White Papers

HLN authors white papers to explore new ideas and help educate our clients and the broader healthcare community

Immunization Information Systems (IIS) as Sources of Vaccine Credential Information in the US, March 2021

There are many possible sources of immunization data in the US scattered across many systems. Identifying the most complete, accurate and easily accessible data source is critical. Immunization Information Systems (IIS) consolidate data from many sources, mostly EHRs and other clinical records, and they provide clinical decision support to determine vaccine doses due now or in the future. This white paper discussed issues concerning the use of IIS data to support vaccine credential initiatives.

IIS Technology Over Time: Impact and Changing Roles, American Immunization Registry Association, December 2018.

The last two and a half decades of IIS overlapped with a new era of intense and rapid changes in digital technology—what is now termed the rise of the Information Age. This period of time saw the move from mainframes to desktop PCs, to networks, and, ultimately, to the internet, the web, the cloud and mobile technology. While the private sector speedily embraced new developments as they came, healthcare and public health approached these emerging technologies with caution. Over time, IIS have maintained their core mission. But they have also grown and changed as the underlying technologies they require have evolved, and as our culture has imposed new demands and expectations on how IIS—and information generally—are viewed and used. This spotlight highlights the long and pioneering journey of the IIS community, from its scrappy beginnings cobbling together the first IIS in an environment driven by legacy mainframes, to finding its footing in a more digitally connected world.

IIS and EHR Feature Overlap, Revised April 2018. 

Immunization Information Systems (IIS) have been around for nearly twenty years. Their functionality, completeness, and usefulness have all increased over time. IIS and electronic health record systems (EHR) have always had unique features, as well as some overlapping features, and the deployment of electronic health record (EHR) systems has enhanced the local immunization capabilities of clinician practices. Several critical clinical features that are considered to be core functions of IIS are beginning to be supported by EHRs. This paper reviews and discusses five such critical features. The paper offers insight into the likelihood and implications of their migration from IIS to EHRs, and offers recommendations to both the IIS and EHR communities for how to thoughtfully guide this migration.

The Case for Payer Participation in Health Information Exchange, New York eHealth Collaborative (NYeC), April 2018.

Health information exchanges (HIEs) are collaborative efforts that focus on health data exchange on a community, regional, or statewide basis. HIEs are quite diverse; their services have yet to be fully leveraged by the payer community. HIE is an important tool in improving the quality of patient care and outcomes, increasing accuracy and speed of diagnosis, eliminating unnecessary or duplicative tests and procedures, and reducing healthcare expenditures. Payers who participate in HIEs can experience greater oversight and can be better equipped to manage and coordinate patient care.

Effective Technical RFP Development: A Guide for Jurisdictions and Other Organizations, December 2016. 

Many organizations – public and private – use formal competitive bidding instruments to procure technical products and services. This may be done by law, policy, or practice. The driving reasons are to help ensure both a clear understanding of the organization’s requirements and expectations, as well as fairness in the marketplace to all potential respondents who wish to do business with the organization. This white paper offers some practical advice for organizations issuing competitive solicitations.

Decision Support for Data Segmentation (DS2): Technical and Architectural Considerations, May 2014.

This paper presents the results of a research-oriented project to demonstrate that certain Data Segmentation for Privacy, orDS4P tasks can be enhanced through the use of clinical decision support (CDS) technology.  It advances a novel use of CDS tools to 1) identify and sequester certain types of information from electronic medical records and to 2) help mitigate the potential risks of exchanging records from which data have been sequestered. The approach is called Decision Support for Data Segmentation, or DS2, builds upon standards-based open source CDS technology to create a familiar CDS-based platform for the development and testing of functions to identify and redact selected conditions from clinical summary documents in various contexts including Health Information Exchange (HIE) between healthcare providers. The DS2 prototype demonstrates how deterministic clinical rules and machine learning-based classifiers can work together to detect clinical facts that may imply a condition even if they are not directly related to the condition and how CDS at the point-of-care can potentially make use of clinical information even after it has been sequestered.

IIS and HIE: Web Services Strategies, February 2014.

The purpose of this paper is to describe the options that are available to immunization information system (IIS) projects in collaborating with health information exchanges (HIE) or other service providers to facilitate the exchange of immunization information between electronic health record systems and IIS. In many jurisdictions HIEs can play an active role in providing part of the technical infrastructure to make EHR-IIS interoperability work, especially through the use of SOAP-based web services, the current interoperability transport standard for these transactions. Various options are available for the deployment of these web services with differing operational and security implications for both the HIE and IIS projects.

IIS and HIE: Is there a Future Together?, November 2013.

The purpose of this paper is to describe the developing health information exchange (HIE) landscape, including current HIE collaboration with IIS, and to provide some insight about the future of IIS-HIE collaboration. After briefly defining and discussing IIS development with a focus on interoperability, the paper defines HIE functionality, including the benefits to public health and the contributions public health can make to HIE efforts. The paper continues with a description of some current research on IIS-HIE collaboration before concluding with a discussion of the key question: Do IIS and HIEs have a future together?

Towards a National IIS Strategy: Options for Developing a National Immunization Information System Architecture, November 2013.

Immunization Information Systems (IIS) have been under development for over twenty years in the US with systems deployed in nearly every state and territory. Yet no national IIS exists, and no serious discussion is underway for a national strategy for IIS data access. This white paper describes the enablers and barriers for creating a national IIS strategy, as well as various potential models for its development, including the attributes, strengths, and challenges for each proposed option. Finally, suggestions are made for informing US policy in this area moving forward.

Future Information Capabilities for Public Health, (in conjunction with JPHIT, September 2013).

Architectures and Transport Mechanisms for Health Information Interchange of Clinical EHR Data for Syndromic Surveillance, November 2012.

This report developed for the International Society for Disease Surveillance clarifies electronic health information interchange requirements for public health syndromic surveillance by providing:an assessment of various health information interchange architectures for their ability to meet syndromic surveillance business requirements; a  comparison of potential data transport mechanisms; and recommendations for data transport to support Meaningful Use implementation.

IIS Interoperability Model, June 2008.

There is a growing phenomenon in the United States towards deployment of electronic data systems of many kinds to improve effectiveness and efficiency. The near ubiquity of the Internet has fueled even stronger desires to promote electronic information over paper-based records and has enabled system-to-system sharing of data more easily than ever before. This paper shows potential system interactions with IIS by placing the IIS at the “center of the world” and explaining related systems interoperability both within and outside of public health.

Evolution of Public Health Information Systems: Enterprise-wide Approaches, July 2007.

Public health agencies go through changes in political and organizational leadership, reorganization and realignment of public health functions and their relationship to Medicaid, changing budgetary resources and governmental priorities. It is therefore important to view agency health integration efforts with an understanding of how they may develop and adapt their strategies to these changing realities and how the perception of success or failure may be defined by the value that they can create under a changed set of realities. This paper reviews the evolution of public health systems, models for integration, and key concepts related to integration strategies and deployments. Examples are provided from a number of leading public health agencies around the country and indicate how their strategies have managed and/or survived change.

Response to Request for Information, Development and Adoption of a National Health Information Network, Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, January 2005.