A summary of presentations from the weekly Summit partner webinars
April 14, 2022 – The latest Summit summary
- The Immunization (IZ) Gateway Updates – Lynn Gibbs-Scharf (CDC)
- Adult IIS Capture and AIRA Initiatives Update – Liz Abbott (AIRA)
- Consumer Access to Immunizations – Michelle Consolazio (Audacious Inquiry)
The Immunization (IZ) Gateway Updates – Lynn Gibbs-Scharf (CDC)
Lynn Gibbs-Scharf, MPH, Immunization Information Systems Support Branch Chief, NCIRD, CDC, gave an update on the Immunization (IZ) Gateway. VIEW PRESENTATION SLIDES
CDC is focused on work that addresses the lessons learned during the pandemic, as well as how progress is leveraged, and the infrastructure built from COVID-19 vaccination to advance routine immunizations. This has allowed for the updating of one of the key components of data exchange––the Immunization (IZ) Gateway.
The Immunization Gateway is facilitating data exchange for three different case scenarios:
Data Exchange between Multi-jurisdictional Vaccine Provider Organizations
Data exchange supports increased submission of data to the IIS and enhances the completeness of the data. This allows for a connection between IISs and vaccine providers so that providers can access data and can get a complete immunization record to inform their clinical decision-making with patients. The focus is trying to onboard federal agencies to use IISs through the IZ Gateway. Currently, 95% of IISs are functionally and technically ready for provider-to-IIS data exchange and there are three organizations with 68 facilities in 8 jurisdictions that are exchanging data with the IIS. The next steps focus on onboarding and initiating data exchange between Veterans Administration facilities and IISs, as well as continuing with planning conversations with the Department of Defense (DOD) and Bureau of Prisons (BOP) about onboarding activities.
Data Exchange Between IISs
The IIS-to-IIS data exchange allows for an IIS to submit a query for immunization data with another IIS, which improves IIS data completeness and allows providers access to complete and accurate patient immunization history. Currently, about 47% of IISs are functionally and technically ready for IIS-to-IIS data exchange, and 21 jurisdictions are actively engaged in inter-jurisdictional data exchange. The next steps include facilitating functional and technical readiness for additional IIS and preparing US Virgin Islands, NJ, NYC, and RI for data exchange by September 2022. Many more states are queued to go live soon.
There are currently a total of 119 IIS-to-IIS connections in 21 jurisdictions. Of those, 118 are active bi-directional connections and one is uni-directional (TN to AZ). US Virgin Islands, NJ, NYC, and RI will be connecting this fall for a total of 25.
Data Exchange between IIS and Consumer Applications Offering Patients Access to Their Immunization Record
The IIS-to-consumer app/patient portal provides patients with direct access to their complete, accurate immunization records for proof of vaccination and vaccination schedule adherence. Enabling this access has led to a reduced burden on public health agency staff that have to respond to record requests. Currently, NJ, UT, and MN provide residents access to immunization records by using the Docket app consumer application via the IZ Gateway. The next steps will include AK and ID to go live for data exchange with Docket in the spring of 2022.
Policy is always the biggest hurdle with data exchange whether it’s across jurisdictions or from providers to jurisdictions. Multiple point agreements are typically required for data exchange and jurisdictions have varying policies around consent and patient data exchange. These policies impact jurisdictions’ ability to use the IZ Gateway. There are variations in jurisdiction data exchange message format and content that need to be addressed. Multiple IIS connections also need to be made by providers for consolidated records for patients who have been vaccinated in more than one jurisdiction. Manual data submission to the CDC could also be improved with automation to eliminate labor intensiveness.
The IZ Gateway significantly expands IIS access to federal agency data. There are enhancements planned to address challenges by the immunization community such as automating the IZ Gateway onboarding for efficiency, allowing providers to initiate a specified query and receive records, and easier data submission to CDC. The IZ Gateway is also establishing common legal frameworks with centralized legal agreements for immunization data exchange amongst various exchange partners.
Adult IIS Capture and AIRA Initiatives Update – Liz Abbott (AIRA)
Liz Abbott, MPH, Adult Program Manager, American Immunization Registry Association (AIRA) gave a presentation on Adult IIS Efforts, including a Bi-directional Data Exchange Update. VIEW PRESENTATION SLIDES
The 2020 IIS Annual Report shows that while adults are lagging behind other age groups, adult participation continues to increase, with 68% of adults represented nationally in 2020. This is an 8% increase over 2019 at 60%. While the national coverage is at 68% (excluding territories), there is large variability across states and jurisdictions, with more than half of jurisdictions above 75%.
