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The committee met to hear invited testimony and to take up and consider bills. This report focuses only on invited testimony and HB 465.
 
 
Dr. David Lakey, Associate Vice Chancellor, University of Texas System

  • America’s Health Rankings from 2014 show Texas at 31st in the nation; Texas is getting better in those rankings over time
  • Doing worse than other states in diabetes, obesity and other rates
  • People are dying from chronic diseases in Texas as opposed to infectious diseases which killed more Texans around one hundred years ago
  • Tobacco is the biggest killer of Texans followed by obesity
  • Substance abuse is the next driver of poor health in Texas
  • Ethnicity plays a significant role in the health of Texans; education and income have a significant effect on health as well
  • Texas has been making serious progress on prematurity and birth outcomes but still has a lot of work to do
  • Texas must continue to progress in chronic disease prevention but also stay focused on wild card events like Ebola and H1-N1
  • Texas has a major challenge related to inpatient care, substance abuse prevention and other mental health issues; mental health has a big impact on physical health
  • Improving health outcomes takes a lot of effort; education, clinical interventions, addressing socioeconomic drivers of health
  • Rep. Elliott Naishtat asked where the legislature should be focusing funding
    • The state is investing in mental health services and that is paying off; disparities are another area, many people believe zip code is a better health predictor than genetic code
  • Rep. Nicole Collier asked about Texas’ uninsured rates
    • Texas is at the bottom of the list for many reasons
  • Collier asked if there has been a study on improving access to care in terms of the African American community
    • The reason there is that ethnic disparity has a lot to do with access to care; studies show the disparity goes away in military populations because they have access; need to determine ways to improve that access; expanding primary care has been a good step, insurance is another component but there are others
  • Chair Myra Crownover noted the two places the most impact can be made are tobacco and obesity; these are things the individual can choose to improve; that is good news
  • Rep. John Zerwas asked about the extra money invested in mental health; what are the outcomes that have improved, and where would be the best place for increased investment
    • Some immediate improved outcome measures include decreased waiting lists, crisis services; have to improve inpatient mental health services, there is a significant gap between needed and available capacity; state hospitals are in poor shape

 
HB 465 – Howard, Relating to the immunization data included in and excluded from the immunization registry.

  • Legislation passed the Public Health Committee and House Chamber last session but did not make it through the Senate
  • Common sense legislation that will protect public safety and health in Texas
  • The bill does not in any way limit access to vaccine exemptions; it does not force or coerce anyone to get vaccinated; it does not involve the enforcement of vaccine mandates or set up any tracking mechanism
  • The bill helps to ensure people have access to vaccination history for school, work, travel or health related purposes
  • DSHS operates an immunization registry (ImmTrac); currently individuals must provide consent to have their information recorded
  • Since consent must be verified prior to placing information in the registry, a very laborious and inefficient system is created
  • If a child does not provide additional consent upon becoming an adult, the information and data is expunged and lost
  • Many providers choose not to use the registry because of its issues
  • Texas is one of only two states that has the same consent provisions that make it so hard to maintain the registry
  • Individuals who choose to maintain their records through the registry may access them at any time of their life for any number of the multiple reasons they may be needed
  • Would ensure Texas has the most secure immunization registry in the nation
  • Rep. Bill Zedler asked if there is anything different about the bill this session versus last session
    • The security measures in the bill have been increased over the last few sessions
  • Zedler asked about the opt-out; is a list maintained of people who have opted out
    • No; their name is flagged and their information is never entered; the agency can provide more information
  • Collier asks if people are automatically going to be “in” if they don’t opt-out, if no rights are being lost
    • Correct, person still has choice to be included in registry
    • People are given notice about the opt-out policy
    • No rights lost
  • Collier comments that bill makes a lot of sense
  • Zerwas asks if we have 98% uptake with opt-in
    • Yes, but 95% are not entered into the system, people drop out
  • Zerwas asks in states that have opt-out, what the compliance rate is
    • Understanding is that opt-out promotes robust registries
  • Zerwas asks if value of registry is in question
    • No, registry is very valuable, gives access to records that people need
  • Zerwas comments that he and other representatives were talking about usefulness of having vaccination records for children’s enrollment etc.
  • Crownover comments that even with meticulous record-keeping, her children were still missing records

