Steve and Claire, recent measles outbreaks have reignited focus on the importance of immunizations so I’m hoping you can provide an update regarding what state and local governments are doing to ensure proper tracking of children’s vaccinations.
Yes, measles is a big issue – already in early April 2019 we have exceeded the number of cases nationwide for all of 2018. But it’s also mumps, pertussis and even hepatitis A, which has killed more than 40 people in one state alone. These are all vaccine-preventable diseases, which points the cause to less vaccine acceptance. The reasons for that are complex, but information is the best tool to combat vaccine hesitancy, and immunization information systems (IIS) are the primary tool used to track, measure and understand vaccination patterns at a public health level.
I understand health agencies in Delaware and Philadelphia are embarking on immunization data sharing that has the potential to improve immunization compliance and in turn diseases outbreak outcomes. Please tell us about that.
Due to various laws in the US, we don’t have a national registry of immunizations, so responsibility is passed to the state or local jurisdictions to run their own IIS. Until recently, there hasn’t been a clear legal and technology mechanism to facilitate sharing of data between two independent jurisdictions. For the past several years, though, there has been a project sponsored by the Office of the National Coordinator in the Department of Health and Human Services to kickstart this sharing of immunization data, allowing states to maintain a more comprehensive view of patient protection within their populations. ONC’s contribution has included both standardization of the data use agreements between jurisdictions, and they have also stood up a messaging hub which supports the actual data integration.
While the pilot has been open to all public health jurisdictions, the first to complete a production connection were the State of Delaware and the City of Philadelphia. Both happen to use our IIS platform – WebIZ – but we’re actively trying to include some other neighboring jurisdictions as well. The project is described in this March 2019 issue of AIRA’s (American Immunization Registry Association) SnapShots newsletter.
So, Envision’s WebIZ solution is the backbone of this data sharing success. Please tell us more about that solution and where it’s implemented.
WebIZ is used in twenty state, local and territorial jurisdictions overseen by the Centers for Disease Control. We’re a standardized, commercial-off-the-shelf solution that is highly configurable but managed as a single code base. As a result, we can deliver software quickly and reliably without a lot of site-specific customization. And our customers benefit by receiving all enhancements which are paid for by any other customer, which leverages their investment dollars. Like many state and local government agencies, public health has faced years of diminished budgets, so that is a real benefit to them.
Some of the WebIZ implementations are on the Azure Government Cloud. Why are governments choosing that option, and what are the benefits?
State IT budgets are also under pressure, so there is both a movement away from home-grown IIS applications to vendor-supplied solutions, as well as increased support for cloud-based solutions. We were an early adopter of the Azure Government Cloud and have transitioned most of our larger sites over to it. We include hosting as a requirement, and it actually makes our job a lot easier. IIS tend to have a lot of moving parts – web interface, messaging interface, flat file and vital records imports – so it helps if we can have unfettered access to help diagnose problems that may arise. Managing the application infrastructure – which is mostly IaaS today, but starting to take on more PaaS flavors – also means that we have more control over operational upgrades for performance, scalability and security.
Please tell us about innovations in the immunization registry market. With AI being the center of so much attention, is there anything you’re doing to utilize AI to improve immunization registration?
If there is any silver lining to the recent outbreaks, it’s that public health agencies are spending more time slicing and dicing their data in order to learn more about their populations. We’ve been receiving many requests for assistance creating data extracts, and we’ve been adding functionality to make it easier for customers to analyze their own data, but there is a lot of variability in the technical resources available to immunization programs. So, we’ve been looking at tools like Power BI to increase the options available to less-technical users, while expanding the power of more advanced analytics through machine learning and related features. Some of the machine learning features have potential in our ongoing challenges with patient-matching, which plagues most large-population, multi-contributor databases.