title: Technological and Organizational Context around Immunization Reporting and Interoperability in Minnesota.
abstract: BACKGROUND
  Immunization information systems (IIS) operate in an evolving health care landscape with technology changes driven by initiatives such as the Centers for Medicare and Medicaid Services EHR incentive program, promoting adoption and use of electronic health record (EHR) systems, including standards-based public health reporting. There is flux in organizational affiliations to support models such as accountable care organizations (ACO). These impact institutional structure of how reporting of immunizations occurs and the methods adopted.
  
  
  OBJECTIVE
  To evaluate the technical and organizational characteristics of healthcare provider reporting of immunizations to public health in Minnesota and to assess the adoption of standardized codes, formats and transport.
  
  
  METHODS
  Data on organizations and reporting status was obtained from Minnesota IIS (Minnesota Immunization Information Connection: MIIC) by collating information from existing lists, specialized queries and review of annual reports. EHR adoption data of clinics was obtained in collaboration with informatics office supporting the Minnesota e-Health Initiative. These data from various sources were merged, checked for quality to create a current state assessment of immunization reporting and results validated with subject matter experts.
  
  
  RESULTS
  Standards-based reporting of immunizations to MIIC increased to 708 sites over the last 3 years. A growth in automated real-time reporting occurred in 2013 with 143 new sites adopting the method. Though the uptake of message standards (HL7) has increased, the adoption of current version of HL7 and web services transport remains low. The EHR landscape is dominated by a single vendor (used by 40% of clinics) in the state. There is trend towards centralized reporting of immunizations with an organizational unit reporting for many sites ranging from 4 to 140 sites.
  
  
  CONCLUSIONS
  High EHR adoption in Minnesota, predominance of a vendor in the market, and centralized reporting models present opportunities for better interoperability and also adaptation of strategies to fit this landscape. It is essential for IIS managers to have a good understanding of their constituent landscape for technical assistance and program planning purposes.
authors.affiliation: Public Health Informatics Program, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sripriya
authors.initials: S
authors.lastname: Rajamani
authors.affiliation: Minnesota Immunization Information Connection (MIIC), Immunization Program, Minnesota Department of Health, St. Paul, Minnesota.
authors.forename: Erin
authors.initials: E
authors.lastname: Roche
authors.affiliation: Office of Health Information Technology (OHIT) and Minnesota e-Health Initiative, Minnesota Department of Health, St. Paul, Minnesota.
authors.forename: Karen
authors.initials: K
authors.lastname: Soderberg
authors.affiliation: Minnesota Immunization Information Connection (MIIC), Immunization Program, Minnesota Department of Health, St. Paul, Minnesota.
authors.forename: Aaron
authors.initials: A
authors.lastname: Bieringer
keywords: EHRs; immunization reporting; interoperability; public health informatics; standards