We are at an interesting crossroads for Immunization Information Systems (IIS). COVID funding is ending by June 2025, and even though PHIG funding continues into 2027 this may mark a return to much more meager Federal support for ongoing enhancements and operations. A new administration takes office in a few weeks and with it proposed leadership that seems far from immunization-friendly. All of these realities will trickle down to state, territorial, local, and tribal governments eventually.
Several jurisdictions have recently started to replace their IIS with different products and pursue a variety of strategies, with several others waiting in the wings to see how these projects fare. Several differing strategies have emerged. We have seen jurisdictions choose existing, more mature COTS products (e.g., Hawaii, Michigan, Virginia), some with newer products (e.g., Iowa, North Carolina). Others are presenting different strategies that are more focused on product development than product acquisition (e.g., California, Minnesota). We saw jurisdictions move away from awardee-developed systems (Michigan) and others towards them (Minnesota). This seems to indicate that there is no consensus forming yet on how to proceed as existing products continue to age.
Recently, as part of a procurement interview, the jurisdiction asked us, “In your view, what are the most important considerations for building an IIS that will serve effectively for the next decade?” We have written and had informal discussions about the “IIS of the Future” for years now. Regardless of “buy” versus “build” strategy, here are some key “pillars” or criteria that are important for any IIS moving forward to ensure sustainability:
- Flexibility: IIS should become increasingly modular to promote flexibility in their components and sub-systems. This would facilitate rapid deployment of improvements that may be available piece by piece rather than all at once.
- Reliability/Scalability: IIS should be built and deployed using modern technologies that promote reliability and scalability, including cloud computing, microservices architectures, Artificial Intelligence (AI), and leverage of Software as a Service (SaaS) and Platform as a Service (PaaS) capabilities.
- Standards-based: IIS should be built supporting current as well as emerging standards both for software development (like Java, Spring Boot, and React) and interoperability (like FHIR).
- Ease of acquisition: Procurement in the public sector can often take many months, even years. Sustainable solutions should be able to be easily acquired, products as well as services, with open source solutions and strategies under consideration.
- Cost: To be sustainable, solutions need to be affordable over time. But that means that an agency’s attitude toward cost must be realistic. For example, if an agency wants to get the benefit of sharing expenses through a COTS/GOTS solution it cannot approach the project with a laundry list of custom-development expectations.
The next few years will be challenging for public health. IIS projects will in many cases need to take an incremental approach to change and improvement and collaborate with one another if they are to succeed in creating sustainable systems. We stand ready to assist in any way we can to help strengthen IIS projects both short-term and long-term.