 
Kelly Patson, Immunization Branch Manager, DSHS (resource witness)

  • Zerwas asks what the process now and what process upon passage would be
    • Currently opt-in, requires consent to have records given to agency, if ImmTrac turns to opt-out then children under 18’s records will be automatically delivered to agency
    • Opportunity to consent or not consent at birth, or can provide consent at any time visiting doctor
    • If patients forget, would require call to State, burden on healthcare provider to tell patients
  • Crownover asks if choice not to immunize carries record
    • No
  • Crownover asks if there is a list of clients who have chosen not to grant consent
    • No, a form exists that provides for opt-out, but no list is maintained
  • Crownover asks why some people are not aware of the program
    • Not all doctor’s offices use the programs
  • Crownover asks if there is a fee
    • Not necessarily a fee, but certain data requirements are in place, ImmTrac systems and doctor systems must be compatible
  • Crownover asks if some doctors are able to not participate in the system
    • Providers are required by statute to submit info to agency, but are not required to register and participate with ImmTrac
  • Rep. J.D. Sheffield asks if there are issues with electronic and paper records
    • ImmTrac allows for Providers to register to be able to input paper records into ImmTrac system
  • Sheffield comments that paper charts are a “headache,” possible reason why certain doctors have not participated
  • Crownover comments that this could be a “lovely service” if the parent wants it

 
Georgia Armstrong, RN representing herself and People’s Community Clinic, for HB 465

  • Comment that unique password requirement makes program very private
  • Record has clear, neat information and no personal information but name and DOB
  • Scheduler system streamlined for medical providers, “it’s wonderful”
  • Current registry is very cumbersome, offices too busy to offer opportunity to opt-in to ImmTrac
  • Appreciate any help State can give

 
Public Comment for Texas Pediatric Association

  • Ensuring that children are vaccinated at appropriate times is very important, and keeping track to avoid duplications etc. is also important
  • 90-95% of Texans choose to use registry
  • Opt-out system means that providers are able severely lessen the amount of paperwork, would only need opt-out paperwork for the 5-10% who do not wish to participate
  • Moving to opt-out makes sense from an efficiency standpoint
  • Opt-out suits needs of the “vast majority” of the population
  • Rep. Bill Zedler asks if any time a patient comes in the provider must ask if patient wishes to be in or out
    • Glad to do it, merely asking does not require administrative support
    • Smaller segment of population would need to sign forms etc.
  • Sheffield asks for clarification, if only change is that patient is asked “you’re on ImmTrac, do you want to stay in?”
    • Yes, lowers workload
  • Comments that nurses on his staff very much appreciate the proposed system

 
Anna Dragsbaek, Immunization Partnership CEO, for HB 465

  • Immunization Partnership working on this issue for about a decade now
  • ImmTrac very important tool for public health
  • Registries were originally designed to combat outbreaks like the current Measles outbreak
  • Help to identify those who have and have not been vaccinated
  • Data is more secure in proposed system as information for people who do not wish to be included is never sent to the State
  • HB 465 would make Texas registry most secure registry in United States
  • No fee for providers to participate in ImmTrac, but significant cost in ensuring that systems are DSHS compatible
  • Texas’ consent laws require major spending on off-the shelf purchasable records system
  • Committee asks if this would be a cost-saving measure
    • Yes
  • Zedler asks if according to statute if all information is sent in under current system
    • Yes, it is. Under opt-out those choosing not to participate would be excluded at point of care