AIRA compiled a Landscape Analysis summarizing the practices, challenges, and opportunities for improving adult capture. This engagement called out the importance of establishing electronic interfaces between electronic health records (EHR) and IIS as one of the best methods for increasing adult immunization capture in IIS. Some of the key takeaways include:
- Prioritize, fund, staff adult vaccination capture activities
- Motivate providers to report
- Reduce or eliminate barriers to reporting
- Address data confidence/data quality concerns
A May 2021 MMWR (Surveillance of Vaccination Coverage Among Adult Populations––United States, 2018) highlighted the large gaps in adult vaccination coverage and the role that the IIS has in improving the low coverage rates. IIS may provide more timely data and help with the lag in survey data.
Data comes to the IIS from a variety of sources, most being electronic health records (EHR). There has been an increase in data exchange in 2020 from 2019––most of the exchange being bidirectional––which demonstrates the shift towards electronic exchange. The 2021 numbers are predicted to reflect the magnitude and impact from COVID-19 and the increase in non-traditional providers. See CDC IIS Annual Report Data: https://www.cdc.gov/vaccines/programs/iis/annual-report-iisar/index.html.
Reporting of data must be easy, automatic, and sustainable for providers to use in an emergency, which will encourage ongoing, routine use of the IIS.
Onboarding Shared Services Program (OOS)
OOS will help make the Onboarding Consensus-Based Recommendations actionable by providing various services. OOS will streamline the processes and promote consensus-based practices. The goals of the program include:
- Reduce IIS backlogs of providers waiting to onboard
- Enhance and accelerate the ability of jurisdictions to onboard providers efficiently and effectively
- Increase the standardization of onboarding processes across jurisdictions to improve the timeliness of interfaces and completeness and accuracy of data
OOS has eight workstreams including technical assistance, documentation, tracking, communications, and training to build IIS staff capacity to conduct onboarding in alignment with best practices. Services provided include:
- Technical Assistance (direct onboarding assistance)
- Solutions for provider self-testing prior to onboarding
- Onboarding process and documentation development and consultation
- Onboarding and interoperability training
Immunization Integration Program (IIP)
IIP is a program in an effort to support and strengthen the interoperability between EHRs and IIS. The strategies include:
- Testing and Recognition Initiative is a way for EHRs to demonstrate and be tested on immunization capabilities so that they can be recognized for their ability to exchange data with IIS
- Collaborative brings the immunization ecosystem together and provides a forum to develop recommendations and solutions and drive the adoption of those solutions
2022 Collaborative Priorities
COVID-19 highlighted the need for large provider organizations and payers to have a standardized way to access large amounts of IIS data for their patients/members. There are four priority topics that the EC voted for in the last meeting.
One being focused on now is the Access Bulk Query Data from IIS, which allows large providers and health payers to benefit from a standardized way to access large amounts of IIS data for their patients/members. The project team is exploring how to work with partners on developing best practice guidance for bulk query options.
ONC Immunization Data Exchange Advancement and Sharing Project (IDEAS)
In January 2021, ASTHO was engaged by the Office of the National Coordinator for Health IT (HIT) to develop and implement the IDEAS Program which has brought together multiple partners from the IIS and health information exchanges (HIE) community. These partners carried out an environmental scan and will convene a learning community of states who will receive technical assistance with the overall goal to advance IIS and HIE data sharing and exchange.
Public Comment and Advocacy
AIRA has been involved in other federal initiatives including providing public comment on the DHHS Vaccines National Implementation Plan, and the NCQA Adult Immunization Composite Quality Measure. AIRA provided a technical review of Medicaid and CHIP Payment and Access Commission (MACPAC) recommendations to improve vaccine access for adults in Medicaid, and AIRA participated with AVAC to provide comments on the Immunization Infrastructure Modernization Act, H.R. 550.
AIRA will be hosting its national meeting on April 26–27. Topics include but are not limited to data modernization, health equity, vaccine credentialing, pandemic lessons learned, and the impact on IIS and routine immunizations.
The AIRA repository information, services, and support can be found on their website: www.immregistries.org.
Consumer Access to Immunizations – Michelle Consolazio (Audacious Inquiry)
Michelle Consolazio, Director, Audacious Inquiry, gave a presentation on ONC- and CMS-sponsored project to improve patient access to immunization records. VIEW PRESENTATION SLIDES
Most consumers do not have easy, electronic access to their immunization records, especially cross-jurisdictionally. The focus for the project has been on two use cases: parents of school-age children who need access to their children’s records to satisfy school and camp requirements, and adults who need access to immunization records for secondary education, travel, and some job requirements.
The project is sponsored by Centers for Medicare and Medicaid (CMS), Division of Quality and Health Outcomes as well as the Office of the National Coordinator for Health IT (ONC). Project partners include American Immunization Registry Association (AIRA) and Docket Health App.
The project team has been engaged with Docket since 2019. This app expands consumer access to personal and family immunization records by integrating with IISs and jurisdiction-specific requirements. Of Docket’s many functions, it is intended to give access to immunization records and create an official PDF, improve immunization coverage with immunization reminders, and will soon offer recommendations on where to get vaccinations.
Docket is currently live in Utah, Minnesota, and New Jersey (COVID-19). The app will soon include Idaho and Alaska, which should be live by the end of April.
