A summary of presentations from the weekly Summit partner webinars
October 12, 2021 – The latest Summit summary
- AD Council Upcoming Flu Season Campaign Update – Madeline Miller (Ad Council)
- CDC IIS Infrastructure Update – Daniel B. Jernigan and Lynn Gibbs-Scharf (CDC)
- IIS Initiatives Update – Rebecca Coyle and Liz Abbot (AIRA)
AD Council Upcoming Flu Season Campaign Update – Madeline Miller (Ad Council)
Madeline Miller, Campaign Director for Ad Council, gave a presentation on the Ad Council’s upcoming flu season campaign.
The Ad Council, in collaboration with the AMA, CDC, and the CDC Foundation, has been working to build off the success of the 2020–2021 season with the No Time for Flu campaign. They shared new creatives to amplify this year’s campaign. They also provided an overview of the last year’s campaign, its success, and what’s to come for this 2021–2022 flu season.
Where Creativity and Cause Converge
The Ad Council uses the power of communications to tackle the nation’s toughest issues that can be impacted by awareness, education, and individual action. Flu vaccination falls into that category.
Flu and COVID-19
The typical flu season is bad enough, but when coupled with the effects of COVID-19, it could be much worse. Flu season typically results in thousands of illnesses and hospitalizations and with COVID-19 there are additional factors to consider, one being overburdening the medical system.
There are many people questioning how COVID-19 vaccine efforts may impact flu vaccine uptake this year. Because of the low incidence of the flu last year, there is also uncertainty about the likely severity of the flu by the public for this upcoming flu season.
The Ad Council’s communications campaign’s objective is to encouraging people to get a flu vaccine for the 2021–22 season; the core audience includes Black and Hispanic adults age 24–54 years. Long-standing inequities and barriers that put a burden on Black and Hispanic Americans have contributed to lower flu vaccination rates among these communities. The creative team is specialized in reaching multicultural audiences and the focus is to encourage and motivate those who are uncommitted––those who have not decided whether to get a flu shot this year.
“No Time for Flu” Campaign
People all juggle a lot every day and don’t have time to be sick with the flu, thus the name of the campaign, “No Time for Flu”, that launched in October. This campaign during the 2020-21 campaign was a great success that drove impact. Last year the campaign had 10 million dollars of donated media, 480 million impressions, and 450 thousand unique visitors to the campaign site, GetMyFluShot.org, in just five months. There were high levels of PSA recognition in the short amount of time––41% of respondents in the Black community and 37% of respondents among the Hispanic community recognized the PSA. There was a significant number of respondents seeking information about flu shots.
Quantitative Study Learnings
Through this study, the campaign developers learned a few new things:
Building on the success of last year’s campaign and understanding the barriers from last year, they found those barriers held true for this year’s campaign. With a survey of over 800 respondents in the target audience they found that similar levels of adults are not committed to getting a flu shot this year. Thirty percent of Black respondents and 33% of Hispanic respondents say they are not sure that they will get a flu shot this year. This is the target audience: those in the movable middle.
They also found that inertia is the biggest factory of why people don’t get the flu vaccine. Most people are not grappling with the science, but rather are following their established habits. They are asking, “do I really need this?” Not getting the flu shot has become a habit.
The key motivator was found to be the protection of oneself and loved ones. And people were found to be most trusting of doctors, healthcare professionals, local health organizations, and institutions like AMA and CDC for information.
People have questions about how the flu shot may interact with COVID-19 vaccines. To address this, they updated the website with answers to key questions related to the coadministration of the two vaccines.
The “No Time for Flu” PSAs were very positively received, highly relevant, and motivating. Seventy-three percent of Black respondents said the ad was relevant and motivating, as did 68% of Hispanic respondents (and 63% of white respondents). This made it easy to decide to bring back the campaign for another year, alongside a complementary campaign introducing new creative ideas.
New Creative Idea – #FLUFOMO
The creative agency, Fluent 360, developed the new campaign called “Flu FOMO”. This campaign depicts the “fear of missing out” on daily activities, events, work, family gatherings, etc. when sick with the flu. The campaign uses humor and culturally specific monuments to show that a flu shot is the best way to protect yourself from a case of “Flu FOMO”.
