SVIS - E:BRP Summary

ATTACHMENT - E: BRP Summary

Immunization Information Management Blue Ribbon Panel
Executive Meeting Summary
May 16-17, 2013
Background
The Centers for Disease Control and Prevention (CDC), National Center for Immunization and
Respiratory Diseases (NCIRD), understands the critical role of effective immunization information
management in reducing the burden of vaccine-preventable diseases and providing insight into vaccine
usage and need. This includes further developing and strengthening Immunization Information Systems
(IIS) throughout the nation. In Fall 2012, the NCIRD engaged the consulting firms of Intellix and Gartner
to launch an NCIRD IIS Strategic Initiative. That initiative will, in part, create a roadmap to guide future
investments in immunization information management, including enhanced interoperability between IIS
and Electronic Health Record Systems (EHR-S) and enabling IIS to capture vaccine usage information
from EHR-S. As part of the Initiative, CDC convened a Blue Ribbon Panel of twelve experts in
immunizations, IIS, health informatics and health information exchange (see Appendix A). The Panel was
charged with providing input on the future of immunization information management and IIS.
Meeting Overview
The two-day meeting was held May 16-17, 2013, at the Task Force for Global Health in Decatur, Georgia.
The meeting objectives were to:
 Review, discuss, and provide input on future state capabilities for immunization information
management in the context of the changing health care and health IT environment
 Discuss and provide input for milestones to achieve those future state capabilities
 Identify initiatives for executing the strategy, including dependencies and priority order
This meeting also served as one of many inputs to the IIS Strategic Initiative mentioned above.
Meeting attendees included Panelists, Participants who served as expert resources to the Panelists, and
staff from the CDC, the Public Health Informatics Institute (who hosted the meeting), Intellix, and
Gartner. Appendix A contains a list of all attendees.
Between October 1, 2012 and May 1, 2013, over two dozen interviews were conducted with the
Panelists and others by the Intellix/Gartner team. The synthesis of these interviews (see next page)
provided a framework for reviewing interview results to date, highlighting major topic areas and
frequently-cited issues in the areas of Service, Sustainment and Policy. This matrix also served to help
frame small group working sessions to identify:
 Future capabilities needed to increase the ability to meet the national IIS vision
 Current challenges to achieving those future state capabilities
 Possible future initiatives NCIRD could implement to address the challenges and achieve the
future capabilities

Synthesis of Interviews: Frequently Cited Topics and Issues
Topic Area

Service

Sustainment

Policy

Interoperability &
Integration

• Interstate exchange
• Intrastate exchange
• EHR / EMR
Integration

• Immunization
Information
Stakeholders

• Interstate exchange

Process Management

• Clinical Decision
Support
• IIS Standards
• Vaccine Inventory
Management

• Conflicting Priorities
• Certification
• Financial Resources
• People Resources

• Regulatory
Environment

Data Management

• Data Quality
• Data Sharing
Architecture

• Scalability

• Security
• Patient Identity

In addition, Dr. Chesley Richards, Director of the immunization Services Division within NCIRD, provided
an introductory presentation on the current status and recent accomplishments of IIS: “Achieving a
Healthier Population through Immunization: The Critical Role of Immunization Information and
Systems.” In his overview, he presented the following vision:
A world in which real time, consolidated immunization data and services for all ages are
available for authorized clinical, administrative, public health and consumers anytime or
anywhere.
He emphasized the value of the Panelists’ input to NCIRD in considering the following questions:
 What are the best strategies to achieve the future state?
 What investments ought NCIRD to be making?
 What new opportunities to pay most attention to?
The Blue Ribbon Panelists then met in plenary session to define IIS future state capabilities. Next, three
break-out groups of four panelists each identified current state challenges and milestones, presenting
their findings in a subsequent plenary session. On the second day, each break-out group defined
candidate initiatives which were then collectively reviewed, revised, and prioritized in a final plenary
session, each Panelist being given ten “votes” to assign as they saw fit.
What are the future state capabilities that will realize the national IIS vision?
The following ideas on future state capabilities for immunization information management and IIS were
provided by the Panelists. The purpose of identifying such future state capabilities is to stimulate
discussions and planning; how they will be interpreted and acted on will undoubtedly evolve over time
as conditions in the broader environment change. The ideas are presented as stated by the Panelists.