The human-centered design work has made sure the workflow is simple and the language is appropriate for all. The app ensures patient data is secure with authentication. State cases helped improve updates to the app to work more efficiently. One of the most significant enhancements is the queueing system, which was brought about from a NJ state case. A press conference prompted the team to prepare for an overload of users after the announcement of the new app. In concern for the overload of users and the potential crash of the app, the team created a queueing system to put users in line for access to the data.
The current goals of the project include:
- Expansion in states that are already live and additional states
- Greater and continued collaboration with school nurses and school districts, as well as the expansion to universities
- Continue to have recurring surveys shared with users to understand their experience and identify enhancements that can be made to the app
- Identify additional vendors and resources
- Focus on outcomes and have a better understanding of the technical policy issues for IIS
- Create additional resources to help provide solutions and answers to technical policy issues
- Continue to learn and implement new strategies to enhance the app so that all consumers can have access to their immunization records
Is there a cost to use the app?
Consumers don’t pay to use the app. Federal funds help support the initial implementation of the app.
Will vaccination exchange for Docket in NJ expand to NY, and CT?
That goes back to the IIS-to-IIS exchange. Docket needs a relationship with IIS and would have to have a relationship with the neighboring states to be able to exchange information. We are working towards that.
How do the IIS and IZ Gateway fit into the CDC Data Modernization Initiative (DMI)?
There are five strategies for the Data Modernization Initiative at CDC. The first is about building the right foundation, which is where the IZ Gateway primarily sits. This strategy is focused on ensuring real-time data collection, leveraging cloud-based services, automation, all the things that the IZ Gateway is striving to achieve. DMI is ramping up at CDC. We are looking at how the IZ Gateway may be leveraged for other kinds of data and programmatic areas as one of the building blocks that we want to make available to jurisdictions. This is part of the ongoing conversation at CDC.
Will people be able to use a QR code in the future to access immunization records? Would that happen through the IZ Gateway or Docket?
The gateway is not going to produce the QR code. There are tools that leverage the gateway such as the Docket, that allow sharing of data to generate a QR code.
Docket uses smart health cards which is a standard created by the Vaccine Credentialing Initiative (VCI). Smart health cards for COVID-19 are available in a lot of jurisdictions, which has been promising to see many jurisdictions moving toward smart health cards. We are also working with VCI on a smart health link to share information. The QR code isn’t meant to store a lot of information, so for example, child records hold many vaccinations that would be too much for the QR code. The smart health link may be the solution to this problem.
AIRA has been helpful in these efforts to support jurisdictions and collaborate. There is information in our repository on this.
Will CMS claims help populate the registry and will they be able to access the vaccinations via the IZ Gateway or other program? In other words, are discussions including how insurance can identify persons already vaccinated which would help target outreach?
CMS is not a federal entity providing or receiving data exchange with IZ Gateway. There have been a number of conversations between CDC and CMS about exploring some of these data linkages and trying to do some pilot projects with some jurisdictions on data linkage and implications. It is an ongoing conversation and we want to explore the linkage itself first and be sure we can do that effectively before thinking about how we will enable a more real time data exchange.
You mentioned the DOD; is that just active duty and dependents as well? What part of the population are they considering?
We aren’t that far along in the conversation with DOD. I suspect that will be part of the planning with them to see how far we can extend that data collection.
It will not be for active duty, just for their dependents. We haven’t gone much more beyond that.
What do we need to do to overcome state policy barriers that prevent the centralization of immunization data collection?
COVID-19 really put these issues on the radar in a lot of states, fostering a lot more attention and ideas. AIRA is working closely with AVAC to contribute talking points and information on IIS for various state legislatures. There is a need for more legislator education and we are doing our best to track the different policies in every state. AIRA is interested in creating additional resources that can help when individuals and organizations are called upon to testify to state legislatures.
It’s ultimately a multi-pronged approach, education being one of the primary ones, as well as identifying best practices, legislation, and policies. The other piece is exploring this at the federal level to see if there’s something we can do to overcome some of the state-to-state variations to enable reporting both to the IISs and for data to be shared where it needs to be shared. This is part of the DMI conversation to modernize some of these data systems and get data flowing and exchanged between different players across the public health system. This will require a hard look at policy reform.
Thirty-two percent of adults don’t have any vaccine in the registry. Why is that still relatively high? What are your thoughts on how the 2021 data pull will compare?
This will be coming soon.
The 2022 Influenza Vaccine meeting, What’s Up with Flu in ’22! Surveillance, Vaccines, Policy, and Communications Last Year and Next, will be held virtually on May 19, 2022, from 2:00–4:45 p.m. (ET). Pre-meeting registration is required by 5:00 p.m. (PT)/8:00 p.m. (ET) on May 18, 2022, to attend. For more information and to register, visit: https://www.izsummitpartners.org/2022-naiis/.