The Rise and Expansion of Immunization Information Systems (IIS)

History of Immunization Information Systems (IIS)

State and local communities have compiled vaccination data for decades. Some public vaccination records in the United States date back to the 1970s as an initial effort by HMOs and local communities to track immunizations for infants and children. Yet, paper trails were difficult to maintain or share, making recordkeeping challenging.

The introduction of the internet and the expansion of information technology that followed paved the way for modern Immunization Information Systems (IIS). From initial funding and implementation to innovative expansion as public health initiatives and IT capabilities have evolved, let’s take a closer look at how immunization information systems progressed over the last few decades.

The Crisis that Inspired Change

Between 1989 and 1991, the United States experienced a severe measles outbreak despite a successful vaccination campaign that had dropped case rates to an all-time low just years prior.

Despite early efforts to maintain vaccination records, there was no official system to track immunizations at the time of the outbreak. The measles crisis didn’t call into question the efficacy of the vaccine itself, but rather the documentation and tracking of immunizations across state and local communities.

The All Kids Count initiative was launched in 1991 by the Robert Wood Johnson Foundation to improve preventive healthcare for children across the nation. This program provided grants for the development of community-based immunization registries. By 1997, All Kids Count had established the first fully operational immunization registry, and its trial-by-error approach revealed critical lessons that would drive the creation of health information systems well into the 2000s.

Meanwhile, evolving support from public policy initiatives, federal agencies, and national organizations accelerated the efforts and funding of immunization registry development across the country.

In 1995, the Centers for Disease Control and Prevention (CDC) defined core data components necessary for immunization registries and established HL7 guidelines for electronic data exchange. By 1998, the National Immunization Program had identified IIS as a top priority to achieve Healthy People 2000 goals.

Despite limitations in public policy, technology, and stakeholder engagement, the late 1990s fostered immense growth and development of what would become modern-day IIS.

The Expansion of EHRs and Increased Collaboration with IIS

Strategies to improve access, cost, and quality of care in the United States increasingly focus on collaboration between patients, providers, payers, and public health departments via the electronic exchange of patient information. Like IIS, Electronic Health Records (EHR) have gradually developed into a core component of our healthcare system and serve as a primary means to achieve these goals.

EHRs provide a real-time digital record of patient information and interactions that can easily be updated, traced, and shared across care teams. The expansion of electronic medical records allows for strategic data sharing between health systems and IIS, eliminating the need for time-consuming manual data entry or file-sharing processes.

Using HL7 standards, IIS receives real-time vaccination data as patient records are updated within the EHR by clinical staff at the point of care. These data feeds allow for a seamless exchange of patient information to keep immunization records within IIS up to date.

To further promote interoperability, IIS have also developed capabilities to send immunization data back to EHRs. This functionality allows IIS to provide clinicians with a comprehensive view of patient immunization history regardless of where they received their vaccines.

Continued development and expansion of collaboration between EHRs and IIS will enhance patient-centered care delivery and better inform decision-making at the individual level for providers and population level for state health departments.

A Renewed Importance

Like the measles outbreak of the early 1990s, the COVID-19 pandemic brought a renewed sense of urgency around immunization tracking in the United States. After decades of progress, state health departments are better equipped to respond to public health crises given enhancements in documenting, tracking, and sharing immunization status.

However, COVID-19 revealed there’s still room for improvement within state immunization registries and a need for a centralized IIS within the United States.

Many states struggled to keep up with the increased volume of immunization records as elevated numbers of patients sought vaccines to comply with requirements for work, travel, and recreation. Additionally, limitations in reporting capabilities created significant challenges in the seamless exchange of data between providers and state immunization registries as well as timely reporting from state registries to federal agencies.

Immunization registries have made considerable progress since the All Kids Count initiative first launched in 1991. Yet, as state and federal agencies continue to seek innovative solutions to address unmet needs across the healthcare system, IIS will remain a crucial component of enabling public health initiatives and generating impact on a local and national scale.

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