patients. Often these are based on computerized information systems designed for other purposes such as billing. There is also a growing movement toward development of totally computerized patient medical records. These site- or plan-specific registries cover only immunizations administered by participating providers to covered patients.

Only population-based immunization registries can provide information on all children and/or adults and all doses of vaccines administered by all providers.
 

How do providers access the Registry?

Providers will be able to submit records through one of two mechanisms:

• Through a special, secure World Wide Web site.
• By direct interface with their medical billing or clinical management software. This requires the medical software vendor to create an interface program to the Registry.
   

Do providers need to have a computer in order to participate?

To receive the full benefit of the registry, a provider will need to have a computer that is able to connect to the World Wide Web. If you administer less than 20 immunization shots per month, you can submit your immunization information via fax or mail.
 

Which of the various reporting and querying methods should I use?

The Registry is designed to afford the most reporting and querying flexibility possible to providers. Once a provider is enrolled with the Registry, they may report and query the system by mail, fax or Internet. Providers will not be required to always use the same method of reporting or querying; they may change their reporting method at any time, provided the desired means of reporting is available. Decisions may be influenced by the following factors:

• Technological resources available to you
  • Ability to report to and query the Registry using the web interface depends on whether the office has a PC available for Registry purposes. Reporting through an interface to medical software will be available only to those providers whose software vendors have written an interface program. This method of reporting will require more time for initial setup. Registry staff will be working with vendors to make the software interface option available as soon as possible, and will notify providers of new reporting and querying options as they become available.
• Types of information and reports desired from the Registry
  • Each querying option offers varying types of information. Some features are available through the website, such as on-line vaccine information, a link to the Georgia Immunization Section, and GRITS manuals and tutorials. All other reports and information, such as school and childcare certificates, CASA reports, and VFC Inventory reports are available to providers through any interface option and can be either retrieved over the internet or sent to the provider by fax or by regular mail.
• How quickly you want to get information and reports from the Registry
  • Each querying option offers varying response times. Providers requesting information and reports to be returned by fax will experience a faster response than those requesting materials to be returned by regular mail. An immediate turnaround time can be achieved through using the Internet interface. Reports and information can be immediately printed from the website.
     

Will providers be required to enter the shot history of existing patients?

Although providers are not required to back-enter existing records of all their patients, a complete immunization history can offer key benefits, such as calculation of immunization rates, accurate precall/recall and automated school certificates.  Entry of immunization histories will also benefit other immunization providers, who can access the records through GRITS, therefore avoiding administration of duplicate immunizations.
 

Can medical office staff enter records into the Registry?

Yes. The provider accepts the responsibility for the submission of immunization records according to the requirements of the registry legislation, and he/she may authorize additional members of the office staff to enter the records.
 

What if a provider has already entered immunization information into his or her own computer system?

GRITS staff will provide specifications that will allow software vendors to build links between existing clinical record or billing systems and GRITS. The GRITS staff will work with interested vendors to see that this option is exercised wherever possible. The registry staff does require a provider to sponsor our conversations with their vendor.
 

Is training available for providers?

Yes. Once an organization has been set up in GRITS, the Training Coordinator will contact the Immunization Program Consultant (IPC) for their district and arrange onsite training for the provider and staff.
 

Is there a Help Desk to assist providers?

Yes. GRITS has a Help Desk which is available to all users between the hours of 8 AM and 5 PM Monday through Friday @ (866) 483-2958. Users can also submit questions and suggestions to the Registry Help Desk via the Help Desk e-mail address, gaimmreg@dhr.state.ga.us.
 

What hours will GRITS be available?

GRITS is available to all users 24 hours per day seven days a week. GRITS also has a back-up system that will automatically take over and continue operations should any service interruptions occur.
 

How will the accuracy of the data in GRITS be validated?

When data is submitted, certain "edit checks" and de-duplication processes are executed to ensure the validity of the data. In some instances, it may be necessary to verify the information with the submitter.
 

How do you handle system errors: saying immunizations are due when they really are not?

If you receive an error that you feel is inaccurate, please contact the GRITS Help Desk at 866-483-2958.
 

Who is responsible for the loading of legacy data?

GRITS is equipped with multiple means of loading legacy data. The first method is for the existing system utilized by the physician to transmit data securely using an NCIRD, HIPAA compliant HL7 immunization transaction set. A second method is to work with GRITS and coordinate the creation of a legacy load Flat File data transfer. The registry team understands the burden placed upon the physician and the organization in this area and desires to work very closely with the organization to reduce this effort. If the legacy data can be loaded electronically, then the registry team will work with the organization to extract the data and load it into GRITS. The organization is expected to work with the registry team to ensure that the data is accurate prior to loading it into the registry and to assist in verifying that the data loaded successfully.
 

Will GRITS interface with my existing Practice Management System or Medical Records Management System?

GRITS is willing to work with any vendor who desires to build an interface solution with the Registry. Click here to view a one page summary of various data exchange options available. Please contact the GRITS Interface Team @ 404-463-0810 or e-mail to: immreg@dhr.state.ga.us to inquire if your vendor has developed a certified interface with GRITS.
 

