Two Public Health Systems, One Goal: How Immunization and Vital Records Systems Work Together

As families prepare for a new school year, many find themselves looking for two familiar documents - a birth certificate and an immunization record. It is a routine part of school enrollment, but few people stop to consider where those records originate. Those records come from two distinct public health data systems, vital records and immunization information systems, each serving different purposes but together helping families and schools verify the information needed for enrollment.

With back-to-school season underway, it is a timely opportunity to look at how these systems intersect and why that connection matters.

What Each System Does

Both systems are maintained and operated jurisdictionally, within all states and several large cities, islands, and territories.

Immunization information systems, or IIS, consolidate vaccination records from providers across the health care system (pharmacists, pediatricians, health departments, etc.) into a more complete record for each person. Providers use IIS to see an individual's vaccination history and determine what vaccines may be due, while health departments use the data to understand vaccination coverage across populations. Today, 61 IIS operate across the US, US Territories and Freely Associated States. 

Vital records offices and our National Vital Statistics System, register every birth and death in the United States and maintain the legal record of who was born, and when and where that birth took place. This document serves as the very first proof of legal age, identity, and citizenship. There are 57 vital records jurisdictions across the US and US Territories.

Together, these systems help support the public health needs of Americans.

Where the Systems Meet

In many jurisdictions, birth data are transmitted electronically from vital records into the IIS. This creates an IIS record early in a child's life and helps establish the population of children a jurisdiction expects to serve.

Mortality data can play an equally important role. When IIS records are reconciled with death records, health departments can more accurately identify the population they are measuring. Without that reconciliation, IIS may include people who have died, distorting population estimates and vaccination coverage rates.

That matters because coverage rates guide public health decisions, from identifying communities that may benefit from additional outreach to planning vaccination efforts. Better data exchange produces a more accurate picture of who is protected and where gaps remain. More accurate information helps public health agencies use limited resources more strategically by targeting outreach and interventions where they are most needed.

How This Supports Patients and Families

For families and providers, this data exchange often becomes visible only in its results: a more complete vaccination history, fewer records to track down, and better information available when care is provided.

A family may never know that vital records helped establish a child's IIS record or that mortality data improved a health department's population estimates. A parent enrolling a child in school can access a more complete immunization record without having to reconstruct it from multiple providers or past clinics. That invisibility is, in many ways, a sign that the systems are doing what they are supposed to do.

Across the country, IIS respond to roughly 145,000 queries per system on an average day from providers, pharmacists and other authorized users seeking vaccination records and information about vaccines that may be due. This volume illustrates how routine this exchange of public health information has become.

More Work Ahead

None of this integration happens automatically. It depends on provider participation, strong data standards, accurate exchange between systems (electronic health records/health systems, vital records, IIS, etc.) and data-sharing agreements and operational processes that make data sharing possible.

When those connections work well, information can move between IIS, electronic health records, pharmacies, and other public health systems with little visibility to the people using it. Where they do not, providers and public health agencies may be working from an incomplete picture.

Public health information systems cannot prevent every missed vaccination. But better-connected systems can shorten the distance between reliable information and the people who need it to make decisions.

The American Immunization Registry Association (AIRA) supports the IIS community and the data standards and best practices that help enable immunization data exchange. The National Association for Public Health Statistics and Information Systems (NAPHSIS) represents the state offices that hold vital records.

Both communities have made substantial progress in connecting once-siloed systems, but the work is far from finished. Continuing to strengthen those connections will make public health data more complete, accurate and useful.

If your organization has worked through an integration barrier between immunization and vital records data, share what you did and learned in the comments. We may feature those experiences in a future post.

Workforce Development Spotlight: IIS and Vital records

A skilled workforce is essential to IIS and vital record systems. Maintaining these systems, exchanging data across organizations, and adapting to evolving technology and standards all depend on staff with current technical and operational knowledge.

Workforce development resources include:

- AIRA Interoperability Course Series: self-paced HL7 and interoperability training for IIS staff

- AIRA Trainings: onboarding videos and technical assistance for new IIS staff

- PHII IIS Learning Hub: central training and tools hub for the IIS workforce

- PHII IIS Role Description Curricula: competency-based learning paths for 12 IIS roles

Additionally, NAPHSIS provides several in-person trainings for vital records staff on topics such as Data Management, Data Quality, and Statistics and Data Innovation.