COVID-19 Vaccine IT Overview

The Vaccine Tracking System (VTrckS) is the Centers for Disease Control and Prevention’s (CDC) vaccine order management system, which supports routine vaccination with almost 80 million doses of vaccine annually. CDC uses VTrckS as its platform for ordering all COVID-19 vaccines. VTrckS users—the 64 state, local, and territorial public health jurisdictions and enrolled national provider organizations (i.e., the Department of Veterans Affairs, Department of Defense, Indian Health Service, Bureau of Prisons, and pharmacy chains participating in COVID-19 vaccination) —use VTrckS to:

• View vaccine allocations for each program
• Place and manage vaccine orders for their providers
• Generate reports throughout the vaccine distribution process, from vaccine order placement through distribution
• Track vaccine shipments

As part of the overall IT infrastructure to support COVID-19 vaccination, VTrckS can receive or exchange data with the following systems or organizations:

• VTrckS ExIS Portal: Jurisdictions together with federal and commercial partners connect with the portal or directly with VTrckS to submit vaccine orders, enrolled provider master data, as well as vaccine inventory, return, and wastage information. In return, VTrckS provides vaccine shipment data via downloads to the jurisdictional IIS.
• McKesson, the VTrckS logistics contractor: McKesson receives orders from VTrckS, directs vaccine manufacturers to ship vaccines, and transmits vaccine shipment details from providers to VTrckS.
• Federal data and reporting systems: The Immunization (IZ) Data Lake receives data feeds from VTrckS related to provider data, orders, shipments, inventory, and allocations.

Immunization Information Systems (IISs) were formerly known as “immunization registries.” All 64 jurisdictions have or will soon have web-based IISs. Some IISs are hosted by vendors in the cloud, while others use secure servers housed by the jurisdiction. The IISs vary by jurisdiction in several ways:

• Systems have varying capacity to automate processes and to handle a large volume of data.
• There can be significant variations in data quality across IISs, sometimes due to data reporting policies.

Vaccine recipients and enrolled providers (e.g., clinics, healthcare systems, pharmacies) use IISs to access people’s vaccination records. The 64 jurisdictions use their IISs to support providers by:

• Creating a centralized data repository for vaccination information specific to that jurisdiction
• Approving vaccine orders from enrolled providers and submitting orders to VTrckS
• Monitoring vaccine distribution and changes in vaccine inventory, including accounting for wasted, spoiled, expired, and transferred vaccine
• Providing vaccination coverage assessments

Most IISs can:

• Provide unidirectional or bidirectional data transmissions for providers
• Connect with local/state Health Information Exchanges
• Connect to the IZ Gateway to share and receive information from national providers and other IISs

In addition, IISs collect data from public and private healthcare provider organizations (e.g., electronic health records), health information systems (e.g., vital statistics, state Medicaid agencies), and pharmacies. IISs share these data with the IZ Gateway, CDC, and other jurisdictions if an agreement is in place. IISs also share vaccination records with healthcare providers and individuals.

As part of the overall IT infrastructure to support COVID-19 vaccination IISs connect with:

• VTrckS for information on submission of vaccine orders; access to vaccine allocations; submission of data on wasted, spoiled, or expired vaccines; and viewing of user reports
• VAMS (see below for details), if used by the jurisdiction
• Federal data and reporting systems: IISs send vaccine administration data to CDC via the IZ Gateway or through submission of extract files to the CDC Data Clearinghouse

The Vaccines.gov website helps people find providers who offer select vaccines. Vaccines.gov also allows healthcare providers to list their vaccination locations in a centralized, searchable database and to track vaccine supply.  Vaccines.gov serves two roles in the COVID-19 vaccination program:

1. Inventory reporting (required for all COVID-19 vaccine providers): Providers report on-hand COVID-19 vaccine inventory each day through Vaccines.gov.
2. Increase access to COVID-19 vaccines (optional for COVID-19 vaccine providers): CDC encourages the public to use Vaccines.gov to find locations offering COVID-19 vaccine.

As part of the overall IT infrastructure to support COVID-19 vaccination Vaccines.gov sends data to and receives data from the IZ Data Lake.

