Using a Registry to Improve Immunization Delivery

Abstract

The NJIPSP was successful in encouraging a group of small urban practices to adopt the use of immunization registry and to transform immunization delivery from a mechanistic well-child service to a visible, monitored process of care. The project represents a unique combination of technology, public-private collaboration, and well-established quality improvement techniques. The change process involved the whole office as a team in adopting new immunization delivery roles and services. The greatest barrier to acceptance of the registry was (and continues to be) the need for manual data entry as the primary source of data collection, rather than electronic data transfer from other systems. The manual entry of data was labor intensive for participating practices and affected data measurement. Despite this barrier, however, the majority of practices substantially improved the quality of their immunization delivery practices in multiple areas. The rapid movement of primary care practices toward some form of electronic record may reduce this barrier and increase the percentage of practices willing to use a community registry. Practices that engaged collectively in the change process gained momentum from the group effort. Equally important was the public health partnership that helped identify and reduce improvement obstacles. Sustainability of practice-based immunization changes will rely, in part, on the registry's ease of use and the continued visibility of public health at the practice level. Active practice level collaboration by public health adds great value to change efforts. We believe that the best possible immunization delivery relies on both technology (registries and the EMR) and effective office systems. Projects like the NJIPSP are models for systems that integrate technology, practice change, and quality improvement, and their success has the potential to foster the spread of this approach to other primary care practices (especially in New Jersey). The NJIPSP combination of office-based change approaches and an active partnership and hands on involvement with public health has the potential to support the delivery of consistently excellent immunization delivery.

Provider Attitudes Toward Public-Private Collaboration to Improve Immunization Reminder/Recall: A Mixed-Methods Study

“…This is consonant with prior research documenting that 20% or fewer of private providers typically conduct reminder/recall for their patients. 8,11 Similarly, many of the barriers to practice-based reminder/recall reported by our survey respondents and interviewees have been reported elsewhere, including perceived cost, 7,11 feasibility, 7,13 time, 7,11,12 staffing issues, 7 and distrust in the accuracy of immunization registry data. 13 …”

“…2-6 Reminder/recall is sometimes conducted with the help of immunization information systems (IIS), or immunization registries, which contain immunization records of all children within a geographic area. 7 Use of such registries improves the effectiveness of reminder/recall and significantly improves immunization delivery. 4,5,8 …”

“…8-10 In one national study, less than 20% of private providers reported using a reminder/recall system; 8 in another study, only 16% of private pediatricians routinely used reminder/recall messages, compared to 51% of public clinics. 11 There are significant barriers to practice-based reminder/recall, including time constraints, 7,11,12 cost, 7,11 need for additional training and/or staff time, 7 concerns about ease and functionality of the reminder/recall system, 7,13 concerns about confidentiality and Health Insurance Portability and Accountability Act (HIPAA) privacy and security, 7 lack of coordination between the practice’s clinical and administrative systems, 7,11 and distrust in the accuracy of immunization registry data. 13 …”

Immunization Registries in the EMR Era

“…The CDC hopes to have >95% of children under 6 included in an IIS by the year 2020 [17], a goal that will require participation of many additional institutions. Given the parallel federal incentives to implement EMR systems, many institutions are similarly hesitant to participate in an IIS due to concerns about extra work for staff [18,19]. …”

Reminder Cards and Immunization Rates Among Latinos and the Rural Poor in Northeast Colorado

“…12,[23][24][25][26] Arguments against these registries include the large labor costs of data entry and inconsistent or incomplete data entry leading to the assessment of lower UTD rates using the registries compared with chart reviews. [27][28][29][30] Recall and reminder cards seem to have an overall positive effect on immunization rates in both children and adults. [31][32][33] The effect is less in lowerincome populations.…”