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Pandemic underscores challenges with exchanging immunization data

March 1, 2022

The AAP has been involved in advancing immunization information interoperability for several decades, including initial work to promote pediatricians contributing information to web-based immunization information systems (IISs). The COVID-19 pandemic has made apparent that challenges remain to reporting and sharing accurate immunization data.

Subject matter experts have been identifying concerns, prioritizing work and promoting solutions through the Immunization Integration Program (IIP) Collaborative launched by the Centers for Disease Control and Prevention and driven by the Healthcare Information and Management Systems Society (HIMSS), the American Immunization Registry Association and the Drummond Group (

Stuart Weinberg, M.D., FAAP, has lent his pediatric and technical expertise to advance this work as an IIP Technical Advisory Panel participant since 2016 and co-chair of the executive committee since 2019.

The collaborative plays a key role in the project’s efforts to improve information sharing and enable access to immunization information among IISs, electronic health records (EHRs), health information exchanges (HIEs), clinicians, and federal, state and local public health agencies. The purpose is to identify challenges associated with EHR-IIS immunization information sharing and management and develop and drive the adoption of solutions to address those challenges.

As COVID-19 vaccines were developed rapidly, it became apparent that the usual timelines for partners in information exchange (EHRs, HIEs, IISs, etc.) to update new code sets would be insufficient to enable meaningful data collection. In addition, unique differences in reporting requirements between states and other jurisdictions presented additional challenges for technology vendors to build and support smooth information exchange pathways. These ongoing difficulties underscore the IIP’s work that was underway prior to the public health emergency.

Dr. Weinberg is leading several IIP efforts, including one to better understand acknowledgement and error messages that are generated when EHRs and IISs exchange information. This work was presented at the 2021 AAP National Conference & Exhibition ( and has led to a guidance document ( that will inform advancements.

This year, the IIP Collaborative will focus on the following priorities to improve immunization interoperability, information sharing and management (

  • accessing data from IISs using bulk queries;
  • improving data validation to reduce reasons for IIS rejections;
  • capturing race and ethnicity; and
  • updating code sets across systems regularly.

These efforts will help pediatricians identify methods to improve workflow, reduce immunization documentation errors and maintain more complete and accurate immunization records across systems.

In addition, the IIP has developed a Testing and Recognition Initiative ( that can be used for EHR certification from the Office of the National Coordinator for Health Information Technology. The initiative has robust testing requirements that many pediatricians will consider helpful and can improve immunization support for infants, children, adolescents and young adults. Pediatricians are encouraged to bring this program to their EHR vendor’s attention.

“Each year, members of the IIP collaborative review and prioritize issues to be addressed,” Dr. Weinberg said. “AAP members can provide very valuable feedback describing pain points specifically related to sharing data with IISs, making sure their concerns are heard and addressed.”

Email comments, concerns and priorities to

Dr. Kressly is a member of the AAP Council on Clinical Information Technology and is chair of the Payer Advocacy and Advisory Committee.

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