Immunization Information System Measurement and Improvement

By Mary Beth Kurilo, MPH, MSW, policy and planning director, American Immunization Registry Association; a HIMSS Non-Profit Partner and National Health IT Week Partner

During National Health IT Week, champions from across the industry are uniting to share their voices on how health IT is catalyzing change in U.S. healthcare. The following post from a National Health IT Week Partner is one of the many perspectives of how information and technology is transforming health in America.

Mary Beth Kurilo

Interoperability between systems is a key priority across healthcare. Providers need the most complete, most accurate information at their fingertips at the point of care to support their clinical decisions. When I get a flu shot at my pharmacy, I want to know that a record of that shot will make it into my doctor’s medical record, and that she’ll be aware of it at my next visit. But how do we know our IT systems are doing what we need them to do? How do we ensure interoperating systems are speaking the same language, connecting seamlessly and sharing relevant data? Well, in public health, we create measures, and we test, improve and retest, of course!

The Importance of Interoperability

Why is interoperability with immunization information so important right now? One reason is that, as individuals, we move around. we may receive immunizations from a number of providers in a variety of locations (offices, emergency rooms, pharmacies, urgent care centers, student health centers, etc.) and we need that information to move with us.

The immunization schedule itself is challenging to keep up with, given new vaccines and changing recommendations. Querying immunization information systems (IIS) directly from electronic health records (EHRs) allows providers to have their patient’s full record and forecast available during the patient visit, providing the most comprehensive information for clinical decision support.

Take New York City as an example; their immunization registry alone receives more than 2.2 million queries to their system from EHRs and other partners every month. A recent study in New York City demonstrated how EHR-IIS data exchange can improve child and adolescent immunization coverage, with up-to-date status increasing from 75 percent to 81.6 percent following the introduction of query response functionality between EHRs and the IIS.

Measuring Our Progress

The American Immunization Registry Association, or AIRA, has launched a community-driven IIS measurement and improvement initiative, with the goal of providing IIS, or immunization registries, with information and guidance to more fully align with published standards.

IIS operate independently in nearly every state; their goal is to consolidate immunization records from clinics, hospitals, pharmacists, local health departments and others into one complete immunization record for individuals across the lifespan living in their area. Increasingly, IIS are exchanging data dynamically with providers who are using EHRs. IIS supply consolidated immunization records and forecasts of immunizations due to providers at the point of care, through queries from EHR systems. In addition to using these data during the clinical encounter, the data are also used to develop population health coverage rates, pinpoint pockets of need where immunization rates are low, conduct reminders and recalls for immunizations due, and past due, meet school vaccination requirements, and more.

IIS Connected to Testing System

Image courtesy of AIRA

As part of this measurement initiative, testing systems are connected with IIS pre-production (or test) systems to measure their messaging functions. IIS can then see and share their test results with their peers and key partners. As of fall 2018, more than 80 percent of the IIS’ pre-production systems are currently connected. The data available are helping to guide individual IIS enhancements to align with standards. As a result, we are seeing significant improvements in interoperability between IIS and EHR systems across the country.


Early results from the initiative show great progress with both participation and improvement across the community. Below are snapshots of content areas that display the sites participating (bars) and progress in meeting measures (line graphs) for the content areas of transport (the way a message gets from system A to system B) and Query/Response (the EHR sends a message to the IIS asking which vaccines the person may have had. The IIS responds with the vaccine history and forecast for the person queried).

Results: Transport

Image courtesy of AIRA

Results: Query and Response

Image courtesy of AIRA

Vaccines are among the safest and most effective public health interventions. Ensuring all systems can interoperate in a standardized, seamless way improves care coordination while lowering provider burden and helps ensure the right vaccines are given to the right patients at the right time.

The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.

National Health IT Week | October 8-12

Healthcare Transformation | Access to Care | Economic Opportunity | Healthy Communities

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