PSA Creative Preview
The ads are visually consistent with last year’s campaign. The bright imagery in bold with a teal background can be found on billboards, social media, and the website. There are also radio and TV ads as well. All materials are available in both English and Spanish.
Updated Website – GetMyFluShot.org
The updated website, GetMyFluShot.org, found in both English and Spanish, primarily serves as a resource for the audience to learn more about common questions in a relatable and easy-to-understand language. There is now a new section at the top that helps address some questions about coadministration of flu and COVID-19 vaccines. There is also a link at the bottom to a flu vaccine finder so that readers can find a flu shot in their area.
The toolkit for the campaign can be found at GetMyFluShot.adcouncilkit.org. This toolkit contains many social media graphics with corresponding posts, sized to each specific platform, as well as other resources such newsletter copy that can be shared with Summit partners’ networks and co-workers.
Creative Use Guidelines
The PSAs have expiration dates due to talent agreements (through spring 2022). They must only be run in donated time and space and cannot be altered in any way. However, there are social media graphics that can be branded and customized to put into your own voice. When placing these ads online, please aim to use the YouTube links provided in the toolkit. Videos cannot run directly on corporate or for-profit web properties.
New Asset Timing
Currently there are many assets for the “No Time for Flu” campaign. The assets include TV ads, radio ads, out of home (OOH) ads, digital banners, and social media graphics. The website has been updated and now includes a link to the vaccines.gov website’s flu finder application so that visitors are able to find a flu shot near them. A partner toolkit and social media graphics with copy are also available on the website.
“Flu FOMO” assets will be available in late October, including online videos, radio ads, OOH ads, digital banners, and social media graphics.
AD Council Promotion
The press release for the “Flu FOMO” campaign included a media tour with spokes people from AMA and CDC, social media influencer outreach, press pitching, and social content development.
Distribution national and local outreach tactics include the use of broadcast radio, digital ads, OOH distribution, programmatic distribution, digital marketing on Facebook, and PSAs available on Ad Council properties including AdCouncil.org, YouTube, and social channels. The media team helped secure donated media opportunities for the campaign so that ads can be distributed to TV, radio, and to the inboxes of directors.
How to Support this Effort
Partners can play a role in sharing and spreading the message of this campaign in their own channels and networks. The toolkit has many resources such as tips, messages, and graphics that can be used for flu vaccine promotion. There are also professional resources such as email copy that can be used in workplaces and networks.
There are many people who are more afraid of the COVID-19 vaccine than getting the disease. As you developed the creative for this did you do any focus groups, and did you find out if there is a positive or negative impact with COVID-19 and the fear of missing out? Does this impact the fear of missing out from the flu?
For this campaign we conducted research up front and then did additional testing with the respondents. We found that there is certainly a difference in terms of how flu and COVID-19 are perceived. We are leaning into the idea that flu isn’t necessarily immediately thought of as a deadly virus, but more often considered an inconvenience.
CDC IIS Infrastructure Update – Daniel B. Jernigan and Lynn Gibbs-Scharf (CDC)
Daniel B. Jernigan, MD, MPH, Deputy Director for Public Health Science and Surveillance and Lynn Gibbs-Scharf, MPH, Immunization Information Systems Support Branch Chief, National Center for Immunization and Respiratory Diseases, CDC, gave a presentation on an immunization information systems (IIS) infrastructure update.
Daniel B. Jernigan – Data Modernization: Priorities and Next Steps
What is the problem we are trying to solve?
At the beginning of the pandemic response, many of the public health systems that we had in place did not work for us. The software programs in use at the time were not able to talk to one another and the public health workforce was not where it needed to be in terms of data scientist capabilities. There was a huge burden on healthcare providers and those in public health. Public health agencies were not able to provide information to CDC in a structured format, as older technologies and systems did not connect and share information. Over time electronic public health records and the sharing of information got better, however there still needs to be more useful and efficient ways to bring public health into the healthcare ecosystem.
What is the goal of data modernization?
The siloed and brittle public health data systems need to be connected, resilient, adaptable, and sustainable “response-ready” systems that can help solve problems before they happen and reduce the harm caused by the problems that do happen. There’s a lot that needs to happen in the public health data systems space and our ability to be “response-ready”.