 
Lt. Colonel Riggle, against HB 465

  • Would allow State to collect information on every citizen, not just children
  • Currently individual responsibility dictates record-keeping
  • Neither Government nor Private Sector has proven itself trustworthy enough to bear the responsibility
  • Costs of healthcare data breaches are high, may outweigh cost benefits from HB 465
  • Committee comment that ImmTrac does not keep records for the entire lifetime
  • Zedler asks if record-keeping would change with HB 465
    • Collier answers no
  • Sheffield asks Lt. Colonel to clarify his understanding of the difference between medical and ImmTrac records
    • ImmTrac contains much less information, but this does not detract from how enticing the database is to thieves
  • Sheffield comments that he does not see how vaccination status would be enticing
    • More the names and DOB within the registry, also system with individual log ins is easy to hack, “only as strong as the weakest link”
  • Sheffield comments that it would be a difficult to hack system, but he understands the Lt. Colonel’s point

 
Rowena Tomlin, against HB 465

  • Only concern is if she would be penalized for not vaccinating her children
    • Crownover comment that this does not affect right to vaccinate or not

 
Patsy Schanbaum,  J.A.M.I.E. Group, for HB 465

  • Important for college students to have access to information about vaccination status

 
Katie Greely, Pediatric Chiropractor, against HB 465

  • Concern about opt-out forcing registration on patients
  • Wonders if this system is actually helpful to college students, records are supposedly expunged at 18
  • Sheffield asks for clarification on her point about how patients are forced to register
    • More concerned that clinics are going to be “too busy” to opt-out patients
  • Also concerned about registry process for home births

 
Caroline Davis, against HB 465

  • HB 465, per text, will also be used to “promote” an immunization protocol
  • Bill is redundant and “threat to maintain private health information”

 
Blair Cushing, Texas Academy of Family Physicians

  • HB 465 should greatly improve efficiency, has had problems in the past reconciling different immunization records from different offices and patients who have been vaccinated multiple times for the same issue
  • Guarding against multiple vaccinations and confusing records can help with vaccine shortage issues
  • Zedler asks if Cushing understands that nothing has kept providers from collecting and sending information to State
    • Yes, but ImmTrac does not necessarily have this data
  • Zedler comments that patient should be asked for consent in all cases
    • HB 465 also provides for notice printed on all ImmTrac documents that patients are able to opt-out
  • Rep. Sarah Davis comments that bill provides for consent notices at each doctor visit
  • Sheffield asks for a general idea of average vaccinations per patient
    • Greater than 26 vaccines per
  • Sheffield comments that this is a very intricate process, requires detailed record-keeping

 
Coleman Hemphill, against HB 465

  • §6 (a) (2), comment that HB 465 provides for written request to opt-out after 18, implying that records are kept after 18. Further implies that a list of opt-outs is kept.
  • HB 465 is a slippery slope to loss of rights

 
Maria Perez, RN, for HB 465

  • HB 465 central registry and opt-out would help school nurses in collating records of vaccinations before student enrollment
  • Crownover asks what percentage of students do have ImmTrac records
    • Has not been able to figure this out as her school does not track where information comes from
  • Rep. Bobby Guerra asks who has to collate and process information
    • Teachers, during the time they are supposed to be preparing classroom they are having to assist with getting vaccination records
  • Guerra comments that he would rather people be doing what they are supposed to than trying to

 
James Turner, against HB 465

  • Concern that current system is in favor of patient, but if bill passes then system is in favor of the State
  • “Less government is better government”

 
Lindsey Schiebe, against HB 465

  • Concern that providers who are “too busy” to allow people to opt-in will be “too busy” to allow people to opt-out

 
Claire Bocchini, Texas Children’s Hospital, for HB 465

  • Deals with many families and many different vaccination records
  • Bill will allow doctors to deal with vaccinations and patient care in a costly and effective manner
  • Zedler asks what happens if providers fail to give option to opt-out
    • Does not think her institution would fail to do so

 
Sheila Hemphill, against HB 465

  • Concern over data protection, ownership of data
  • Data belongs ultimately to the patient, patients must have access to data
  • Worried that this could lead to mandatory registration or vaccination

