Monthly Update

October 2018 in Review

In This Issue…

  1. Best in the West: AIRA Regional Workshop in Boise
  2. AIRA/CDC Cooperative Agreement Meeting
  3. The MQE Tool Sprints Ahead!
  4. Update on Measurement and Improvement: The Latest on Validation
  5. Be Part of the Solution for Improving Provider IIS Participation
  6. PHII Launches ‘Welcome to IIS’ Email Course
  7. HIMSS19 -– Champions of Health Unite 
  8. CDC Wins an Award!
  9. AIRA Wins an Award Too!
  10. AIRA 2019 National Meeting Planning Kicks Off
  11. Recent Information Requests Added to the AIRA Repository
  12. Steering Committee Updates: October Recap

Check Out the AIRA Events Calendar for Upcoming…

Best in the West: AIRA Regional Workshop in Boise

AIRA and staff from IIS in the West Region met in Boise, Idaho, October 2–3 for a 1.5-day regional workshop. The workshop kicked off with each IIS sharing its current activities, challenges, needed resources, best thing they learned over the past year, and most creative data use. Attendees continued to participate in roundtable discussions on identifying pockets of need, measurement and improvement activities, and tools and strategies for data validation for assessment of incoming data. The roundtable discussions provided interactive sessions allowing community members the opportunity to learn and share.

From left to right (front row): Danelle Wallace (San Diego); Karen Meranda (WA); Dannette Dronenburg (WA); Rachael Miles (WY); Heidi DeGuzman (San Diego); Tracy Little (AIRA); Beth Parilla (AIRA); Michael Powell (CA); Heather Crawford (OR)

From left to right (middle left row): Jennifer Baker (ID); Carrie Sprague (ID); Kelsey Pistotnik (AK); Marcey Propp (HLN); Kathryn Turner (ID); Gary Wheeler (DXC); Mary Woinarowicz (ND); Kristy Westfall (WY); Michael Day (OR); Jenne McKibben (OR); Katie Reed (DXC); Rebecca Coyle (AIRA); Kristi Siahaya (AIRA)

From left to right (back row): John Ferreri (DXC); Rafe Hewett (ID); Allen Whitenack (NV); Amanda Diehl (STC); Tamarie Olson (ID); Eric Larson (AIRA); Jyl Bosone (UT)

Not present for photo: Emily Dorris (ID); Mari Hilleman (DXC)

AIRA/CDC Cooperative Agreement Meeting 

On October 16–18, AIRA staff, including Rebecca Coyle, Alison Chi, Mary Beth Kurilo, and Amanda Dayton, as well as AIRA president-elect Amanda (Mandy) Harris and incoming president-elect Aaron Bieringer, attended a Cooperative Agreement meeting in Atlanta, Georgia, with CDC/IISSB leadership. This meeting allowed AIRA and CDC staff the opportunity to discuss in detail the plans, strategies, and activities for the coming year that will support the objectives set forth by the cooperative agreements AIRA receives.

The first day of the meeting started with a discussion on promoting standardization and the status of AIRA’s measurement and improvement activities, as well as a recap of AIRA’s evaluation findings on the impact of AIRA activities and products. The rest of the day consisted of dialog on topics such as improving provider participation in IIS and completing the transition of AIRA’s Cooperative Agreements to an OSTLTS funding mechanism. On day two of the meeting, discussion focused on continuing, new, and emerging partnership opportunities to help achieve strategic priority goals for sustainability, enhancing performance, promoting standardization, and influencing the health IT space. On the third day of the meeting, partners from Chickasaw Health Corporation joined the meeting to discuss interoperability next steps and how we can better coordinate EHRs and IIS to influence the health IT space.

Key takeaways from the three-day meeting included appreciation for the high levels of participation and collaboration in the IIS community and that progress is being made. The meeting was beneficial to AIRA and provided an opportunity to give progress updates and discuss key strategic issues impacting the IIS community. 

The MQE Tool Sprints Ahead!

On October 1, 2018, the immunization community took the lead for all development on the Message Quality Evaluation (MQE) Tool. A cadre of people from the Joint Development & Implementation Advisory Workgroup (JDI) and AIRA have been organizing efforts up to this point.

The new MQE Project Team, comprised of a technical team, tool testers and non-technical staff, meets monthly to discuss the tool’s new and planned functionalities, test them, and decide what to develop next. Erin Maurer O’Shea (Tennessee) facilitates these conversations, while AIRA provides administrative support.

This type of collaborative model is a new one for the community. AIRA and the project team are excited to see how it grows and what we can learn to apply to other joint development projects.

A Peek into the Technical Development Process

A core group of technical staff works on the code and functionality each month, using Agile Methodology, an approach to technical projects that employs incremental, iterative work sequences called “sprints.”

