Approach E: Modernizing IIS

Module 1	Introduction	Unit 1 IIS Sustainability Toolkit Introduction
Module 2	Getting Started	Unit 1 How to Use this Toolkit
Module 3	Defining IIS Sustainability	Unit 1 What is IIS Sustainability and Why Does it Matter?
Module 4	Strategy 1: Diversifying Funding	Unit 1 Diversifying Funding Introduction	Unit 2 Approach A. Leveraging Medicaid Match	Unit 3 Approach B. Billing for IIS Data
Module 5	Strategy 2: Optimizing IIS Efficiency	Unit 1 Optimizing IIS Efficiency Introduction	Unit 2 Approach A. Increasing the Use of Shared Services	Unit 3 Approach B: Leveraging Shared Infrastructure	Unit 4 Approach C: Using Open Source Software	Unit 5 Approach D. Implementing Process Automation	Unit 6 Approach E: Modernizing IIS
Module 6	Success Stories from the Field	Unit 1 Success Stories Introduction	Unit 2 Using Medicaid Match to Diversify IIS Funding	Unit 3 Diversifying IIS Funding Through Health Plan Billing	Unit 4 Slowing the Curve to Manage Rising IIS Costs
Module 7	Additional Considerations	Unit 1 Additional Considerations
Module 8	Additional Resources Related to Sustainability	Unit 1 Additional Resources
Module 9	References	Unit 1 References
Module 10	Abbreviations and Acronyms	Unit 1 Abbreviations and Acronyms

What is meant by modernizing IIS?

Modernizing an IIS can involve a wide range of technical, operational, and organizational improvements that enhance the system’s performance, usability, scalability, and sustainability. While modernization may include transitioning to cloud-based infrastructure, it also encompasses adopting modern system architectures, improving interoperability, strengthening cybersecurity, enhancing data quality, expanding analytics and reporting capabilities, and supporting consumer access to immunization records.5,6 Modernization may further involve replacing legacy code, implementing modular and standards-based components, streamlining workflows through automation, improving the user experience for providers and public health staff, and strengthening the workforce skills needed to support and maintain the system.

Rather than focusing solely on technology upgrades, modernization can also be viewed as a process of continuously improving how the IIS supports immunization programs, providers, partners, and the public. One jurisdiction described its modernization approach as identifying pain points experienced by staff and providers and then prioritizing investments in modern software solutions and process automation to address those challenges (see examples under Approach D: Process Automation).

IIS and immunization program teams have worked to enhance and modernize IIS for many years, predating the CDC-funded Data Modernization Initiative (DMI) underway in health departments across the US. The work of these teams continues and may also include participating in data modernization activities with other programs within their jurisdictions. These collaborative efforts are focused on realizing CDC’s broader vision of creating a stronger and more resilient public health system at the jurisdictional and national levels across the US. The goal of this wider effort is to meet current health needs better and increase the nation’s preparedness for future health threats.

In recognition of the need for public health to modernize its data, technology and workforce infrastructure, Congress allocated funds to CDC to support the Public Health Infrastructure Grant (PHIG) initiative. CDC has operationalized the PHIG initiative through an extensive grant program for jurisdictions. A specific PHIG initiative for modernizing IIS was established in late 2024 to support IIS modernization and be directed by immunization programs, under the umbrella of their agency’s overarching data modernization efforts.

CDC defines a modern public health system as one that is:

Scalable: able to receive, send, and process unpredictable volumes of data.
Flexible: supports rapidly changing data, workflows, end users, and end user needs.
Interoperable: can easily exchange data with other relevant systems.
Sustainable: system is designed to ensure that continuous development, maintenance, and operations costs can be covered by the jurisdiction’s routine funding sources.
Reusable: usable for both daily and emergent public health action, across multiple disease areas and types of public health threats.
Intuitive: can be quickly understood and used effectively by new staff, whether for purposes of routine public health action or emergency response.

Planning for IIS modernization?

Use the IIS Modernization Self-assessment to measure your current modernization maturity and identify opportunities that align with Public Health Infrastructure Grant (PHIG), Data Modernization Initiative (DMI), and IIS modernization goals. The assessment can help support strategic planning, prioritization, and resource allocation.

Specific IIS modernization activities may include:5

Upgrading technology infrastructure: Moving from legacy, server-based systems to cloud-based infrastructure to expand scalability and improve secure access for immunization providers and other authorized IIS users. Moving to cloud hosting can increase costs, however. One state reported significantly reducing these costs by optimizing its cloud environments. This entails hyperscaling, i.e., scaling down their test, production, or development environments during periods of low usage (e.g., weekends), then scaling up during peak usage. The state looked at usage patterns and automated a scaling schedule to align with usage levels. When necessary, they can temporarily change the schedule for a particular environment, such as scaling up a test environment during periods of heavy testing.