Data Modernization Initiative (DMI) Priorities
The priorities fall into five areas developed with input from partners. Data Modernization Initiative (DMI) priorities include:
- Building the right foundation – The data will need to be moved from the source into a usable platform in the cloud so that it can be shared with other information systems. A new information infrastructure and automated data sources will help us be pandemic ready.
- Accelerating data into action – To take the burden off of those who have to provide information we need to do work that is automated.
- Develop a state-of-the-art workforce – We need to develop, identify, and retain experts in health IT, data science, and cybersecurity to help generate meaningful public health insights.
- Support and extend partnerships – It’s important to work with our public health partners, healthcare providers, EHR venders, and also work in ways that don’t just revolve around technology, but also around addressing policies.
- Manage change and governance – The necessary public health structure needs to be able to support the modernization and aid in the adoption of unified technology, data, and data products.
Priority 1: Build the right foundation
The first priority involved coordinating people and systems to provide a new cloud foundation and automated data sources for response-ready data sharing and break down data system silos. The priorities are aligned to the DMI roadmap.
Develop a shared vision of a public health ecosystem – Developing a shared vision will allow for coordinated and seamless actionable data between healthcare data providers and public health agencies.
Expand foundational infrastructure – Providing scalable, flexible services for timely and appropriate access to actionable data in the public health ecosystem involves moving the data to the cloud. The systems built on the cloud are serving as a model on how to implement a shared ecosystem within CDC.
Modernize and connect public health systems and sources – This focuses on streamlining and consolidated collection, routing, exchange, and linkage of public health data through the use of standards and functional infrastructure.
Transform legacy public health data systems, processes, and activities – The use of foundational infrastructure, replacing and combining existing siloed systems with systems that work for all diseases and conditions to reduce duplicative activities, cost, and time to scale up and respond in emergencies.
Create the ability for CDC and State, territorial, local, and tribal (STLT) public health to easily store, discover, analyze, and visualize data in the public health ecosystem – It will be possible for people to get multiple data systems that they were able to get before and replace surveys and surveillance systems as well.
Priority 2: Accelerate data into action
Faster, more interoperable data provides high-quality information that, in tun, leads to knowledge and provides a more real-time, comprehensive picture to improve decision-making and protect health. There are five parts to this priority:
Develop, align, test, and implement new data standards to increase interoperability – This priority is looking at data differently; instead of using existing standards like IIS, and developing new standards including the FHIRE standards.
Increase data linkages across diverse data assets – This priority involves exploring and utilizing privacy records, much like using immunization and data link privacy preserving approaches.
Advance the use of forecasting and predictive analytics to make efficient and effective decisions to respond to outbreaks, emerging threats, and exposures – The CDC has received funding to develop a workforce of data analysts for forecasting and for better understand predictive analytics for outbreaks.
Implement tools for scalable outbreak or emerging threat response This priority includes the implementation of the HHS and data integration tools that programs will be using for their lab linkage that can be scaled rapidly to respond to national concerns and needs.
Identify health inequities and promote equitable health outcomes – The last priority is the identification of health inequities and the promotion of multiple health outcomes. Race, ethnicity, and social determinates of health information need to be better represented so programs can act on the data.
Priority 3: Develop a State-of-the-Art Workforce
The third priority involves identifying, recruiting, and retaining critical workforce in health IT, data science, and cyber security to be stewards of larger quantities of data tools (better and faster) to generate meaningful public health insights.
The CDC has received $3 million for three years as part of the American Rescue Plan and they are spending that money to give grants to educate in data skills, developing programs with fellowships, and bringing on new staff training through health departments so that they can implement skills in broader public health. The three parts to this priority include:
- Identify workforce capacity and capability needs and opportunities
- Increase the data science and capabilities of the CDC workforce
- Facilitate data science upskilling for epidemiologists and technologists at state, territorial, local, and tribal (STLT) agencies
Priority 4: Support and Extend Partnerships
The fourth priority includes engaging with state, territorial, local, and tribal (STLT) partners to ensure transparency, addressing policy challenges, and creating new strategic partnerships to solve problems. The two parts of this priority include:
- Increase collaboration, communication, and messaging among CDC and partners to ensure alignment and participation across DMI activities.
