Immunization Information Systems (IIS), implemented in the mid-late 1990s, have evolved and grown over the years, most recently during the pandemic as they contain robust data sets of patient demographic and vaccination data. Similarly, Disease Surveillance Systems (DSS) have evolved over time from simple case counting systems to sophisticated, interoperable platforms that support case management, electronic case reporting (eCR) and case investigations and contact tracing.
CDC’s Data Modernization Initiative (DMI) launched in 2019 primarily focused on lab and case reporting to public health. With the subsequent identification of IIS data as a core data source and supplemental Public Health Infrastructure Grant (PHIG) funding specifically allocated to IIS modernization efforts, IIS are now sitting alongside DSS in many jurisdictions with a seat at the DMI table and a voice in prioritization and allocation of resources and energy.
Immunization programs have been assessing their IIS platform functionality and technical capability over the past several years due to the aging of existing technology and waning support for the WIR platform. Searching for a path forward toward the next generation of IIS, the question of “buy versus build” is re-emerging from past decades, but are we ready to learn from experience and be realistic in terms of affordability, achievability, and sustainability? We have seen jurisdictions opt for the known solutions with existing platforms available in the marketplace. We have also seen others take a chance on new products coming to market by potentially viable entrants; and still other jurisdictions who believe that building a new platform themselves will enable them to acknowledge and learn from the past lessons and achieve the stability, innovation and sustainability they are seeking.
Similarly, public health agencies are struggling with aging DSS solutions. Although continuous enhancements of the systems have been made over the years, the underlying technology and infrastructure are becoming more and more outdated, and efforts to add new, modern features are becoming increasingly challenging in a timely and cost effective manner. With a limited number of available disease surveillance products and vendors, we see jurisdictions with the desire to replace their existing systems, but with few options for consideration. Significant investment has been made encouraging clinical care organizations to send initial electronic case reports (eICR) to public health agencies. These efforts have highlighted public health’s inability to absorb those eICRs into their systems or leverage emerging technologies, such as FHIR, to query the clinical care organizations for follow-up patient data.
ASTHO contracted with HLN to facilitate three onsite agency visits in August and September 2024 to understand the current DMI activities undertaken by each agency, chronicle the successes and challenges of these efforts and provide recommendations for mitigating the challenges that could be leveraged by agencies across the country. As we discussed data modernization with a representative group from each agency that included the program managers/leads of key DMI data sources, it became readily apparent that the solutions being explored and decisions being made across the IIS landscape were similar to those taking place within the DSS domain. Although a few paces behind IIS, both agencies are looking for potential solutions offered by a small cadre of vendors and products that will enable them to modernize, innovate and sustain their public health platforms over the next several years.
For both domains – IIS and DSS – the approach seems clear. An agency needs to assess the current strengths and constraints of its existing system, determine any gaps, identify and prioritize current and strategic requirements, and determine an implementation path forward. This path could be through procurement (buy) or build, depending on the available resources, including a skilled workforce and funding. HLN has extensive experience supporting jurisdictions through this process to operationalize, optimize and modernize your public health information systems. We have assisted many jurisdictions in platform assessment, requirements collection and prioritization, landscape analysis, product/vendor selection (including buy versus build), and implementation planning and deployment.
For more information on how HLN can assist in your DMI efforts, please reach out to Marcey Propp (mepropp@hln.com) or Aasa Dahlberg Schmit (aasa.dahlbergschmit@hln.com).