Interorganizational systems without hierarchy: immunization information systems

The 2020-2021 COVID-19 pandemic spurred change across multiple healthcare industries. This study explores how managing vaccination data in the United States of America required cooperation among many different organizations necessitated by an emergency response. We studied how individual states interacted with the federal government to address the need for vaccination-related information during the pandemic.

In total, 11 interviews were conducted with individuals responsible for collecting vaccination data and reporting it to the US Federal Government. Seven of those individuals were directors of USA jurisdictional Immunization Information Systems (IIS). Archival data were also combined with the interview responses to inform the analysis and development of guidelines.

States across the USA had different ways of tracking and storing immunization data that was heavily influenced by state-level and federal legislation. The lack of a universal patient identifier made cross-state patient identification difficult. Federal requirements for reporting dictated much of how the different state-level entities collected, stored and reported data.

This study highlights the importance of data interoperability and data sharing by exploring how a loosely coupled set of entities without direct top-down control or a profit motive can govern data effectively. Our analysis provides greater clarity about the interactions between different stakeholders in a complex system.

This study presents primary interviews of 11 individuals, each responsible for tracking and reporting immunization information. Analysis of the data expands existing research on IIS on data sharing, system interoperability and dynamic pandemic responses.