- Public health policies support the exchange and use of data between CDC, STLTs, partners and data providers
Priority 5: Manage Change and Governance
Data modernization is not easy; it will have to do with culture change as well. CDC will need to develop tools to help state health departments through DMI coordinators that are funded at state level.
We are listening…
There are a number of recommendations that have come out from mostly public health organizations. As part of joint initiative with CDC and ONC, recommendation on how to improve public health data systems will continue engagement with partners.
What will be different because of DMI?
When the next emergency happens, there will be:
- A foundation for data sharing across all levels of public health for coordinated, scalable, and timely case investigation, management, and reporting
- Shared analysis capabilities for rapid identification of trends within and across jurisdictions, including race- and ethnicity-trends and risk factors, as well as improved forecasting and response capabilities.
Daniel can be contacted at firstname.lastname@example.org with questions.
Lynn Gibbs-Scharf – Immunization Information Systems (IIS) Overview and Update
Lynn Gibbs-Scharf gave an IIS presentation overview and update.
Introduction to Immunization Information Systems (IIS)
IISs are confidential, population-based, computerized databases that record all vaccine doses administered by participating providers in a specific geographic area. They can provide consolidated vaccination histories for use by providers to determine the appropriate vaccines needed by patients.
Some data can be leveraged to support vaccination programs at the population level to identify at-risk populations and assess vaccination coverage. This includes:
- Collecting and consolidating vaccination-related data from multiple healthcare providers
- Capturing vaccination-related data on children, adolescents, and adults
- Supporting immunization programs to identify populations at risk for vaccine-preventable diseases and to analyze vaccination coverage for their population and conduct outreach.
Overview of IIS History
There are misperceptions about where we are and how we got there.
The first funding for immunization systems started in the early 1990s due to a measles outbreak and became an experiment to see if the registries would even be usable. They were not common standards as they were based on jurisdictional law and policy. The All Kids Count funded registry was developed also in the early 1990s but varied on jurisdiction regulation and policy and had no common standards. CDC developed the first set of common functional standards in 2001. A lot has changed over the decades and standards have evolved and became increasingly sophisticated, however, in terms of technology, we still have a long way to go.
IISs have various core capabilities and functionality standards to improve vaccination coverage. We are seeing first-hand through the COVID-19 pandemic that one of the most important functions is monitoring vaccination coverage during outbreaks, calculating vaccinations that are needed, and consolidating information.
What do IISs do?
- Monitor new vaccine uptake
- Track and evaluate trends in coverage levels
- Automatically calculate vaccinations needed
- Consolidate immunization-related information
- Generate vaccination reminder and recall notices
- Connect providers
- Monitor Vaccines for Children (VFC) vaccine use and provider compliance
What are the core capabilities?
- Evaluating vaccine validity and forecasting next appropriate vaccination(s) due, specific to each patient
- Supporting emergency preparedness and pandemic planning
- Integrating with other electronic health information systems
- Supporting vaccine management at the provider and immunization program levels
Primary IIS Data sources include birth and death records, Medicaid and insurance billing/claims, direct data entry by providers, and electronic medical records.
Policy is a complex factor for these systems, and it comes into play at multiple levels. First, it impacts the data that an individual chooses to share with their provider. Second it impacts what the provider can share with the IIS. Lastly, it impacts what the system IIS jurisdictions can share with other including other jurisdictions, CDC, and other parts of the federal government.
Things are continuing to evolve and improve over time. Right now there is not much difference between the participation by adults and children in terms of policy for the IIS.
Routine Immunization Reporting to CDC Through IISs
There is not consistent widespread reporting of routine immunizations to the CDC, therefore there isn’t always data to assess coverage and identify pockets of immunity in the community. However, there is monitoring of achievement of CDC functional standards and whether jurisdictions and awardees are meeting the requirements of the funding given out.
Data from 13 awardees have been consistently received by the CDC, as they are receiving funding through competitive funding by participating in the Vaccine Coverage Assessment Project, a component of the Vaccines for Children Immunization Program Cooperative Agreement and must meet certain data quality standards.