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In the future, there are broader, more primary uses of the data, easily available to support program
needs.
 Effective use beyond just management (e.g., population health). This may make IISs more
attractive to use
In the future, the registry has to be placed in a political and organizational position that supports the
IIS vision.
In the future, all IISs have to have the capabilities to support the vision.
 Important to think about reaching out to the smaller or less mature registries to engage /
support them
In the future, analytics capabilities not only support immunization [program level], but also support
evolving, robust operational needs and goals with real-time, uniformly high-quality data, efficiency
in management, monitoring, and validation.
In the future, all the data and services (e.g., CDS) are commonly accessible by the user (provider,
schools, patients, etc. as defined in the vision) in a timely manner.
 Registry data available through EMR; don't want to have to log in to another system
In the future, all the data and services (e.g., CDS) are commonly shared with and / or by EMR
vendors in a timely manner.
 National Hub Model for Data Exchange. Can resolve vendor challenges (e.g., transport
methods -route, not read)
 Having a more uniform way for registries to talk to each other makes sense
 Includes Patient Identification
In the future, there is the ability for registries to share across jurisdictional lines.
 Will have the policy and legal framework to support this
In the future, systems will support submissions and queries (bi-directional) for decision support, in a
reasonable, "real-time" fashion.
 For example, the forecast for vaccination―patient / parent can access forecast on iPhone
In the future, there are efficient standards for CDS, data quality, de-duplication, inventory
management, interfaces, transport mechanisms, messaging mechanisms, etc.
 Certification of those capabilities?
 Provide a CDS web service?
 CDS, and its connection to IIS, may be evolving. Don't have to hit an IIS to get clinical
decision support; we should think about this connection relative to the use cases for the
data
 Precise business rules and a consolidated records are key to accurate forecasts
 Some vendors are interested in building the CDS themselves versus plugging into a web
service
 More worried about pharmacy portals that give rudimentary forecasts
 No matter what these programs talk about with standardization, they don't practice it; for
the foreseeable future, every IIS will have to sanction a set of rules
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In the future there is a national, single-point CDS (i.e., "Standard CDS")
 Sustainability is a challenge when no one wants to fund it; how do you raise the value?
In the future, IIS are sufficiently valued such that stakeholders are willing to invest in sustaining the
system
 We are inefficient now. Why? Turf issues, absence of vision for a common infrastructure
 CDC needs to consider whether CDS is about the immunization alone, or is it more than one
use case (e.g., chronic disease CDS)?
In the future, there are standardized technologies/approaches (e.g., MIROW) that result in cost
savings / improved sustainability
Meeting Results
The final prioritization represents the Panel’s input to NCIRD on near-term initiatives for investment.
Final Prioritized Initiatives
Initiative Name

Initiative Description

Votes

IIS architecture is scalable,
modular and shared

Define candidate IIS services for modularizing; i.e., define an
architecture and establish a consortium for jointly
developing, sharing software modules.

16

Common approach to
resources/investments across
CDC and IIS community

Establish a common approach to resources and investments
across CDC and the IIS community, including a more
harmonized approach to Meaningful Use, greater crossprogram collaboration within CDC, and a defined scope of
“common approach.”

15

Validate and refine the value of
IIS for stakeholders

Secure funding/proper resourcing for continued
maintenance and enhancement of IIS.

13

Assessment of current and
aspiring models for interstate
data exchange

Conduct a best practice study for interstate exchange to
inform policy recommendations.

13

IIS informatics fellows (part of a
cross-cutting workforce
category)

Hire three informatics fellows focused on and working in IIS
programs; support “InfoAid”1 projects using informatics
fellows; provide IIS training to (and/or by) fellows.

11

Data quality (part of a crosscutting data exchange/data
quality category)

Identify data enhancements to improve data quality at
different stages of interoperability.