During the project’s beginning months, the technical team worked simultaneously several hours a day every day for a full week each month. They used tools that facilitated remote collaboration under the leadership of Michelle Barber, an AIRA consultant. Starting in September, the new technical team adopted and modified that model and now work together remotely for one full day each month, with Michael Powell (California) serving as “scrum master,” or process facilitator. Working for a complete day allows the team to minimize interruptions and maximize their focus on coding.

Have questions and/or want to get involved? Please email Maureen Neary.

Update on Measurement and Improvement: The Latest on Validation

Measurement and Improvement took a big step forward when the content areas of submission/acknowledgement and query/response moved into the validation stage. Thank you to all the IIS programs and vendors working to align their systems with standards. We continue to show improvements across all areas of measurement each month. 


The content area of transport has now been measured quarterly since the third quarter 2016, with the most significant gains seen in IIS’ meeting the security fault measure.

Some of the improvements listed below are called out in the latest assessment report for submission/acknowledgement:

Passed all measures: 10 IIS have successfully passed all measures and tests. No IIS passed all measures during the initial baseline measure.

Accepts minimally required messages: 20 IIS can now accept messages that contain only the required fields as specified by the National IG (Measure 10). This is an increase of eight IIS since the initial baseline.

These gains translate into results in the latest basic validation report. Forty-seven sites were tested for alignment with standards in submission/acknowledgement. Thirty-four of these 47 connected IIS (72%) became validated or validated with minor differences at the basic level for submission/acknowledgement.

Readers may note the change in color schemes for these maps; MACAW discussed the colors and agreed that gradations of green were better for representing both who was being measured and who met measures for current and upcoming content areas.

For query/response, we now have 43 IIS that are capable of responding to a query message and are being actively measured. We look forward to seeing significant gains in query/response conformance in the coming measurement cycles.

Clinical Decision Support – Coming Next!
The measures and tests for Assessment for Clinical Decision Support were published in June 2018. The first testing phase will take place this fall, with measure thresholds recommended by MACAW and presented to the AIRA board by the end of 2018. Stay tuned for more data and information on this next content area of measurement!

For more information on Measurement and Improvement, contact Kristi Siahaya.

Be Part of the Solution for Improving Provider IIS Participation 

Provider participation is the cornerstone of every immunization program and every IIS. Low provider participation creates gaps in the documentation of immunizations. These gaps negatively impact vaccine forecasting, coverage assessment, and coverage rate improvement efforts. Nationally, about 85% of providers participate in an IIS. This rate is well below the national target of 95% participation.

Among awardees, IISs report participation ranging from less than 47% to as high as 100% for VFC providers. For non-VFC providers, the IIS participation statistics aren’t as good, starting below 35% with only a few IIS reporting over 82% IIS participation.

We can do better!
CDC initiated a collaborative project to establish a community of practice, provide individualized technical assistance, and support the efforts of seven (7) awardees to improve provider participation in their IIS. This project will help us develop best practices for improving IIS provider participation nationally.

There are two ways your IIS team can be part of the solution:
1. Participate as a member of the community of practice.
2. Mentor community of practice members.

To be considered for the collaborative or to volunteer as a mentor, contact Jan Hicks-Thomson by email ([email protected]) or at 404-718-1555 by November 13. Awardees interested in being part of the collaborative or volunteering as a mentor will be invited to the project kick-off call in late November.

PHII Launches ‘Welcome to IIS’ Email Course

Do you need to strengthen your new IIS employee orientation materials? Or are you taking on more managerial or administrative responsibilities and want to learn more about how IIS are staffed and operated? PHII’s new flagship course, Welcome to IIS, has the answers you’re looking for.

This 18-day email course builds foundational knowledge of IIS in bite-sized daily emails (Monday through Friday only). In less than 10 minutes a day, learn what IIS are, how they work, and how they’re supported. Each email includes resources and activities, so you can apply what you learn to your own organization.

Whether you’re new to IIS or just need a refresher in how it all fits together, the Welcome to IIS course is designed to fit your needs. To start the course, sign up now at, and you’ll receive the first email right away. It’s completely free, and you can unsubscribe at any time.

HIMSS19 – Champions of Health Unite 

The 2019 HIMSS Global Conference & Exhibition will be February 11–15, 2019, in Orlando. HIMSS is a health information and technology conference that brings together over 45,000 professionals for the education, innovation, and collaboration they need to transform health through information and technology. 

AIRA is proud to be a Collaborator of HIMSS19. As such, our members receive the member discount to attend! To receive the discount, go to the conference website and select “Register Now.” Select AIRA from the “Conference Collaborating Organizations” drop-down in the registration process and enter the code "COLLABH19”.

CDC Wins an Award!

