Connecting States’ Immunization Status: Q&A with Information System Expert Vijay Pathangi

In the U.S., when someone receives their first COVID-19 vaccine, they get a Centers for Disease Control and Prevention (CDC) COVID-19 vaccination card. Apart from those who laminated theirs, this all-important proof of vaccination has often become worn and faded as people have pulled them out for restaurant and concert entry, travel, employment and public gatherings. So what happens if you lose this lifeline to society? 

Only a couple of decades ago, that vaccination card would have been the only record of your immunization against COVID-19. Since then, thanks in part to The Task Force’s All Kids Count program launched in the 1990s, immunization information systems are capturing vaccination records to create a population-level picture of immunization status.

In the early 1990s during one of the worst measles outbreaks in the U.S. that took the lives of 89 children, The Task Force’s All Kids Count program, supported by the Robert Wood Johnson Foundation, set out to develop the new frontier of population-level tracking of vaccinations. The team sought to create community-based immunization registries so that no child would be at risk of dying from a vaccine-preventable disease.

This population-level tracking has come a long way from the initial paper records, floppy disks and unreliable internet of the 90s, and today the All Kids Count program has evolved into the Public Health Informatics Institute (PHII).

To understand the important value of immunization information systems (IIS) and how far they’ve come, we spoke with The Task Force’s PHII IIS Team Lead and former IIS manager of Indiana, Vijay Pathangi.

These systems have been around for 30 years and are supported by All Kids Count’s successor the American Immunization Registry Association (AIRA). So what’s the current IIS landscape in the U.S.?

IIS, formerly referred to as immunization registries, have come a long way over the past two-plus decades. They have evolved into mature information systems and house a lot more information than just patient vaccination data. 

Almost every state (and some cities) currently has a functional IIS. IIS now provides consolidated immunization history for use by providers at the point of clinical care. They exchange data by allowing for submitting and querying almost in real time. Many IIS provide a patient portal that allows patients to query and download their vaccination information from their computers, tablets or even their phones. Through these systems, states are also able to track population-level vaccination rates for surveillance and reporting. By adhering to national standards and best practices, IIS have matured into systems that serve as a source of secure immunization information and help reduce vaccine preventable diseases.     

Give us a real world example. How are they working during the COVID-19 pandemic?

For years, inter-jurisdictional data exchange has been talked about, but COVID-19 brought to the fore the importance of sharing data. With the help of the CDC and partners, a system called IZ Gateway was developed to provide a secure way to electronically exchange immunization data between IIS. Many IIS across the nation are currently participating in the IZ Gateway project, enabling inter-jurisdictional, bi-directional exchange of COVID-19 vaccination data. This has eliminated the need for patients to carry multiple COVID-19 vaccination cards in the event they moved or got vaccinated at multiple geographical locations. The IZ Gateway enables vaccinations received elsewhere to be automatically transmitted to the patient’s home jurisdiction’s IIS. Further, several states now provide the ability for patients to generate their COVID-19 digital vaccination certificate that contains up-to-date info of the patient’s vaccination status.  

In the early 2000s, All Kids Count rebranded to become PHII. What is PHII’s role in supporting IIS now?

PHII, through its cooperative agreement with CDC, provides assistance to jurisdictions in the areas of workforce development and technical assistance. PHII works closely with the CDC IIS Support Branch (IISSB), the American Immunization Registry Association (AIRA), and other partners, which include the immunization programs themselves. This coalition of partners both identifies the workforce development and technical assistance needs and addresses these needs through thoughtful training and technical assistance based on best practices. PHII and its partners also provide jurisdictions a wide variety of resources such as toolkits, guidance documents and templates. 

 PHII strengthens and supports immunization information system (IIS) performance by:

  • providing foundational and specialized competency-based training to equip the IIS workforce with the knowledge, skills and abilities to be successful in their roles.
  • providing specialized expertise and technical assistance to jurisdictions.
  • connecting the IIS community through collaborative partnerships to share evidence-based best practices that enable IIS functionality to achieve national standards.

What’s next for these systems to continue to improve?

IIS are pretty mature since they have existed since the 90s, which means that they house a lot of data. The recent pandemic has demonstrated the need for immunization systems to be both robust and scalable. Right now, the focus is to make sure that IIS have the right infrastructure to not only securely store data but also have the ability to scale as needed. This has resulted in many IIS migrating to a cloud environment. This trend is likely to continue.

As a result of COVID-19, demand for immunization information across the spectrum of public health has increased exponentially. This has put a focus on the quality of data contained in the IIS. IIS teams will need to focus on data quality to ensure that the information they provide is available, accurate, timely and valid and is of the highest quality. The third area of focus is interoperability and data sharing. CDC is working with AIRA, PHII and other partners and with state and local IIS jurisdictions to ensure that interoperability of data between jurisdictions and states and at the federal level is taking place. The final area of focus is consumer access. Digital vaccination certificates are already a reality, with several states making these available to their residents. This trend will likely continue to allow consumers to not only access their COVID-19 vaccines but also other vaccinations in a secure and easily accessible manner.

With maturity also comes the need for modernization. Last month, PHII hosted a data modernization workshop with approximately 400 participants from states and local jurisdictions across the nation. In collaboration with the CDC, PHII is providing guidance and support to public health jurisdictions on developing data modernization plans, as well as improving informatics infrastructure, data access and workforce capacity across multiple areas of public health including immunizations.

Some activities that PHII supports include facilitating a data modernization learning community, providing planning resources and coordinating workshops for data modernization leads. Data modernization will continue to be a focus for immunizations and other public health domains for the next several years. 

Header photo: A doctor logs information in a digital health records system. Credit: Billy Weeks.

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