A substantial proportion, almost 78% of IIS records are reported to the IISs in less than one day. States must submit aggregate data to the CDC. The data is submitted quarterly for children 0-18 years and twice a year for people of all ages.
IIS data quality improvement is monitored annually using the IIS Annual Report (IISAR). The IISAR assesses key data quality metrics, including timeliness and completeness of data, and provider and patient participation.
The Blueprint Defines Goals for IISs and Guides Awardee Activities for Data Quality Improvement
The IIS data quality blueprint is one of the things that was launched pre-COVID-19. The blueprint focuses on jurisdictions and their data quality, with the intent to improve completeness, timeliness, validity, and availability of data, with additional guidance to jurisdictions on what to prioritize in improving their IIS data quality. This will support improved immunization outcomes by supplying credible immunization data.
The blueprint will also inform the technical assistance approach and how to address sheer challenges, which will help to move towards a more adaptable framework at all levels––national, state, and local––so that emerging priorities and needs can be addressed.
Immunization (IZ) Gateway
The Immunization Gateway is a cloud-based message routing service that enables data exchange among participating jurisdiction IISs and multi-state provider organizations. This sees incoming information, just like an email, and routes the messages to the correct place without reading the information inside. This enables exchange of data from one jurisdiction’s IIS to another and enables exchange of data to federal agencies and other multi-state providers.
IZ Gateway Onboarding Status
There has been tremendous progress made during the pandemic due to a lot of help from CDC’s partners.
Federal Agencies and Other Provider Organizations include:
- 4 multi-state provider organization systems actively exchange data with IISs through the IZ Gateway: Docket, DocStation, VAMS, AZOVA HER
- Providers who are currently onboarding:
- Veterans Administration (VA)
- Providers who are preparing to onboard:
- Bureau of Prisons (BoP)
- Department of Defense (DoD)
- Electronic Disease Notification (EDN)
Jurisdiction IIS Onboarding:
- 53 jurisdictions onboarded to IZ Gateway
- Executed Association of Public Health Laboratories Data Use Agreement and completed integration testing
- Onboarded for receipt of VXUs/QBPs from Electronic Health Records.
- 46 jurisdictions have signed the Interjurisdictional Memorandum of Understanding (MOU)
- 44 jurisdictions have signed the Share Task Order
COVID-19 Vaccination Data Flow
The COVID-19 vaccination data flow is much more complex due to the new infrastructure needed to support the huge numbers of vaccinations. Because of that there has been an unprecedented visibility to ordering distribution, inventory, and administration of COVID-19 vaccines. Many lessons have been learned from this experience with COVID-19 that CDC can apply to routine immunization as well.
There is a lot of work to do. We are learning every day through the pandemic but have a strong foundation to build on. The following are some of the things CDC is working towards:
- Establish streamlined funding mechanisms
- Advance data exchange through acceleration of IZ gateway roadmap
- Build on a solid foundation to increase standardization and forecast the needs of future immunization information systems
- Maintain and enhance technology infrastructure, robust data analysis and consistent reporting for COVID-19 response
- Engage stakeholders to help understand successes and challenges and evaluate IIS standards based on lessons learned from the COVID-19 response
- Provide direct technical assistance to jurisdictions, pharmacy, and commercial partners, and federal partners to support their transition to the future state of modernized vaccination data systems.
IIS Initiatives Update – Rebecca Coyle and Liz Abbot (AIRA)
Rebecca Coyle, MSEd, Executive Director, and Liz Abbot, MPH, Adult Program Manager, American Immunization Registry Association (AIRA) gave a presentation on IIS Initiatives Update.
Access to Data
Regardless of where you received the vaccine, your provider is going to need to have access to that information when they provide care for you. The pandemic has helped healthcare providers understand the importance of putting patient vaccination records into the IIS.
Data Lakes, Data Warehouses
There are a lot of new people needing to access patient vaccination data such as insurance groups, clinicians, and the entire healthcare system. So many places have been querying the IIS, which has been creating challenges because there is a lot of data flowing between those administering vaccinations and those needing to pull info out of the system for other uses. A lot of jurisdictions are now enabling secondary databases to avoid overloading the system, meaning there is copy or a data link that allows outside entities that don’t need the fresh, immediate information. This allows them access to the data without crashing the system.
