Vaccinations are at the top of many people’s minds right now: when to get vaccinated, how to get vaccinated, and whether the country is on track to vaccinate a majority of its population against COVID-19.

Even before the pandemic, the question of who has been vaccinated and for what has been one that policymakers, healthcare workers, and health technology developers have been working hard to answer. Today, there is a huge opportunity for digital health solutions and partners to support the rollout not only of the COVID-19 vaccinations but also of all the other vaccinations that help keep our population healthy.

A (very) Brief History of Vaccines and Immunization Tracking

As you dive into the world of vaccination integration, you’ll see the words vaccination and immunization used almost interchangeably. A vaccine is a biological substance that provides immunity to a disease. Immunization is the result of the vaccination.

States and nations want to know how much of their population have been vaccinated against different diseases so they can make important public health decisions. To that end, states, districts, and cities created vaccine registries to help track their population’s immunization status.

Historically, vaccination campaigns have been targeted at children (well, their parents) to prevent disease as early as possible. This has been very successful. With the seasonal flu shot and other newer vaccinations–like the COVID-19 vaccine–there is a general shift in thinking from “vaccines are for kids” to “vaccines are for everyone.” This shift in thinking also affects vaccine tracking, as individuals move from one state to another and will need to have their vaccination histories updated for each registry and accessible by their healthcare provider.

Now let’s talk about how that vaccination information is created and how it moves.

Vaccination Data Flow

A vaccination appointment is a standard outpatient style appointment.

1. The patient is scheduled either within the EHR or outside of the EHR
2. Patient arrives
3. The patient’s vaccination history is queried and retrieved from a registry
4. The vaccine is administered and then sent to the registry

Today’s Challenges with Vaccination Data

State by State & Local Registries

Even though there has been a big effort over the last 15 years to make every state’s registry electronic, or at the least to have a state registry in every one of the 50 states and 14 jurisdictions (cities and territories), the implementation of these electronic registries has been inconsistent. That means there are 64 unique organizations that are keeping track of immunizations.

Some state registries have solidified around HL7v2. But even with strong CDC guidance on how to send and receive information, the transport standards vary significantly. With 64 registries, it’s beyond challenging for healthcare providers to connect with them all.

Lackluster National Solutions

This national problem needs a national solution. There are some in the works but they’ve had varying results. For example, the ONC has been working on the Immunization Gateway (IZ Gateway) to “support the exchange of immunization data between immunization information systems, provider organizations, and consumer applications.” However, only federal facilities are allowed to onboard right now.

Another attempt at solving the problem was the $45 million Vaccine Administration Management System (VAMS) built by Deloitte and given to states to use for free to aid the COVID-19 vaccination rollout. We call it the VAMS fiasco for short. VAMS was riddled with bugs. People couldn’t schedule their vaccines, and healthcare organizations were frustrated because they couldn’t administer their allotted vaccines. States declined the free system and worked on developing their own scheduling systems.

Recently, a $500 million bill was introduced for public health funding to accelerate vaccination data, public health data, and infrastructure. While this doesn’t help us now, it does give us something to look forward to.

How Redox Helps

Many of the frustrated healthcare organizations have reached out to Redox to see if our partners had solutions that could help them. Lucky for them, many of our partners had developed readily adoptable solutions for testing, scheduling, administration, and reporting. Moving forward, our goal is to help healthcare organizations find good fits for their organization and improve the rollout of this and future vaccines.

Redox can help your health technology system fit into the overall vaccination flow whether that is receiving information or writing information.

Scheduling

An appointment can be scheduled in two ways: direct schedule or third-party schedule.

• Direct schedule is when the appointment is scheduled within the primary EHR system. Data can be sent outbound to authorized entities via Redox.
• Third-party schedule is when the appointment is scheduled outside of the primary EHR. Data can be sent inbound to the EHR via Redox. For example, a patient chooses an appointment time, which is then pushed to the EHR.

Redox has a long history of helping our partners with both types of scheduling. We’re seeing more and more health-tech products working to fulfill this role for healthcare organizations.

Data Overview:

The technical standard issued by the EHR is typically an HL7v2 SIU message. Some use the newer standard for this data, which is the FHIR appointment resource, or a slot resource. Or, you may come across proprietary EHR APIs if you’re dealing with an Athena or Allscripts site.

Redox normalizes and standardizes this data using the Redox scheduling data module and API. Once you connect with Redox, you won’t have to deal with such a wide variety of data types across health system partners.

Vaccination History Retrieval

Another aspect of the vaccination workflow is accessing and understanding an individual’s vaccination status. An organization may want this information to ensure proper and timely administration of a vaccine, to minimize the risk of exposure to a virus, or to verify an individual’s vaccination history for other purposes.

A couple routes are available to you to pull these records from various sources:

• Pull Patient History: Review records and reconcile vaccine history.
• Query Registry (state or national):
  • Redox can connect your core system to statewide registries. (However, if you are not doing administration, some states may not allow you direct access to the registries.)
  • Redox can help you connect your ancillary application to your partner EHR to directly pull vaccination information
  • Redox can help you connect to nationwide networks to pull vaccination history from over 22,000 healthcare organizations. This will give you a broad reach with a single business agreement.

Data Overview:

When dealing with registries, you’ll typically come across HL7v2 QBP (query by parameter). When you issue the query by parameter, you’ll get a response back with a vaccination history. Another data type is CDA documents (continuity of care), which contain a rich set of information including COVID lab results, allergies, prescriptions and medications, and the vaccination history on file at the healthcare organization.

Redox normalizes and standardizes the vaccination data model and clinical summary data.

Vaccination Administration Reporting

After a vaccine is administered, it must be reported to the statewide or city registry. This will need to be done manually unless your system is integrated.

Redox can push vaccine administration:

• to a registry in each state where you operate,
• to an EHR that then sends the data to the registry,
• via a direct protocol that would alert the primary care provider (or any one of the other 1.5 million providers) that is reachable via that protocol.

Data Overview:

Vaccine administration is typically performed with an HL7-v2 VSU message. Or, if you are integrating through Redox, the Redox Vaccination data model.

Going Beyond Vaccinations…

Understanding a patient’s history and their vaccination status is of course significant for immunizations, but it’s also important when considering a more holistic, longitudinal view of patient health. Healthcare products that aren’t directly related to scheduling or administering vaccines will benefit from being able to facilitate this workflow.

For example, being able to query a patient’s history to confirm if they’ve had COVID or a COVID vaccine can help track the long term effects of COVID.

There is an upswing in new digital health organizations, telehealth organizations, direct primary care and innovative niche clinical care for diabetes and other chronic care physicians. Each has their own healthcare organization. Each will need to have access to a patient’s history.

And that’s why your connection with Redox matters: to make the patient data accessible, so it can be meaningful, and ultimately, so data can improve lives.