Who owns the liability for the incorrect entry of vaccination information from a nurse/clerk?

All users of GRITS are responsible for the accuracy of the information provided.  The GRITS staff will monitor and validate the accuracy of the data at regular intervals.
 

How soon after the shot is administered will a provider have to submit the record to the Registry?

Providers should submit records to GRITS as soon as possible so the information will be available in the event that the child sees another provider soon after they have received that shot. This will allow other providers to see the most up-to-date record on the child and will reduce duplicate immunizations. The Georgia Department of Public Health has identified 30 calendar days as the maximum time that a provider is allowed to delay submitting shot information to GRITS.

Parents and Children

What are some of the benefits of immunization registries?

Immunization registries can be extremely helpful, if not essential, to maintaining the current high immunization coverage. This is true particularly since disease levels are at record lows and do not serve as a constant reminder to patients/practitioners of the need for timely immunization.

For parents, immunization registries:

• Consolidate in central location all immunizations a child has received;
• Provide an accurate, official copy of a child's immunization history for personal, child care, school, or camp entry requirements;
• Help ensure that a child's immunizations are up to date;
• Provide reminders when an immunization is due;
• Provide reminders when an immunization has been missed;
• Help ensure timely immunization for children whose families move or switch health-care providers; and
• Prevent unnecessary (duplicative) immunization.

For communities, immunization registries:

• Help control vaccine-preventable diseases;
• Help identify high-risk and under-immunized populations;
• Help prevent disease outbreaks;
• Provide information on community and state coverage rates; and streamline vaccine management.
   

What information are parents able to obtain from the Registry?

Authorized parents or guardians will be able to obtain a copy of their child's immunization record from their provider, their county health department, or GRITS directly.  In order for GRITS to send a copy of the child’s immunizations, a copy of the parent/legal guardian’s state issued ID should be faxed to: 404-657-7496.
 

What age groups are included in the Registry?

The law applies to all immunizations given in the State of Georgia, whether to children or adults.
 

How will parents be informed that their children are entered in the GRITS?

The Registry Law has identified the State of Georgia as an Opt Out State. For the parent this means that their child is automatically added to GRITS at birth. The Georgia Immunization Section will provide posters and other educational materials to provider offices to be made available to parents. In addition, the Registry will be issuing public information about the benefits of the Registry.
 

What if parents do not want their child's record in GRITS?

As an Opt Out State, the Registry Law allows authorized parents or guardians to exempt their children from the registry. They will have the responsibility of completing an Opt Out form to initiate their request. These forms are available to all public and private providers.  The Opt Out form can also be accessed at: http://www.health.state.ga.us/pdfs/forms/grits008.03.pdf. Parents will have the option of re-registering their child if they change their mind at a later date.
 

What happens to the patient’s data if they choose to Opt Out and then Opt Back into the Registry?

The information will have to be re-entered from the immunization history record provided by the parent. When an authorized parent or guardian selects to remove their child from the registry, all immunization information is removed from the registry.

Provider Participation and Enrollment

Who benefits from participating in GRITS?

Any provider who administers a vaccine in the State of Georgia, including:

• Pediatricians
• Family Practitioners
• Internal Medicine physicians
• Immunologists
• In-Hospital providers who request immunizations for newborns or other children
• Public Health staff
• Emergency Room physicians
• Military base physicians
• Juvenile detention centers/prisons
   

We provide only tetanus and flu shots in our office. Do we still have to report to GRITS?

Yes. According to the Registry Law, any immunization administered in the State of Georgia must be reported to the Registry. The Registry will also be a source of information available to consult before administering your tetanus and flu shots, helping to avoid unnecessary duplicates.
 

Are fees associated with participation in the Registry?

There is no charge for participating. Providers who choose to access GRITS through the World Wide Web will need to obtain an Internet account from an Internet Service Provider.
 

What support staff will be available to assist providers?

GRITS has a Help Desk which is available to all users of the Registry between the hours of 8 AM and 5 PM Monday through Friday @ (866) 483-2958. Users can also submit questions to the Help Desk via the e-mail address, gaimmreg@dhr.state.ga.us.

Privacy and Confidentiality

What is being done to protect the confidentiality of patients?

The Georgia Department of Public Health has developed GRITS to meet HIPAA privacy and security requirements.

Only providers of immunizations will be able to directly access a child’s immunization records. Parents or guardians may obtain a child’s immunization records from their physician, public health department or by requesting the record from GRITS. The Registry Law allows for the sharing of immunization records with schools. For a school to gain access to a child’s immunization record, the school must sign a Software Use Agreement and agree to handle all immunization information as identified under the HIPAA guidelines.

Through built-in system security features, only providers and related users are able to directly access a patient’s record. When searching for an individual record, providers are not able to view more than a limited number of records while attempting to identify their unique patient. Search criteria for an individual patient requires specific and accurate information and search results will yield a limited number of matches in order to further protect confidentiality.

Additionally, each user of the registry will have to read and sign an End User Agreement stating that they understand that the information in GRITS is confidential and that they will be penalized if they violate that confidentiality or in any way abuse the information to which they have access. Each user of the system has to have an individual user account and password. All access to the system and every transaction is recorded and such records will be reviewed and audited.
 