 
Julie Williams, against HB 465

  • Opposed to tracking measures in bill, opens individuals who do not vaccinate to discrimination
  • Opposing to HB 465 as a precursor to other future bills discussing vaccination requirements

 
Dawn Folds, against HB 465

  • Legislating for convenience is very disturbing

 
Judy Powell, Parent Guidance Center, against HB 465

  • HB 465 states that form for opt-out is maintained in registry, thus, in effect, a list is created; this information is saved by the state
  • Concerned about repeal of complaints collection passage

 
Dawn Richardson, National Vaccine Information Center, against HB 465

  • Discussion in 1997 centered on forced registration, opt-in was developed in response to Senate desire not to assume consent
  • Argues that doctors are wanting to be back in control of consent

 
Jeremy Newman, Texas Home School Coalition, against HB 465

  • Parent has a right to control children’s care and upbringing
  • Coalition does not view security measures as insufficient
  • Every person who wishes to be included and excluded can currently be included or excluded

 
Reed King, against HB 465

  • Core issue is that HB 465 would remove control of information from patients

 
Michelle Schneider, Texans for Vaccine Choice, against HB 465

  • Concern that HB 465 does not serve patients and that information collection is a State mandated privacy violation
  • Rep. Davis comments that HB 465 provides for removal of information at any time, and provides for online records control
    • Currently, record removal should happen automatically, but that is not necessarily how it occurs

 
Donna Voetee, against HB 465

  • Basic construction of United States is contrary to the tracking at issue
  • ImmTrac program is “communism”
  • Medicine is a matter of “faith”
  • HB 465 is only the start of a series of Bills that leads to mandatory vaccination

 
Laura Flemings, against HB 465

  • HB 465 is part of a “nefarious” scheme to take care choice away from parents
  • Crownover comments that current bill is not about mandatory vaccination
    • When HB 465 is combined with other proposed bills, it is a dangerous overreach by the government
    • If mandatory vaccinations are instituted, such a registry would be used to enforce them

 
Susan Peace, against HB 465

  • Concerned that the opportunity to say “no” to registration and vaccines is being taken away
  • List would allow all providers to deny coverage, would not be allowed to withhold vaccination information in order to receive care

 
Howard closed

  • HB 465 is a simple bill with simple changes
  • Many comments seem to be caught up in larger vaccination conversation
  • Does not in any way limit access to vaccine exemptions
  • Does not force or coerce anyone to get vaccinated
  • Does not involve enforcement of vaccine mandates
  • If you choose not to vaccinate, you do not have a record at all
  • Every time patients have contact with a provider, they are given the opportunity to opt-out
  • State has previously adopted the strongest data protection in the country for these records, HB 465 strengthens this
  • San Antonio’s registry is an opt-out registry similar to HB 465’s proposal, and HB 465 would allow both systems to communicate
  • Roughly 95% choose to have records included in the system, but many are not being given the opportunity because of low provider participation and cumbersome nature of the registry
  • Rep. Rick Miller asked, other than the healthcare providers who has access to this information
    • Kelly Patson, DSHS, responds that healthcare providers, licensed for immunizations Public Health Districts Local Health Departments, Payors through healthcare providers Employees of the Department, Other States if their citizens move to this state, individual or legal representative of individual
  • School or childcare facility where patient is enrolled
  • Miller asked what other purpose this would be used for
    • Research possible, but it would have to follow federal guidelines
    • During vaccination shortages or outbreaks information could be useful
    • Patients in the database would have to give their permission for data to be used for other purposes
  • Miller asked if there will there be a list
    • It would not be possible to have a list because a name would never be entered into the system
  • Miller asked how the one-time opt-out requirement from HB 465 will be implemented
    • Once patients have opted-out, they are out
    • If you opt-out, certainly there will be a record of the patient’s name that prevents the information from being entered into the ImmTrac system. This is likely the source of confusion

 
Bill left pending