Kudos to the Immunization Information Systems Support Branch (IISSB) of CDC for its receipt of a 2018 Business Rules Excellence Award in the Innovation category, a new awards program administered by Future Strategies, Inc. IISSB used a business rules approach to streamline and increase effectiveness of several projects. 

Several years ago, IISSB began to implement a business rules approach to address issues with communication and interpretation of common IIS rules. The approach evolved from the introduction of new analysis techniques and a new RuleXpress tool to the expansion of the approach to other areas within IISSB.

The Modeling Immunization Registry Workgroup (MIROW), a joint committee of IISSB and AIRA, was the first to adopt the analysis techniques, using them to facilitate the capture of principles and business rules for operational best practice guides. The MIROW group is starting to leverage the RuleXpress tool to identify areas of inconsistency in terminology and recommend improvements.

Next, IISSB focused on Clinical Decision Support for Immunization (CDSi). This involved understanding the terminology used by the Advisory Committee on Immunization Practices (ACIP), interpreting ACIP recommendations, and expressing them in the form of business rules and decision tables. The result was a well-defined CDSi Logic Specification that provides the IIS community with a common solution for vaccine evaluation and forecasting.

Most recently, the IIS Functional Standards, and the logic for measuring progress toward meeting the standards (based on IIS Annual Report (IISAR) data), have been captured in the RuleXpress tool to facilitate management of the relationships between the standards, operational guidance statements, and progress toward goals.

These changes involved introducing new ways of thinking as well as analysis techniques such as structured business vocabulary, decision tables, and business rule analysis.

The benefits have included:
• Better communication among stakeholders
• Improved reusability, consistency, and accuracy of business rules
• Decision logic understood and validated prior to system design
• Comprehensive impact analysis for changes to business rules

AIRA Wins an Award Too!

You may remember that AIRA launched a new website and membership database in February.

Well, guess what. We won an award of excellence for the best overall usage of the platform.

I guess we’re getting our money’s worth! 


AIRA 2019 National Meeting Planning Kicks Off

AIRA staff rendezvoused in beautiful Beacon, New York for an two-day, in-person #AIRA2019 planning meeting. From breakout sessions to swag, Alison Chi, Carmela Gupta, Ketti Turcato, Brittany Gyer, Amanda Branham, Maureen Neary, and Kristi Siahaya got into every detail and kicked preparations into high gear! So, if you haven’t already, save the date for #AIRA2019, August 13–15, 2019, in Indianapolis, Indiana. It’s AIRA’s 20th anniversary and we promise it will be unforgettable! 

Recent Information Requests Added to the AIRA Repository

Recent Information Requests regarding removing imprecise records and contraindication for “All Vaccines” have been added to the AIRA repository and can be found by using the “Information Requests” filter. Information Requests are viewable only by individual members and individuals affiliated with member and partner organizations. Just log in to view these valuable resources! If you have any questions, please email membership coordinator Amanda Branham.

Steering Committee Updates: October Recap

Assessment Steering Committee

  • The Assessment Steering Committee (ASC) meets quarterly, and the next meeting is scheduled for December 4.

Education Steering Committee

  • The Education Steering Committee (ESC) met on October 17 and received an update from the Public Health Informatics Institute on its live “Welcome to IIS” email course and immunization evaluation and forecasting eLearning module.
  • The ESC briefed the group on the current Education Plan and began planning for the next year.
  • Articles for the next edition of SnapShots are due to Katie Reed by Friday, November 9.
  • The committee also was updated on 2019 National Meeting planning and webinars for the upcoming year.

Standards and Interoperability Steering Committee

  • The Standards and Interoperability Steering Committee (SISC) met on October 10 and discussed the Interoperability Standards Advisory comments submitted by AIRA.
  • The SISC also engaged in a committee discussion about CVX codes for trial vaccines, OBX-14 date, and genders that IIS are able/want to accept.
  • The committee began discussing ballot comments and covered naming local documentation.
  • The SISC Technical Workgroup met on October 24 and reviewed ballot comments, proposed resolutions, and accompanying comments from SISC members regarding truncation, VIS, and profile IDs starting with a Z.

MIROW Steering Committee

  • The Modeling of Immunization Registry Operations Workgroup (MIROW) Steering Committee (SC) met on October 11 and discussed the new MIROW topic (business continuity), the status of the MIROW subgroup projects, and it reviewed the turnaround document for the MIROW session at the AIRA National Meeting.
  • The MIROW Small Group is currently drafting a detailed outline of the Business Continuity Guide and planning for the subject matter expert face-to-face meeting in January.
  • Three MIROW subgroups continue to work, respectively, on repackaging past guides, creating a common vocabulary document for all MIROW guides, and promoting the work of MIROW.