Some IISs have an Interagency Agreement (IAA) or similar relationship with their Medicaid programs that allows for broader processing and sorting of data for payers. This allows others to process, match, and sort data for different entities. Others have enabled and expanded cloud hosting and services utilizing the IIS.
The Evolution of Vaccine Records and Patient Access
Those of us who are vaccinated have obtained small white vaccine cards. There is also access to this information digitally. What is being called the “vaccine passport” is really a digital vaccine record. This is a more secure way to store the record and the “smart healthcare record” can be accessed through smart devises with a QR code. This provides a layer of security that a paper card cannot provide. It is critical to understand that the digital record doesn’t create a policy for how these records may be used. It is simply a paper record moved to a digital format.
This digital record system is not new, and it’s not limited to the COVID-19 vaccine. However, technology has evolved, and we are ready to move beyond the paper cards. The digital option will not replace the paper card, but it will offer another method to capture and keep records.
Clinical Trial Data
There are over 300,000 people who have participated in clinical trials in the U.S. who have a record of being vaccinated, however, there are many who have participated in trials and do not have a recorded record of vaccination. This means these vaccinated people are not able to meet university, work, travel, and event requirements. This problem is in the process of being corrected by working with manufacturers and the CDC to create best practices for clinical trial sites to get data entered into the IIS. Efforts are ongoing to address this issue.
IIS and Long-Term Care:
New and Evolving Guidance:
Long-term care (LTC) have been substantially impacted by COVID-19 and were first to get vaccinated. Here are some important resource links:
- Recommendation for 3rd dose of COVID-19 for immunocompromised
- ACIP Booster Recommendations
- Requirement for all Skilled Nursing Facility (SNF) staff to be vaccinated for COVID-19
- CDC Statement on ACIP Booster Recommendations
IIS is a tool to…
COVID-19 highlighted the need for LTC to be able to determine which residents have received the booster and when they received it. That means that it’s important for these facilities to access the IIS for their residents and be able to report information on the IIS. According to the American Healthcare Association (AHCA), only a third of skilled nursing facilities have served as the vaccine provider and they often don’t have the ability to report that data.
There is also a potential benefit for an employer to access employee vaccination status. However, many states currently have restrictions that do not allow employers to have access to that information.
AIRA and Partner Efforts
AIRA is collaborating with the AHCA to look into various barriers and successes related to onboarding and expanding IIS access to skilled nursing facilities. There has been outreach to the LTCs to raise awareness about the IIS and how to get connected with the system. August Discovery Session Webinar explains what is going on with this effort. AIRA also offers AIRA Resource Repository, technical assistance and resources and the AIRA Discovery Session: IIS and Long-Term Care Onboarding Access if you are looking for more information.
State-to-State Data Sharing
Status of Data Exchange through the IZ Gateway
The IIS-to-IIS is available in 15 jurisdictions: AZ, DE, DC, IN, KY, LA, MD, MS, OH, PHL, PR, TN, WA, WY, WV. Four out of the 15 IIS to IIS jurisdictions are not validated by the IIS: AZ, MS, WY, WV.
The provider-to-IIS is available in 8 jurisdictions: VAMS: CT, DE, KS, NH, UT, VA, DocStation: MN, ND, and AZOVA: UT.
Consumer Access is available in 2 jurisdictions: Docket: UT, NJ.
L.J Tan (IAC)
The Immunization Action Coalition (IAC), with funding support from Seqirus, is offering a limited quantity of FREE Flu Vaccine buttons and stickers in English and Spanish to support your flu vaccine promotion efforts this season. To receive these supplies at no cost, please PRE-ORDER your buttons and stickers now. Delivery (also at no cost) is anticipated by early October. Order the flu buttons and stickers.
IAC hosted two influenza webinars this September that can now be viewed online.
- The Continued Threat of Influenza and How to Sustain Influenza Vaccination Efforts
- Translating COVID-19 Strategies to Improve Influenza Seasonal Flu Vaccination Efforts
We would like to welcome having more NAIIS member organizations to add their support to the Call to Action on adult immunization. Access the call to action and click on the top righthand button to add your organization.