AIRA 2018: Is Open Source the Key to Immunization Software Sustainability?

On August 14-16, 2018 the American Immunization Registry Association (AIRA) held its 2018 National Meeting. This meeting brought together more than 350 informatics professionals, public health officials, EHR vendors, and other stakeholders who all care passionately about Immunization Information Systems (IIS) and their role in the healthcare community.

Noam Arzt and Bill Brand engage in a “fireside chat”IIS projects leverage interoperability with EHRs, PHRs, and other systems to promote clinical practice at the point of care; enable public health surveillance, and reduce cost by assisting in preventing both under and over immunization.

Perhaps the key issue that seemed to dominate the meeting was the notion of sustainability. For some this refers to the challenges of financial sustainability due to the traditional underfunding of IIS projects which rely primarily on Federal funds. For others this refers to political sustainability, as IIS compete with other projects for limited technical staff in an environment where agency-wide or even state-wide information technology consolidation threatens to move IIS projects further from the Immunization Programs they support, just at a time when more complete data and richer functionality have improved their usefulness to support Program initiatives and activities. And others worry about technical sustainability as technical obsolescence of IIS products increases with software’s age, vendor market consolidation continues, and investment in new software is limited.

As a gold sponsor, HLN had an exhibit table at the meetingOpen Source is one potential solution to this set of long-term sustainability concerns. It reduces not only the cost of software acquisition but also the total cost of ownership if proper support structures and community support exist. It can reduce the burden of working with internal IT organizations as system deployments can be done more speedily with a reduced need for financial oversight. And newer technologies can be leveraged, especially if more modular systems are selected and deployed. At HLN, we have been at the forefront of Open Source software for IIS, first with our Immunization Calculation Engine (ICE) evaluation and forecasting engine, and soon with a fully open-source IIS product based on the New York City Citywide Immunization Registry (CIR) which HLN has been developing and supporting for almost twenty years.

Yet the Centers for Disease Control (CDC) remains unconvinced. A senior CDC official told me at the conference that Open Source is an “unproven strategy” which may or may not benefit IIS development and sustainability. Vendor products, according to this individual, are more reliable and therefore less risky. I respectfully disagree. While vendor products will likely have a place for the foreseeable future in the IIS marketplace, a more purposeful investment in Open Source technologies will go far to ensure more sustainable IIS products. With a limited market the stability of commercial vendors is not guaranteed, nor is ongoing cost-effectiveness of commercial software development for Immunization Programs who have to manage competing priorities at the program and agency levels.

Mike Berry and Noam Arzt give a talk about ICEOne of the keys to sustainability for CDC over the next few years is encouraging IIS to become more uniform and less customized. If CDC wants to be successful in encouraging this uniformity Open Source software can be an active component of this strategy. Commercial vendors actually generate significant revenue today from product customization in this space and a reduction in customized solutions will adversely affect the attractiveness of the market. If uniformity is inevitable, Open Source is a natural enabler. But CDC must consider how it can use its own resources to encourage an enable Open Source development.

As a gold sponsor of the meeting, HLN showed its strong commitment to the Immunization Information System (IIS) community by delivering several presentations during this conference, including:

• Strategies for Evaluating and Integrating SmartyStreets [with RI]
• IIS Platform or Module Migration – Is Your Program Prepared? [with CDC, AIRA & PHII]
• CAIR2 Patient Matching: Solving the 25 Million Piece Puzzle [with CA]
• IIS Past, Present, and Future: A Conversation and a Discussion [with PHII]
• Comparative Analysis of AFIX-IIS Tools [with CA]
• Cloud-Based Solutions: A Good Option for Hosting CDS for Immunizations
• Vaccines For Children (VFC)-IIS Integration Strategy [with CA]
• ICE: An Open Source Option for Immunization Forecasting
• Hearing from Everyone: Diverse Perspectives to Improve Oregon School Immunization Reporting [with OR]

Finally, Dr. Noam Arzt, President of HLN received the 2018 Volunteer Service Award from AIRA.