Strategy
The Maine Immunization Program (MIP) recognized that if low rates were found on an annual self-reporting survey for a fraction of the student population, then the problem was likely much larger, and it was time for a change. MIP partnered with Docket, the team providing the state’s mobile consumer immunization information system (IIS) access, to develop and implement a state-wide uniform mechanism for tracking school immunization compliance. Docket allowed for year-round visibility of vaccine and exemption rates for all Maine schools, pre-K through twelfth grade, by both MIP and the Maine Department of Education (DOE).
Challenge
Maine removed philosophical and religious exemption allowances in 2021. Since that time, school vaccine rates have received increased public attention, with heightened interest given to the annual school immunization survey. Maine requires that all public and private schools with kindergarten, seventh, and/or twelfth grades complete the survey, which assesses compliance and coverage rates for both vaccinations and exemptions. In 2023, this survey had a 77% response rate. Of the 502 schools that did report, 197 schools had at least one student with a missing record, resulting in an overall school non-compliance rate of 39%. The Maine Immunization Program (MIP) recognized that if these rates were found on an annual self-reporting survey for a fraction of the student population, then the problem was likely much larger, and it was time for a change. MIP partnered with Docket, the team providing the state’s mobile consumer IIS access, and Docket for Schools was developed.
Solution
The primary objective of this initiative was to develop and implement a state-wide uniform mechanism for tracking school immunization compliance that allowed for year-round visibility of vaccine and exemption rates for all Maine schools, pre-K through twelfth grade, by both MIP and the Maine Department of Education (DOE). This oversight would allow MIP and DOE to ensure adherence to the Maine state school’s immunization laws. Additional goals achieved through functionality development included: system must meet the annual aggregate reporting requirements for schools prescribed by Maine law, ability to produce immediate disease exclusion lists by grade level, automated reporting of the U.S. CDC Kindergarten School Coverage Survey, and generate student non-compliance letters. The system was required to meet Maine Office of Information Technology (OIT) standards and policies as well as maintain the Family Educational Rights and Privacy Act (FERPA) compliance.
Through continued collaboration, Docket created Docket for Schools (DFS). This system was developed over several months and designed to be configurable for all immunization jurisdictions, as vaccine laws differ from state to state. After development and internal testing, Maine school nurses were then invited to pilot the system and provide feedback from a user perspective. Several suggestions and edits were made, including ways to streamline data entry and make roster uploads more efficient. Once DFS went live in May 2025, MIP and DOE sent communications to all state superintendents, principals, nurses, and vaccine providers outlining the requirement for use by all Maine schools. MIP and Docket co-hosted a number of training sessions and office hours for school staff, and these will continue throughout the fall. To help mitigate school staff time, MIP offered resources for individual onboarding, including uploading of rosters and data entry of student records either electronically or on-site. MIP will continue to provide help desk services for DFS in the future. Although all schools have access, full transition and 100% student record compliance are required by December 2025. DFS will officially be required beginning the 2025-2026 school year.
The target population for DFS includes all students enrolled in Maine public and private schools, from pre-kindergarten through twelfth grade. The data gathered through this system will assist school nurses and superintendents in ensuring that students meet school immunization requirements. It will also inform parents if their child is missing or due for upcoming immunizations. In the case of outbreaks, the system will provide school nurses with immediate exclusion lists and will aid state epidemiologists and the Maine immunization program in responding more quickly and effectively to the public health needs of schools and communities. Beginning fall 2025, MIP will review compliance and provide outreach to any school with less than 100% compliance. Additionally, outreach will be conducted in the spring for incoming grades, and Maine public health nurses will provide resources and conduct school-located vaccine clinics to ensure compliance is obtained prior to the start of the next school year.
Partners included Docket, the Maine DOE, school administrators, superintendents, and school nurses.
The initial development of DFS required substantial effort by the IIS manager and an OIT-contracted internal IIS staff member, with limited program manager oversight. These staff were responsible for all testing, implementation, and training efforts. The IIS help desks are fully trained on DFS and are now providing support on both systems. Although data migration resources were offered, very few schools have requested this specific support.
The DFS module development costs were $650,000 paid through COVID-19 funding. Maine has an additional $125,000 built into core funding for ongoing system enhancements as the state transitions to full implementation. Ongoing payment structure will include an annual subscription service fee paid through universal vaccine program funds by MIP. There are no implementation costs or ongoing costs for schools.
Outcome
To date, 50,000 records have been entered into the new system through the retrieval process, where DFS communicates directly with the Maine IIS, ImmPact, and pulls over data. At this stage, 79% of students are compliant with that initial retrieval process. School nurses have until December 15, 2025, to ensure that all student records have migrated into Docket, including vaccine administration records and exemption documentation received directly by schools, and FERPA-protected. Finalized statewide compliance data will be available to share in December 2025.
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