This audit examined the effectiveness of the Department of Human Services’ administration of the Australian Childhood Immunisation Register.

Audit objective, criteria and scope

The audit objective was to examine the effectiveness of the Department of Human Services’ (Human Services) administration of the Australian Childhood Immunisation Register (ACIR).

To form a conclusion against the objective, the ANAO adopted the following high-level criteria:

• Human Services has established effective policies and procedures to support the administration of ACIR;
• Human Services has adequate procedures and controls in place for the collection, use and management of ACIR information, including to maintain the integrity of data in ACIR; and
• Human Services has sound reporting processes which support the timely, accurate and authorised dissemination of ACIR information.

The audit focused on Human Services’ administration of ACIR and did not include an assessment of the broader National Immunisation Program or its overall administration by the Department of Health. ACIR is largely populated using data from the Medicare customer database, which was the subject of a previous ANAO performance audit. The integrity of the Medicare customer database has not been examined again as part of the current audit. However, where relevant, the findings of the previous audit are noted in this report.

Overall conclusion

The Australian Childhood Immunisation Register (ACIR or the Register) records the immunisation details for over 2.25 million children under the age of seven. The Register is a key public health resource used to measure and monitor immunisation coverage rates for policy and planning purposes, and to inform parents and immunisation providers of a child’s immunisation status. Information from the Register is also used to confirm a parent’s eligibility for certain family assistance payments as part of an Australian Government policy to encourage childhood immunisation, as well as for authorised research purposes. The Department of Health (Health) has responsibility for the overall management of ACIR in the context of the National Immunisation Program (NIP) agreed by Australian Governments, while the Department of Human Services (Human Services) is responsible for establishing and maintaining ACIR. A business agreement between the departments documents key aspects of Human Services’ day-to-day administration of the Register.

The ACIR contributes to the overall success of the NIP and the health status of individual children, and in April 2015 the Australian Government announced its intention to also establish an Australian School Vaccination Register for adolescents. Australian governments use data from the current Register to inform immunisation policy and planning including, most recently, a policy response to growing levels of conscientious objections to immunisation. Parents and immunisation providers have also come to rely on the Register as a source of information on the immunisation status of children under seven years of age, including for the administration of essential vaccines in accordance with the NIP schedule. Children will generally receive vaccinations for different diseases over a number of years, potentially from different providers, and a key challenge for Human Services is to maintain the Register’s integrity through accurate and timely data entry and revision. In its administration of ACIR, Human Services relies on information received from parents and providers, and on the reliable exchange of data between ACIR and other departmental ICT systems—the Medicare Consumer Directory (MCD) and the Centrelink program’s Income Security Integrated System (ISIS).

Overall, Human Services’ administration of ACIR has been generally effective. The department has generally met or exceeded performance targets established in its business agreement with Health, and maintains a range of communication channels to facilitate parents’ and immunisation providers’ access to child immunisation records. System controls to maintain the integrity of data on the Register have been implemented and are generally operating as intended, although there remains scope to strengthen the ACIR quality and control framework. In particular, known impediments to the automated exchange of information between ACIR and other departmental ICT systems mean that the department must manually reconcile certain records on a daily basis—an ongoing administrative overhead. Further, while information on the Register can be added or revised on the basis of telephone advice received from immunisation providers, there is no process for monitoring ACIR telephony services for quality control purposes; and the department has not clearly communicated its expectations on the key role played by parents and immunisation providers in maintaining the integrity of ACIR data holdings.

Between 2011–12 and 2013–14, the ANAO’s analysis of Human Services’ documentation indicated that the department generally met or exceeded the ACIR performance targets set out in its Business Agreement with Health. During this period, the department provided 100 per cent of financial reports to stakeholders within five working days of the specified time, exceeding its target of 90 per cent. The department also exceeded its target of making 90 per cent of immunisation provider payments within seven days before the end of the month, with 100 per cent of payments made within the required timeframe. In 2013–14, some 92.5 per cent of immunisation information was processed within 10 working days, against a target of 95 per cent. Human Services has also established a number of useful communication channels for stakeholders, including a dedicated website and telephone lines, and outreach officers for Indigenous and multicultural customers. The Register is a key public health information resource, and effective communication channels facilitate parental access to their child’s Immunisation History Statement (IHS) and enable immunisation providers to interrogate ACIR regarding their patients’ immunisation status.

However, maintaining ACIR data quality remains an ongoing business risk for the department. Limited interoperability between Human Services’ ICT systems (ACIR, MCD and ISIS) and external providers’ practice management software (PMS) makes it necessary for the department to supplement automated data exchange processes with daily manual data cleansing and matching activities. For instance, departmental operational reports of transactions between ACIR and MCD indicate that some 4 900 records required manual resolution over a two month period. Many electronic transactions between ACIR and immunisation providers also required manual investigation during this period, as did transactions between ACIR and ISIS. To contribute to ACIR data integrity and improve the efficiency of information processing, Human Services should establish a pathway for the resolution of persistent and known data synchronisation issues between ACIR and other departmental ICT systems, incorporating a planned process and timetable. There would also be benefit in the department working with PMS suppliers to identify options for addressing errors arising during data exchanges between the ACIR and provider systems.

The department relies on the experience of its Service Officers (SOs), supported by documented procedures, to maintain the quality of its manual reconciliation processes. However, there is currently no systematic quality control process in place to provide departmental management with additional assurance regarding the accuracy of these resource-intensive manual processes. There would be merit in the department introducing a quality control framework for manual reconciliation and review processes applying to data exchanged between ACIR and other ICT systems. Similarly, no quality control process applies to ACIR telephone calls from parents and immunisation providers, which can result in updates to information kept on the Register. Consistent with many other services provided by Human Services, the department should also apply quality call listening processes to ACIR-related telephone calls, to provide additional assurance that the Register is updated in accordance with relevant procedures.

Human Services advised the ANAO that in addition to its own quality control processes, it relies on parents and immunisation providers to assist in maintaining the accuracy of the Register. In particular, the department expects that parents will check that details recorded on their child’s IHS are correct, and will advise the department of any errors. The department also expects that immunisation providers will review their monthly payment summaries to check that vaccines they administered have been accurately recorded, and that payments made to them are correct. However, Human Services’ expectations in respect to maintaining the accuracy of the Register are not clearly and consistently communicated to parents and providers, and the department should include a statement to this effect in relevant communication materials, including the IHS sent to parents and the monthly payment summaries sent to providers.

The ANAO has made three recommendations to strengthen the ACIR quality and control framework, focusing on Human Services: establishing a pathway to resolve known impediments to the automated exchange of information between ACIR and other departmental ICT systems; introducing a process to monitor the quality of ACIR telephony services and manual data reconciliation activities on a sample basis; and clearly conveying departmental expectations relating to the role played by parents and immunisation providers in maintaining the accuracy of the Register.

As mentioned, the current Register contributes to the overall success of the NIP, and informs ongoing policy responses to immunisation issues—such as the $26 million 2015–16 Budget measure foreshadowed by the Australian Government in April 2015. As part of that measure, the Government proposes to establish an Australian School Vaccination Register for adolescents. The findings and recommendations of this audit of ACIR may also inform responsible entities in the implementation and operation of the proposed school vaccination register.