Additional Considerations

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

Additional considerations

Beyond funding and efficiency strategies, several cross-cutting factors influence IIS sustainability.

Governance, workforce capacity, partnerships, policies, and continuous learning shape how well sustainability efforts are implemented and sustained over time. The considerations below highlight organizational practices that help ensure IIS programs remain resilient, adaptable, and well-supported.

Strengthen governance and leadership

Strong governance and leadership provide the structure and direction needed to sustain IIS over time. Clear roles, shared decision-making, and alignment with broader organizational priorities for technology, infrastructure, staffing, and data use help ensure that the IIS is integrated into routine agency operations and strategic planning and not managed in isolation. This alignment makes it more likely that IIS needs are considered in budgeting, staffing, technology investments, and policy decisions, which can help secure ongoing support and resources. Establishing governance structures (e.g., sustainability workgroups) and clarifying responsibilities across immunization, IIS, information technology (IT), procurement, and other teams strengthens accountability and coordination. Aligning IIS priorities with data modernization and immunization program goals further ensures that IIS remains relevant, well supported, and positioned as a critical component of broader public health infrastructure.

Build and retain a skilled workforce

A skilled, capable, and stable workforce is essential for maintaining and evolving IIS; however, many jurisdictions operate with very small teams. In these contexts, workforce development should emphasize flexibility, cross-functional roles, strategic use of available resources, and maintaining core knowledge. Strengthening capacity can include identifying priority skill gaps, building internal “super users” where feasible, and cross-training staff to ensure continuity despite limited personnel. Leveraging CDC educational opportunities, AIRA interoperability and other AIRA trainings, and the PHII IIS Learning Hub, along with peer collaboratives and shared resources, can help strengthen and extend staff capacity. In some cases, jurisdictions may also rely on shared services or contracted support from their vendor, a staffing agency, or other resource to supplement internal expertise.

Strengthen partnerships and partner engagement

Strong partnerships help reinforce the value of IIS and create shared ownership of sustainability efforts. Engaging both internal and external partners early and consistently builds alignment, trust, and opportunities for collaboration. Regular engagement with immunization programs, IT teams, providers, payers, electronic health record (EHR) vendors, health information exchanges (HIEs), schools and other public health and private sector partners can support shared investments and coordinated planning. These partnerships may also create strong advocates for justifying the value of the IIS and the need to sustain it. Regular engagement with these partners, and the use of tools such as data use agreements, success stories, and performance dashboards help demonstrate impact and sustain partner interest.

Enact policies

Enacting new policies or amending existing ones can help strengthen IIS by facilitating complete and accurate data capture, exchange, and use. (See below for specific policy change recommendations, which include, among others, mandatory reporting of immunizations.) Because IIS in the US are independently operated by states, cities, and territories, IIS laws and regulations vary by jurisdiction.¹⁰ AIRA points out that federal policies can facilitate uniformity, while state and local laws can ensure a consistent response to emergencies and routine immunization needs.¹¹Combined, the right policies can help create a nationwide network of interoperable, secure, and high-performing IIS. While most jurisdictions have some policies in place to support their IIS, many need new or amended policies to further the effectiveness of their IIS. AIRA identifies three policy areas most requiring attention and action:¹¹

Vaccine reporting — Policies are needed to ensure timely and complete reporting of vaccine doses administered by all immunization providers for all patients across the lifespan.¹² Reporting mandates or opt-out policies (see 3. Consent below) may help accomplish these goals. Currently, reporting of vaccinations administered to children is more complete than that for adults. Reporting needs to include key data elements, e.g., patient names, date of birth, and gender, along with other fields, (e.g., race, ethnicity, address, phone number, and email address.) This information helps to inform an understanding of immunization coverage among various populations, facilitate outreach to improve coverage, and assist with matching vaccination reports to the correct patient’s IIS record over the patient’s lifetime. In addition, providers need to have timely access to consolidated IIS records for their patients to help inform clinical decision-making at the point of care.
Data exchange — Policies are needed to allow for interstate data exchange between IIS and reporting of aggregate information to CDC. Research has shown, on average, a person in the US changes residence 11 times over a lifetime. Hence, data exchange across jurisdictions is necessary to ensure complete immunization records. Allowing deidentified vaccination data to be shared by IIS with CDC informs national immunization coverage and data-driven decision-making at the federal level. These activities also promote the value of the IIS to funders and other partners, helping raise awareness of the need to assure IIS have the resources they need to provide data for these purposes.
Consent — An opt-out consent policy for participation in IIS by patients of all ages will help IIS capture information for all people in their jurisdictions. Currently, the majority of states have opt-out or a similar policy. However, consent policies in some states require patients to give explicit written or verbal permission to opt-in to have their immunization information included in an IIS. Opt-out, or similar policies such as immunization reporting mandates, reduce barriers to exchanging data and capturing immunization information in IIS for the entire population of their jurisdictions.

Create a learning organization

A learning organization is one that continuously reflects, adapts, and improves based on experience, partner input, and data. Continuous learning supports IIS sustainability by enabling programs to adapt, improve, and respond to changing needs. Organizations that foster a culture of reflection and improvement are better positioned to manage change, complexity and uncertainty. Establishing a culture of learning and improvement, applying Quality Improvement (QI) methods, using data to inform decisions, listening to partners and capturing lessons learned all contribute to stronger, more resilient systems. Participation in national organizations and peer networks, such as AIRA and other public health organizations, also plays an important role by helping IIS teams stay up to date on best practices, learn from other jurisdictions, and remain connected to a broader community of experts. Over time, embedding continuous learning into both internal practices and external engagement helps ensure sustainability efforts remain dynamic, informed, and responsive.

10. Immunization information systems: a decade of progress in law and policy. https://journals.lww.com/jphmp/fulltext/2015/05000/immunization_information_systems__a_decade_of.10.aspx”>↩

11. IIS policies to support pandemic and routine vaccination. https://repository.immregistries.org/files/resources/5ee9315f0930e/iis_policies_to_support_pandemic_and_routine_vax_6_18_20.pdf”>↩

12. Measuring success of the US COVID-19 vaccine campaign–it’s time to invest in and strengthen immunization information systems. https://ajph.aphapublications.org/doi/epdf/10.2105/AJPH.2021.306177″>↩