Transforming Immunization Data from End to End

A few short years ago, before the COVID-19 pandemic and before CDC’s Data Modernization Initiative, tracking of immunizations was limited, burdensome, and slow at the federal level.

While all jurisdictions receiving CDC immunization program funding have access to an immunization information system (IIS), only a fraction of jurisdictions were funded to send immunization data to CDC. The data were submitted quarterly, and the submission processes were mostly manual. Data quality checks and validations were followed by another process in which data would need to be moved — manually — into an entirely different system for analysis.

This end-to-end processing of data submissions sometimes took months; by the time one quarter’s data was finished, the next quarter’s data might already be waiting. The slow speed of processing meant that jurisdictions had to wait a long time for feedback from CDC.

With the massive COVID-19 vaccine roll-out and delivery came an unprecedented volume and velocity of immunization data. CDC needed to rapidly receive that data, analyze it, and share it back with communities to help them make decisions. We needed a complete national picture — and we needed it in near real-time.

CDC’s experts moved quickly to reinvent immunization data from start to finish. The COVID pandemic provided a unique opportunity to not only receive immunization data at the federal level, but to ensure robust data collection at the state and local level by requiring all providers receiving COVID vaccine to report their data using the same standards.

Today, we continue to transform the data at every step of the way, making noteworthy improvements to:

• The number of jurisdictions submitting immunization data
• The pathways used to exchange data between jurisdictions and CDC
• Use of the data
• Our ability to provide feedback to jurisdictions regarding data quality, as well as state and national vaccination uptake and coverage for decision-making

How it works today

The need for immunization data extends beyond COVID-19 into routine immunization and future public health emergencies. The ongoing effort to modernize systems for providers, state and local public health agencies, and CDC will enable data to arrive fast and complete – and that it can be processed and provided back quickly – no matter the disease or condition.

For example:

• We are working to establish national surveillance of immunization. In 2022, we established a new reporting requirement in our grant funding to state, local, and territorial health agencies. We’ve worked on Data Use Agreements between CDC and jurisdictions to support routine reporting for all immunizations. By the end of 2022, 25 of 64 public health jurisdictions had these agreements in place.
• We’ve improved our technologies so that everything is aligned for efficiency. We’ve moved data and processing to the NCIRD’s Data Lakehouse Platform (NDLP) on the Azure cloud and leveraged CDC’s Enterprise Data, Analytics, and Visualization tools to save time and eliminate manual processes. NDLP offers real-time processing in the cloud, and an analytical layer sits on top, allowing CDC’s experts to perform analysis without having to move the data to a different system.
• We’re creating smarter ways to share the data. We’ve expanded the immunization gateway that routes data through a central hub in an automated fashion, while maintaining the privacy and security of the data. As of 2022, 28 of funded jurisdictions have been onboarded to share data with another jurisdiction, and 41 have been onboarded to share data with a multi-jurisdictional provider, such as a federal agency. We are working now to enable the gateway as a tool to help jurisdictions automate their routine immunization data reporting to CDC. We’ve been doing this work in alignment with the North Star Architecture to provide a single “front door” for data exchange (DeX) for CSV, where any partner can submit data files – small or large – through an application programming interface.
• We’ve expanded the use of privacy preserving record linkage (PPRL). This innovative technology allows us to get a more complete immunization history without any personally identifying information being shared. We have been working closely with jurisdictions to adopt PPRL, so that any records received, new or old, are linked in a privacy-preserved way. To date, data from 11 jurisdictions, 22 pharmacy providers, and 1 federal entity have been onboarded to report covid-19 immunization data with a PPRL ID, accounting for over 152M unique individuals.

All of this comes together into a fully modern system in which data can be sent automatically and made available rapidly. This helps CDC programs understand vaccination coverage and identify communities at risk of vaccine-preventable disease outbreaks, and helps jurisdictions target immunization resources to protect the health of communities.

While there is still much more work to be done, these changes set the direction and represent the promise of modernization — not just for immunization data, but for all of public health.