Promoting modern standards, interoperability, and data quality: Implementing modern data standards (e.g., HL7, FHIR) and interoperability approaches advance PHIG and data modernization goals by enabling seamless, standards-based exchange of data across public health systems. This may include improving connectivity between IIS and other jurisdictional systems such as disease surveillance, newborn screening, vital records, laboratory, and data warehouse or data lake environments, as well as strengthening exchange with immunization providers, pharmacies, health information exchanges (HIEs), and federal partners. Efforts such as participation in the IZ Gateway support secure, interoperable exchange of immunization data across jurisdictions and with federal agencies, including the U.S. Department of Defense and Veterans Health Administration. By advancing interoperability and adopting modern standards, jurisdictions can improve data completeness, timeliness, quality, and reuse while reducing duplication of effort and supporting a more integrated public health data ecosystem.8

Enhancing functionality: Creating, improving, and integrating IIS functions increases the value, usability, and effectiveness of the IIS for providers, immunization programs, partners, and the public. Examples include strengthening tools for monitoring the supply, ordering, and distribution of publicly purchased vaccines; expanding mobile and web-based access to immunization records for providers and consumers; modernizing automated reminder/recall systems; and enhancing provider assessment and feedback capabilities. Functionality enhancements may also include developing interactive dashboards that display vaccination coverage by geography and population characteristics, improving interoperability with electronic health records (EHRs) and other systems, enabling consumer self-service features, supporting vaccine forecasting and clinical decision support, and streamlining provider onboarding and data exchange processes. These improvements can increase the utility of IIS data, improve user experience, support data-driven decision-making, and strengthen the overall public health impact of the IIS. Further, improving IIS functions can decrease the manual effort required to complete important IIS- and immunization program-related activities.

Strengthening analytics: Developing modern data and analytics capabilities enables IIS to more effectively collect, analyze, visualize, and use immunization data to inform decision-making. This may include implementing cloud-based data systems and data warehouses to improve scalability, performance, and data access; developing internal and external dashboards that provide real-time or near real-time information on vaccination coverage, vaccine administration, provider performance, and vaccine inventory; and creating tools that allow users to explore data by geography, age, race and ethnicity, payer status, provider type, and other key variables. Analytics enhancements may also include automated reporting, predictive analytics to identify populations at risk for under-immunization, geographic mapping and hotspot analysis, integration of data from multiple sources, and advanced visualization tools to support planning, outbreak response, quality improvement, and health equity initiatives. Strengthening analytic capacity helps IIS programs turn data into actionable insights that support more timely and effective public health action.

Applying automation and artificial intelligence (AI): Working toward AI-enabled solutions that support predictive analytics, identification of populations at risk due to low immunization rates, and advanced analysis of vaccine administration data to inform program planning and intervention strategies. Emerging AI-enabled tools may further enhance process automation by supporting activities such as automated report generation, predictive analytics, anomaly detection, provider communication, and data quality monitoring.9 While IIS use of AI is still evolving, some jurisdictions have made significant efficiency gains by developing modern software solutions for automating major tasks. Other opportunities include data visualization by supporting the development of dynamic public-facing dashboards that display vaccination coverage trends by geography, age, race and ethnicity, payer status, provider type, and other variables. These tools can improve situational awareness, facilitate data-driven decision-making, support health equity efforts, and increase the value of IIS data for public health programs, providers, policymakers, and the public.

Potential AI applications for IIS efficiency9

AI-supported tools could help IIS programs:

Automate generation of provider reminder and recall reports
Streamline production of CDC reports and routine dashboards
Improve patient matching and deduplication processes
Identify data quality issues or missing data patterns
Forecast vaccine demand and inventory needs
Automate responses to common partner or provider inquiries
Assist with onboarding and interoperability testing for providers
Support predictive analytics to identify populations with low vaccination coverage
Reduce manual processing of bulk data requests from health plans or partners

Developing the IIS workforce: Building and sustaining the workforce capacity needed to support a modern IIS may include recruiting staff with expertise in areas such as informatics, data analytics, interoperability, cybersecurity, cloud technologies, and project management; providing advanced training to help existing staff maximize the use of modernized systems and data; and strengthening bench depth through cross-training, succession planning, and knowledge transfer. Workforce development may also involve creating internal “super users,” leveraging shared staff resources across programs, participating in peer learning networks and professional organizations such as AIRA, and utilizing mentoring, coaching, and continuing education opportunities. By developing a skilled, adaptable workforce, jurisdictions can reduce reliance on external vendors, improve organizational resilience, and ensure they have the expertise needed to sustain and continuously improve the IIS over time. (See Build and Retain a Skilled Workforce in Section 7, Additional Considerations.)

How can modernizing IIS optimize IIS efficiency?

Modern IIS can facilitate more efficient and accurate immunization data reporting and submission between partners. They may also support more rapid detection of immunization coverage gaps in at-risk populations to promote health equity and early intervention to prevent or control disease outbreaks.

How can modernizing IIS promote IIS sustainability?

Modernizing IIS can promote operational and technical sustainability. By streamlining workflows and expanding the skills of the workforce, IIS can be better maintained and enhanced over time. As IIS infrastructure becomes more scalable, interoperable, flexible, reusable, and intuitive, the IIS can more easily integrate with evolving technologies and data standards to meet the needs of immunization programs, providers, consumers, and other partners now and into the future.

Additional resource related to modernizing IIS

Modernizing North Dakota’s Awardee-Developed IIS