Background

IIS are important tools in the public health system and exist to improve and protect the nation’s health from vaccine-preventable diseases. A network of 62 independent state, territorial, and jurisdictional immunization information systems (IIS) are operated within the United States. These systems are relied upon to implement an increasingly complex vaccination schedule, consolidate and create comprehensive immunization records, as well as monitor vaccine safety, efficacy, and support vaccine delivery.

Despite their importance and necessity, the number of varying systems, coupled with jurisdictional policy and resource limitations, presents challenges with standardization, interoperability, data exchange, and the capture of complete immunization records. In partnership with the Centers for Disease Control (CDC) and IIS partners, the American Immunization Registry Association (AIRA) instituted its Measurement and Improvement (M&I) Initiative in 2015 as an innovative effort to evaluate and increase alignment of IIS with national functional standards. Lessons and strategies can be adapted for broader implementation as global systems develop methods to better achieve 2030 Sustainable Development Goal (SDG) targets, particularly related to global population health and infrastructure.

Methods

AIRA works closely with its partners to propose, vet, and refine processes and measures that can be compared across IIS, resulting in a uniform, standardized approach for measurement. The M&I Initiative is conducted as a third-party, independent evaluation through AIRA connecting with IIS pre-production systems to test the IIS response to test messages and measures across multiple content areas prioritized by the IIS community. The process includes three stages: 1) Testing and Discovery, 2) Assessment, and 3) Validation. Content areas currently evaluated include clinical decision support, interoperability transport, HL7 submission/acknowledgement, HL7 message query/response, and data quality. Testing is performed using the AIRA-developed Aggregate Analysis Reporting Tool (AART), an electronic testing tool and user interface specifically designed to compile and visualize results from the measures and tests.

Results

The M&I Initiative is voluntary with 86 percent (50/58) of the IIS programs targeted for measurement currently participating. To date, AIRA has actively measured standards alignment and published data on Validation in the first three content areas of Transport, Submission/Acknowledgement, and Query/Response. Thirty-one individual IIS have been validated in at least two of these three content areas. The number of IIS meeting one primary Transport measure has increased from 19 to 39 in three years, an increase of 105 percent. The number of IIS who were able to process the submission of a correctly formatted full immunization record for a patient jumped from 17 to 34, a 200 percent increase from baseline. Similarly, the number of IIS sending standards-conformant HL7 Acknowledgment messages has increased fourteen-fold since measurement began in 2017. The number of IIS who were able to process and respond to a query requesting a patient’s evaluated immunization record and forecast increased from nine to 42, a 367 percent increase from baseline. Within the first two quarters of assessment, the percentage of IIS meeting the CDS measures aimed at supporting IIS alignment with ACIP recommendations increased 15 percent from baseline.

Conclusion

The M&I initiative has helped to reduce variability across IIS and strengthen immunization data in IIS that is more complete, accurate, and can be utilized with confidence. The successes and experience offer an innovative model that could be adapted to standardize measures of success and data-sharing capabilities across global borders, particularly of value in achieving SDGs aimed at ensuring healthy lives and promoting well-being for all ages through strengthened immunization systems.

中文翻译：

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测量和改进作为加强免疫信息系统和克服数据缺口的模型

背景

IIS是公共卫生系统中的重要工具，并且存在以改善和保护国家健康免受疫苗可预防疾病的侵害。由62个独立的州，地区和辖区免疫信息系统（IIS）组成的网络在美国范围内运行。依靠这些系统来实施日益复杂的疫苗接种计划，合并并创建全面的免疫记录，并监控疫苗的安全性，有效性和支持疫苗的运送。

尽管它们具有重要性和必要性，但各种系统的数量以及管辖权政策和资源的限制，在标准化，互操作性，数据交换和完整免疫记录的获取方面都带来了挑战。与疾病控制中心（CDC）和IIS合作伙伴合作，美国免疫注册管理协会（AIRA）于2015年制定了其衡量和改进（M＆I）计划，以创新方式评估和提高IIS与国家功能标准的一致性。随着全球系统开发方法以更好地实现2030年可持续发展目标（SDG）的目标，尤其是与全球人口健康和基础设施有关的目标，可以将经验教训和策略调整为更广泛的实施。

方法

AIRA与合作伙伴紧密合作，提出，审核和完善可在IIS之间进行比较的流程和措施，从而形成统一，标准化的度量方法。M＆I计划是通过AIRA与IIS预生产系统连接的第三方独立评估来进行的，以测试IIS对IIS社区优先考虑的跨多个内容区域的测试消息和度量的响应。该过程包括三个阶段：1）测试和发现，2）评估和3）验证。当前评估的内容领域包括临床决策支持，互操作性传输，HL7提交/确认，HL7消息查询/响应以及数据质量。使用AIRA开发的聚合分析报告工具（AART）进行测试，

结果

M＆I计划是自愿的，目前参与测量的IIS计划中有86％（50/58）。迄今为止，AIRA一直在传输，提交/确认和查询/响应的前三个内容区域中积极测量标准一致性并发布了有关验证的数据。在这三个内容领域中的至少两个领域中，已经验证了31个单独的IIS。满足一项主要传输措施的IIS的数量在三年内从19个增加到39个，增加了105％。能够处理患者格式正确的完整免疫记录的IIS的数量从17个跃升至34个，比基线增加了200％。同样，自2017年开始测量以来，发送符合标准的HL7确认消息的IIS的数量增加了14倍。能够处理和响应请求患者评估的免疫记录和预测的查询的IIS的数量从9增至42。比基准增加了367％。在评估的前两个季度中，满足CDS措施以支持IIS与ACIP建议保持一致的IIS的百分比比基线增加了15％。

结论

M＆I计划有助于减少IIS的变异性，并增强IIS中的免疫数据，这些数据更加完整，准确并且可以放心地使用。成功经验和经验提供了一种创新模式，可适用于标准化跨全球边界的成功措施和数据共享能力，特别是在实现可持续发展目标方面的价值，该目标旨在通过加强免疫系统确保健康生活并促进所有年龄段的人的福祉。