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November marked the five-year anniversary of Rebecca Coyle becoming Executive Director of AIRA, the American Immunization Registry Association. In this issue we get to know Rebecca better, and invite her to reflect on her career, her years with AIRA, and what's to come.
 
 
 
Speak Softly and Carry a Big Carrot
By
Dale Dauten
 
 
Has anyone ever asked a second-grader what career they aspire to and heard, "Immunization Information"? If you have, let us know . Meanwhile, we continue to be interested in how people come to work in IIS. For Rebecca Coyle, it came after starting out to be a teacher. While working on her degr ee at the University of Idaho, thinking she might like to be in health education, she took a part-time job with the Red Cross teaching CPR and first-aid. She loved the work, but before long found herself assigned to go into high schools to handle the HIV module, a topic too touchy for many high school teachers. That's whe n she found herself yearning to get back to working with adults. So she backed out of student teaching and began paying attention to a college pal who'd ended up working in immunization.
After graduation, she took a job working with Idaho's immunization registry, mostly working with schools and childcare providers. She next spent time with the CDC as a Public Health Advisor in Minnesota, then returned to Idaho as a Program Manager in the immunization program. Those years included the triumph of moving Idaho from an opt-in to an opt-out approach for the IIS. Soon after, she began her time with AIRA.
We asked Rebecca to reflect on what she's learned thus far in her immunization work.
 
1. Understand the push-back before you push.
Like most Western states, Idaho has those who are suspicious of government policies and the people who suggest them, including many in the state legislature itself. Understanding this, when it came time to seek an immunization opt-out system in Idaho, Rebecca understood that the push must come from providers, not state employees.  She says, "If we as state employees had said, we want to make this change, the legislature would have scoffed at us. We wouldn't have gotten anywhere." So Rebecca and her colleagues in the state's health department began supporting the efforts of providers and it was the Idaho Medical Association who proposed the change. Included in the proposal was a requirement for providers to report doses administered to the IIS.
 
2. It's not one journey, it's 55 journeys.
As Rebecca undertook her AIRA work with 55 different immunization information systems around the country (not just one for every state but a few specialized ones, as well) she realized that "everyone is on a different journey, at a different place and different pace." When asked how those journeys are proceeding, she said, "For a non-funded network of systems, we're doing very well. Of the 55 systems, the majority are at a mature level while a handful are in need of significant enhancements or a new system." When asked if a national system would accelerate progress, she replied, "That's not politically palatable and probably never will be." That realization has shaped her strategies -- (see #1).
 
3.  Define the ideal, then help everyone move to it.
Moving forward, Rebecca sees AIRA's role in the evolution of IIS as modeling registry operations. "What's needed are business rules, by which I mean the best practices of IT and Business Analytics. If we define how systems will operate, then interoperability will arise naturally." In other words, if you define the ideal and help everyone move toward it, you get something resembling the consistency you want without having to legislate it.
 
4. Be carrot-y, not stick-y.
Rebecca says, "Most people don't want to be told what to do. However, if they can see a system that works, like the one for AFIX, then why wouldn't people want to use it? And most people do use that model, almost line for line. This is how we can get to a system that can assess coverage rates and provide feedback across jurisdictions." When asked how much her work is carrot-versus-stick, Rebecca laughed and said, "We are generally carrot-based. It's good public health and we all want that."
Yes, we do, and we all thank Rebecca Coyle for her contribution.

Asked to comment on Rebecca and her leadership, the folks at STC said this:
Brandy Altstadter, Senior Technical Solutions Architect at STC and AIRA Board member, called Rebecca a "key voice in increasing collaboration and interoperability in a critical period for the immunization registry community." STC's CEO Mike Popovich added, "Rebecca was instrumental in overcoming the many challenges of working in a state where the few risked the lives of many. Since coming to AIRA, she has changed the nature of the national discussion through her authenticity and her can-do approach."  Erich Daub, Senior Public Health Advisor at STC, said,  "Rebecca is focused on the future and by looking forward, sees what can be accomplished today. Although it's only been four years since AIRA held their first national conference under her leadership, it's hard to imagine the immunization community without this annual event. Through similar efforts, Rebecca and her staff have engaged with a host of new stakeholders and topics that have pushed immunization information systems in important new directions."

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