The IZ Gateway is a cloud-based message routing service intended to enable data exchange between IISs, other provider systems, and the IZ Data Lake. The IZ Gateway enables centralized data exchange and eliminates the need for multiple, individual, point-to-point connections. The IZ Gateway enables IISs, federal agencies, and providers to update, query, and report immunization data. The IZ Gateway allows:

• IISs to report data to the COVID-19 Data Clearinghouse
• Cross-jurisdictional queries and data exchange
• Multijurisdictional providers to share data with multiple IISs via a central connection
• VAMS data to be routed to the IIS where applicable

Vaccine Administration Management System (VAMS) is an easy-to-use, secure, online tool to manage vaccine administration from the time the vaccine arrives at a clinic until it is administered to a recipient. VAMS is free for public health-approved clinics, and can be used on computers, tablets, and other mobile devices. It is not a smartphone app, and no installation or download is required for this web-based platform. VAMS has robust security that is shared with Amazon Web Services, which is certified by the Federal Risk and Authorization Management Program (FedRAMP). The guidelines used for VAMS hardware and/or software components are covered in the National Institute of Standards and Technology (NIST) 800-53 Revision 4, which addresses 376 Security Controls covering all security concerns to address the confidentiality, integrity, and availability of information contained within VAMS.

VAMS has modules to support four specific user groups:

VAMS allows jurisdictions to provide end-to-end vaccination and manage vaccination clinics. Specific functions include:

• Adding clinics and clinic administrators
• Adding employers/organizations and employer coordinators
• Actively managing lists of clinics for jurisdictions (adding, deactivating, importing clinic information)
• Managing jurisdiction vaccine inventory
• Providing VAMS-related support to clinics and employers

VAMS facilitates patient scheduling, vaccine administration workflow, and patient monitoring. Specific functions include:

• Supporting social distancing requirements within the scheduling feature
• Tracking vaccine inventory and usage
• Creating patient vaccine administration records
  Note: VAMS does not support vaccine ordering. Ordering is done through the normal vaccine ordering process (i.e., VTrckS).

VAMS allows these groups to bulk input employees, who will receive an email to register in VAMS so they can schedule an appointment to receive a COVID-19 vaccination.

VAMS provides an easy way for COVID-19 vaccine recipients to schedule vaccination appointments, receive a record of vaccination, and receive appointment reminders for the second dose of the specific vaccine they received if and when a second dose is needed.

The COVID-19 Data Clearinghouse is a cloud-hosted data repository that receives, deduplicates, and deidentifies COVID-19 vaccination data that are then used to populate the IZ Data Lake with deidentified data for analytics.

The IZ Data Lake is a cloud-hosted data repository to receive, store, manage, and analyze deidentified COVID-19 vaccination data. CDC, jurisdictions, federal agencies, and pharmacy partners uses the IZ Data Lake to store and process administration, coverage, logistics, inventory, ordering, distribution, and provider data. VAMS, IISs, pharmacies, VTrckS, and Vaccines.gov will provide data for the IZ Data Lake. The IZ Data Lake also aggregates and analyzes data and provides data summaries and analytics via these reporting hubs:

• Data Storefront
• Department of Health and Human Services’ HHS Protect data hub
• Tiberius, a COVID-19 vaccine distribution planning, tracking, modeling, and analysis application

Privacy-preserving record linkage (PPRL) allows jurisdictions and other entities reporting vaccination data to safeguard protected health and personally identifiable information and improve data quality.  With PPRL, jurisdictions and other reporting entities can share vaccine administration information without providing personally identifying data to the Centers for Disease Control and Prevention (CDC) or other parts of the federal government, instead assigning a unique identifier to the data.

The broad use of PPRL offers several benefits. Jurisdictions can more accurately track a patient’s vaccination history by matching identifiers, even when the patient received vaccinations in multiple jurisdictions. Epidemiological surveillance is improved because public health officials have access to more accurate vaccination data without the identity of the patients being revealed.

Jurisdictions need to add only one step to their reporting workflow to implement PPRL. Onboarding can take as little as one day. For additional information, jurisdictions should contact their immunization information system subject matter experts.