How are the electronic records kept secure?

The security of the data on the computer and of electronic transactions - whether over the Internet or via a modem or fax machine - is part of a comprehensive security plan. The computers are housed in a secured room to protect the equipment. Back-up tapes of the data are kept as well. The Department has a computer firewall that severely restricts access to the Department's computer network. On-line users know how to access the system and use a personalized user ID and password assigned to them. Data that is transferred across the Internet will be encrypted.
 

How will the security work for the system Electronic Medical Records (EMR) that uses VPN, and how does it relate to HL7?

Accessing the Registry via a VPN meets the HIPAA requirements for secured connections. GRITS uses Security Certificate technology to establish a secure link between the VPN connection and the Registry WEB server. Security Certificate technology provides 128-Bit encryption and validation of secured transmissions. The purpose for selecting and encouraging the use of the HL7 Immunization transaction sets for all interface and communications is because HL7 is national standard protocol identified by the CDC to meet HIPAA communications privacy and security requirements. The HL7 protocol provides a secure environment by which Personal Health Information can be shared.

Registry Benefits

Why do we need a registry?

In order to ensure that the growing complexity and volume of immunization information is sustained and easily attained if needed.
 

What are the benefits for providers who participate in the Registry?

Benefits include the following:

• Reduces staff time searching for records
• Enables providers to determine whether patients are due or overdue and send reminders to parents.
• Clarifies complex, changing immunization schedules and emerging vaccine combinations.
• Generates immunization certificates for schools and child care facilities
• Reduces over immunization of our children
   

How will the registry information be beneficial?

The information in GRITS will be utilized for the following purposes:

• To obtain the most complete shot record possible on an individual.
• To reduce under-immunization and duplicate immunization.
• To protect the health status of Georgians
   

What information are providers able to obtain from the Registry?

Providers will be able to obtain the following information:

• Individual shot histories
• School and child care certificates
• A list of all children in their practice due or overdue for shots
• A list of all children in the registry associated with that particular provider
• The provider's immunization rate
• Current information about vaccines and immunization issues

Ever since GRITS was implemented, Registry staff has continued to gather information from providers to expand the standard set of reports and offer useful information.  

How will the Registry help with school and child care facility certificates?

GRITS allows providers to print all required immunization certificates. According to state law, a physician licensed in Georgia, a public health nurse, or designated State immunization personnel must certify the certificates. GRITS also allows schools to access the Registry to determine a child's immunization status.

Assessment of Vaccination Status

How will a child's immunization status be calculated?

Up-to-date immunization status is calculated using the current immunization schedule recommended by the Georgia Department of Public Health, the standards utilized within CDC's CASA Assessment system, and the American Academy of Pediatrics. The schedule is utilized along with patient data that has been entered into the system to calculate the percent of up-to-date two-year-olds as well as the percent of all children who are up to date.
 

What if a child has special circumstances that prevent him or her from receiving the full schedule of shots?

GRITS allows providers to document the presence of special circumstances, contraindications or precautions that prevent a child from adhering to the recommended schedule.

Does GRITS interact with the Vaccines for Children (VFC)?

Yes. GRITS interacts with the VFC program. When a provider utilizes the full capabilities of the Registry, the provider is able to manage his or her complete VFC vaccine inventory. With the release of the VFC Reporting Enhancement in the 2nd Quarter of 2004, the provider will be able to electronically report to the VFC program office monthly vaccine usage.
 

Can one site access inventory at another site?

Yes, provided both sites are affiliated with the same organization.

Application

The 3231 form needs to be related to the physician actually signing the school certificate instead of the Primary Care Physician as noted in the system.
 

Is there a drop down menu on the 3231 reporting mechanism that will allow the user to pick?

Yes, there is a drop down list of physicians in the user’s organization. If the physician authorizes a nurse or other designee to sign the form, they will need to sign it with “by direction,” or something indicating their authority to sign in lieu of the actual physician.
 

What is the association of physicians and clinicians to sites within an organization?

Physicians are maintained on the organizational level, not site specific. However, physicians that are actually administering shots can be added to the registry as a physician and as a clinician. Clinicians are maintained on a site-specific level.
 

Is there a limit on the number of results that will be returned in a search?

Yes. The number of items that appear on a single item search (such as birthday) is capped at 75 meaning all other search results will be truncated.
 

How do you enter a .5 or multiple dose in GRITS?

There is a built in method for handling ½ or multiple doses.
 

What is the purpose of tracking ethnicity?

This is a state of Georgia requirement.
 

Will the system separate public and private stock?

Yes. You have the opportunity to select “public” or “private” when adding new inventory.
 

How long will reports be available for viewing after being generated by the system?

The system default dictates that reports are available for viewing/printing for 5-days before being removed.
 

When a child has a documented case of chickenpox, is there a place on the immunization record (website) to document this?

Yes. There are three available options for documenting immunity to Varicella:

• Diagnosed immunity: Varicella
• Historical immunity: Varicella
• Serologic immunity: Varicella