For almost three decades, immunization information systems (IIS) have evolved to meet changing public health needs. Many jurisdictions have upgraded hardware, replaced software platforms, implemented interoperability standards, and expanded functionality. Yet despite these efforts, the conversation around modernization today feels fundamentally different.
Why?
Modernizing an IIS is no longer simply about replacing aging technology. Today’s modernization efforts are occurring within a broader public health transformation driven by the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC)’s Data Modernization (DM) effort, the CDC’s Public Health Data Strategy, increasing demands for interoperability, workforce challenges, cybersecurity concerns, and growing expectations for real-time data access and analytics. Modernization has shifted from a technology project to an organizational and public health strategy.
What does "modern-day modernization" actually mean?
Traditional IIS modernization
Historically, IIS modernization efforts focused primarily on technology, often centered on replacing legacy systems, upgrading infrastructure, implementing HL7 messaging, improving provider participation, enhancing data quality, and adding new functionality. This work delivered significant value and helped jurisdictions build the IIS infrastructure that supports immunization programs today.
Early modernization efforts were primarily related to IIS enhancements and largely conducted within the immunization and IT departments. Planning often focused on system functionality, technical requirements, and vendor implementation activities, allowing technology to drive the objective of these projects. Today, technology represents just one component of a broader modernization effort—one that also requires alignment across people, processes, governance, policy, and organizational strategy.
The new era of modernization
The CDC’s Data Modernization Initiative introduced a broader vision for public health modernization—one that recognizes successful modernization requires alignment across people, processes, policies, data, governance, and technology. Modernization is increasingly being viewed as an enterprise-wide effort rather than a standalone system upgrade, with a primary objective of reducing longstanding organizational silos. In addition, the role of IIS within the healthcare ecosystem is evolving to provide timely, high-quality data to a wide range of users, including state, tribal, local, and territorial (STLT) health departments, healthcare providers, educational institutions, health payers, federal partners, state administration leadership, and individuals and families.
Modernization starts with assessment
Today’s successful modernization effort emphasizes assessment before implementation and begins with understanding the current state before selecting potential solutions.
Beginning with assessment rather than immediately pursuing technology enhancements or replacement ensures that jurisdictions make informed decisions about where investments will have the greatest impact on the IIS and the public health agency at large.
Explore the “Build Strategic Sustainability for Data Modernization “ and the “Assess Current State and Opportunities” sections of the PHII Data Modernization Planning toolkit to help you consider modernization topics and priorities and begin your modernization journey.
In today’s environment, IIS leaders are being asked to answer new questions:
- How does the IIS fit within the agency’s broader data strategy?
- How can IIS data support enterprise analytics and decision-making?
- What governance and security structures are needed to support data sharing and usage?
- How can modernization improve public health outcomes rather than simply replace aging technology?
- What workforce skills are needed to sustain new capabilities?
- How can modernization investments support long-term organizational goals?
The focus is shifting from “What system should we build?” to “What capabilities does our agency need to achieve its public health mission?”
Jurisdictions should assess:
- Systems and Infrastructure: Architecture, technical costs, interoperability, and data flows
- Business Processes: Workflows, pain points, and opportunities for automation and streamlining
- Data and Governance: Data quality, stewardship, ownership, and data-sharing practices
- Workforce Capacity: Staffing, skill gaps, training needs, and readiness for change
- Strategic Alignment: Agency priorities, modernization initiatives, and cross-program opportunities
By taking a comprehensive view of people, processes, data, and technology, jurisdictions can identify where investments will have the greatest impact and develop a modernization strategy that supports both an agency’s IIS and its broader public health goals.
Modernization is broader than an IIS initiative
Perhaps the most important shift in modern-day modernization is recognizing that IIS modernization does not happen in isolation.
Today’s modernization efforts intersect with:
- Enterprise data governance initiatives
- Agency-wide data modernization efforts and cross-program interoperability initiatives
- Public health infrastructure investments
- Workforce development efforts
- Cybersecurity programs
- Public health data strategy efforts
Successful modernization increasingly requires collaboration across immunization programs, informatics teams, health and IT departments, leadership, and external partners.
The jurisdictions making the greatest progress are often those that view IIS modernization as part of a larger public health transformation effort rather than a standalone technology project. This perspective is reinforced by CDC’s Data Modernization, the priorities and considerations for modernizing IIS released by the National Governors Association, and public health modernization leaders and advocates across the IIS community.
Key takeaways
Modern-day IIS modernization extends beyond technology.
Successful modernization efforts:
- Start with assessments before planning or implementation
- Align with agency-wide modernization goals
- Focus on people, processes, governance, and technology
- Prioritize agency-wide opportunities with positive public health impact and outcomes
- Build organizational capabilities, not just new systems
- Create a foundation for long-term sustainability
Modernization is no longer simply about replacing what exists. It is about creating the capabilities–both in terms of the immunization workforce and technology–to support the future of immunization programs and public health.
Additional references
https://pmc.ncbi.nlm.nih.gov/articles/PMC8112731/ – The Evolution and Modernization of Immunization Information Systems
https://www.hln.com/iis-dmi-where-from-here/ – IIS and DMI: A Public Health Path Forward
https://www.cdc.gov/evaluation/php/evaluation-framework/index.html – CDC Program Evaluation Framework
Dr. Tony Winters leads the immunization project team at PHII in providing technical assistance for system transitions and developing workforce resources to support IIS activities. Marcey Propp is the Domain Lead for HLN Consulting, assisting jurisdictions in assessing and modernizing their public health data systems.
For more information, contact iis@phii.org.