10

1

InfoAids are CDC informatics Fellows who can be detailed to a local and state health department to assist them a
short-term informatics challenge.
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Initiative Name

Initiative Description

Votes

Partner collaboration

Increase collaboration among CDC, AIM, AIRA to evaluate
needs and improve data sharing between IIS and CDC
systems; e.g., IIS / VTrcKs, AFIX.

9

IIS Functional Standards

Link existing requirements documents; create new MIROW
chapters; harmonize existing data quality and message
validation tools.

8

Consumer-mediated exchange
(part of a cross-cutting data
exchange/data quality category)

Assess current and aspiring models for consumer-mediated
exchange2.

8

Joint development frameworks

Identify joint development frameworks, including
governance models, open source IIS module library, and
create an IIS certification criteria and process.

6

Transport and messaging (part
of a cross-cutting data
exchange/data quality category)

Examine ways to improve and/or sustain national transport
and messaging services.

4

Message validation tool

Utilize HL7 Implementation Guide Gap Analysis of IISs to
develop National Message Validation Tool to certify
acceptable HL7 Formats.

4

Standardized tests

Develop standardized tests to help providers optimally use
their EHR-S for immunization reporting.

1

Provider on-boarding

Define guidance for on-boarding3 of reporting users.

1

Informatics-savvy IIS
workforce/ecosystem (part of a
cross-cutting workforce
category)

Define IIS manager orientation and sponsor training for
existing staff.

1

IIS informatics competencies
(part of a cross-cutting
workforce category).

Define IIS informatics-specific competencies for workforce
development.

0

Next Steps
The leadership team within NCIRD will be working with the Intellix/Gartner team to analyze how the
Panel’s input on prioritized initiatives can optimally inform the broader IIS Strategic Initiative. The input
will be particularly helpful to NICRD in weighing where to best make financial, technical or policy
2

Consumer-mediated exchange refers to individuals having access to their health information, to support them in
taking recommended preventive actions and in managing their health care online.
3
On-boarding refers to the testing and validation process that health care providers and IISs collaboratively engage
in to ensure that only complete and accurate electronic immunization data feeds are being imported into the IIS.
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investments in the near- and middle-term. NCIRD leadership is committed to regularly engaging IIS
stakeholders on the status, content and implementation of the IIS Strategic Initiative.•

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Appendix A
Immunization Information Management Blue Ribbon Panel Meeting Attendees
May 16-17, 2013

Panelists
Noam Arzt, HLN Consulting, LLC
Laura Conn, CDC/OSELS/HITSS
James Daniel, Office of the National Coordinator for Health Information Technology
Art Davidson, Denver Health
Shaun Grannis, Regenstrief Institute
Molly Howell, North Dakota Department of Health Immunization Program
Mary Beth Kurilo, Oregon ALERT Immunization Information System
Martin LaVenture, Minnesota Department of Health, Office of Health Information Technology
Amy Metroka, New York Citywide Immunization Registry
Jim Pearsol, Association of State and Territorial Health Officials
Pejman Talebian, Massachusetts Department of Public Health Immunization Program
Stuart Weinberg, Vanderbilt School of Medicine

Participants (as expert resources to the Panel)
Rebecca Coyle, American Immunization Registry Association
Therese Hoyle, Every Child by Two
Terri Ann Murphy, Veterans Administration
Chesley Richards, CDC/NCIRD/ISD
Gary Urquhart, CDC/NCIRD/ISD/IISSB
Warren Williams, CDC/NCIRD/ISD/IISSB

CDC Participants and Observers
Kafayat Adeniyi, CDC/OID/NCIRD
Hanan Awwad, CDC/OID/NCIRD
Danny Coviello, CDC/OID/NCIRD
David Farkas, CDC/OID/NCIRD
Nedra Garrett, CDC/OSELS/PHSIPO
Anjella Johnson-Hooker, CDC/OID/NCIRD
Agha Khan, CDC/OID/NCIRD
Melissa Moore, CDC/OID/NCIRD
Jessie Wing, CDC/OID, NCIRD