Mary doesn’t know if she qualifies for the COVID-19 booster shot. When she was vaccinated, they gave her a card, but she can’t find it and doesn’t remember when she had her original shots or which manufacturer made them. However, when she contacts her health insurance provider, she is surprised and pleased to discover that the provider has this information – even though she didn’t give it to them. Now she knows she’s eligible for the booster and what kind she should get.

John thought the COVID-19 vaccine might be a good idea but hasn’t had the time to figure out where he can get it. He is surprised to get a knock on his door. Someone from the state health department is canvassing the area because it has been identified as a pocket of low vaccination rates. The worker is informing residents how and where shots can be obtained. John sets up an appointment for the next day at a location right in his neighborhood.

Both scenarios are made possible by states’ efforts to improve health outcomes with innovative data sharing and analytic cloud-based solutions.

Enjoying the Cloud Advantage

The pandemic created an instant and widespread need for better data sharing about infections and treatment, pushing states to revolutionize their healthcare IT and address new challenges with cutting-edge technology. For many states, the biggest key to success has been moving to the cloud.

In a recent webinar about revolutionizing patient care through IT, Jim Daniels, public health leader for Amazon Web Services (AWS), observed, “It’s not the time to do a rip and replace in the middle of a pandemic. But we can definitely shift systems to the cloud to get some of that scalability. And then, as there are gaps, start building those microservices around your core existing technology.”

Throughout the country, states have found innovative ways to use cloud-based IT solutions to provide constituents and organizations with vital information about COVID-19 and supply valuable analytics capabilities to state leaders.

Providing Information to Constituents

Mary’s situation is not uncommon; people often lose their immunization cards or leave them at home. They may have received a vaccination at a hospital, drug store, doctor’s office, drive-through clinic, or any number of other locations. Tracking down vaccination information can be quite difficult for state residents, but without it, they may not be able to receive their required second dose or seek out booster shots.

Some states have devised programs that allow constituents to locate their immunization records in a self-service way and share the information with others. For example, Louisiana ties immunization information to the pre-existing data in its motor vehicles records. Residents who choose the LA Wallet program can share their COVID-19 status with others. The information can be accessed not only by residents, but also by businesses, schools, sports events, entertainment providers, and other venues, with permission, to protect public health and data privacy.

“The consumer information has already been verified through the Department of Motor Vehicles,” said Quan Le, immunization system manager for the Louisiana Department of Public Health. “And that definitely reduces our verification process tremendously.” The State of Louisiana can also use LA Wallet’s centralized, reliable records to notify residents about booster availability.

Many state IT leaders anticipate that such programs will become more valuable as airlines, nations, and other institutions issue vaccine mandates and seek verified vaccine information. As Daniels noted, “Making sure that there’s real viable information about your immunization status is going to be critical.”


Sharing Data With Third Parties

The pandemic created an enormous need for states to share health data with third parties as well as individuals. Before COVID-19, Massachusetts had a manual process for checking vaccination status. For example, if a region experienced an outbreak of measles cases, public health workers could check on the immunization status of people exposed. However, the pandemic required the state to handle thousands of queries at a time, which was impossible with a manual process.

Records are now available through the Massachusetts Immunization Information System (MIIS), a web-based immunization registry that gives healthcare providers and families a tool to help make sure that all individuals are immunized based on the latest recommendations. At the start of the pandemic, MIIS was an on-premises system that was could not handle the volume of queries it received. In addition, MIIS was not designed to provide access for health insurance providers.

After the state moved MIIS to a cloud-based system, Kevin Cranston, associate commissioner for the Massachusetts Department of Public Health, said, “We onboarded 28 entities – insurance companies …  as well as a number of large providers and [granted] them bulk querying capability. We are currently seeing about 10,000 records per hour being queried by this group.”

The department was also able to quickly generate an export of COVID-19 immunizations for the state’s Medicaid office, Cranston said. Records access has helped payers to remind members like Mary about booster shots.

Like Massachusetts, Minnesota also found that the volume of queries from health insurance providers strained its system. Miriam Muscoplat, immunization information systems manager for the Minnesota Immunization Information Connection, explained, “We’ve had an existing relationship with our insurers … what we didn’t have was a good way to allow them to query our [information system] without putting considerable strain on the system itself.”

To solve this problem, Minnesota stood up a data lake and built a querying feature. The new technology “doesn’t interfere with the application itself, or any of the daily, ongoing transactions at all, Muscoplat said. “But it still has up-to-date information, and it can run much, much, much more quickly than it ever could in the application.”

In addition to reducing the burdens on the state’s information system, the data lake has also helped the state and insurance providers identify gaps in pediatric immunizations for various illnesses.

Enhancing Capabilities With Data Analytics

Data analytics capabilities have also proved useful in fighting the pandemic. The Minnesota Department of Health (MDH) uses data analytics to link data about new COVID-19 cases to information about who has received the vaccine and where they live. Pockets of vaccine breakthrough cases are identified by actively matching Minnesota COVID-19 case records with vaccination records. By applying data analytics, the state can note potential trouble spots. Eventually the system will help MDH evaluate the impact of booster shots.

John’s story above is another example of data analytics at work. Minnesota is collaborating with health insurance providers to identify people in ZIP codes with high social vulnerability index scores and contact them about vaccination. A two-week pilot program that conducted outreach through text message contributed to a six-fold increase in walk-in vaccine appointments. Such data analytics can enable more equitable vaccine distribution.

Data analytics is also useful in managing and cleaning up unreliable data. Self-service portals benefit constituents and save state workers time, but the data – particularly about ZIP codes and other address data – can be incorrect. Minnesota uses artificial intelligence (AI) and machine learning (ML) to clean up data on the back end and integrate with various providers to make sure they get consistent data. AI and ML can also spot patterns of inaccurate data from specific information submitters.

Data analytics and automation also make it simpler for states to create de-identified data for the purposes of statistical research – a process that had been manual in the past.

Improving Access and Interoperability

Although states have made enormous strides over the past two years, they are still facing challenges –particularly with sharing immunization information across state lines. Data sharing agreements can ease this process. Many residents of Minnesota, for example, go south in the winter. So a state like Minnesota may find itself creating a data sharing agreement with states as far flung as Florida and California.

Privacy concerns present another challenge. States must collect constituent data in accordance with existing policies. But when individuals control the information exchange, many privacy concerns can be sidestepped. Some states are developing consumer access portals that would allow the citizens of one state to create a record about receiving a vaccination in another state.

Data interoperability between states is another persistent problem. Le observed, “In the near future I think our challenge is … cross-jurisdictional data exchange interoperability and the ability for the jurisdiction to have a data sharing agreement in place or have a streamlined process so that we don’t have a long time to approve. Because I think the technology is there already.”

For example, health officials in Louisiana can easily share their records with their counterparts in Mississippi but find it much more difficult to share records with Texas. Likewise, health officials in Maryland can more easily share information with Delaware than Pennsylvania. Interoperability and access are particular issues in the age of COVID-19, hampering not only record keeping but also states’ ability to notify people about booster shots.

Despite these challenges, many state IT officials are optimistic about what they can accomplish with data in the future. Muscoplat observed, “We have set ourselves up to do things that I never imagined we’d be able to do by moving some of our technologies into the cloud.” She added, “I think there’s a lot more that we can do that … [allows] us to look at our data in ways that we never have been able to before and … that possibility is really exciting.”

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