January 2000 • Volume 6 • Number 1
Immunization registries take mystery out of record-keeping
BY SHARON DENT
The Recommended Childhood Immunization Schedule has gotten increasingly complex. About 11,000 babies are born every day, and all of them need to receive 18-22 immunizations to protect them from vaccine-preventable diseases. With families moving more than ever, up to 25 percent of those children may visit two or more providers for immunizations before their third birthday.
Clearly, keeping track of which children have had which immunizations can get confusing.
That's why many communities and organizations are promoting immunization registries -- confidential, computerized databases that include immunization information on individual children and populations. Registries can range in size from those used by practices for their own patients to those including statewide information, according to Alan Hinman, M.D., M.P.H., senior consultant for public health programs for All Kids Count, a national network of demonstration projects working to implement community-based immunization registries.
"All states are working on developing registries," Hinman said. "Thirty-four have registries that are partially operational."
The American Medical Association, American Academy of Pediatrics and American Osteopathic Association support immunization registries and have encouraged physicians to participate in them. In August, the AAFP Board of Directors considered support but voted to further study the issue. One concern was that registries would create additional administrative burdens for physicians.
However, Hinman said registry developers are working to limit the paperwork and time required to participate, as well as to ensure that any administrative burden is offset by benefits. "One important benefit is that registries can generate reminder notices and recall notices, so physicians don't miss immunization opportunities," he said, adding that, according to the CDC, only about 25 percent of FPs use a reminder or recall system in their offices.
Hinman said resistance to registries also stems from the perception that immunization rates are already high enough. Although rates for young children are at the highest level ever, substantial resources have been poured into the effort over the last six years, and that's unlikely to continue, he said. When funding for those efforts diminishes, the country could see a rise in cases of preventable childhood diseases unless the immunization process is systemized.
Michigan AFP President Karen Mitchell, M.D., of Southfield has studied the issue of registries while serving on the Michigan Department of Community Health Advisory Committee on Immunization.A statewide registry is well under way in Michigan, and state law requires physicians who provide immunizations to participate in the registry, she said.
The Michigan system protects privacy by requiring health care professionals to enter at least two unique identifiers -- such as name and birthday -- into the registry to access information on a child. If two children with the same name and birthday are found, the system automatically requests a third identifier, such as a social security number.
Physicians can enter or retrieve information in real time through the computer system, and those without computers can use fax, phone or mail.
"It gives us all the information that is sometimes really hard to obtain," Mitchell said. "We can get more accurate information through the registry system than we can by calling other providers, waiting for records to come or even depending on parents to bring in the child's shot record. It can actually save time."
Anecdotal evidence of registries' success abounds. For example:
Registries helped control the size of a pertussis outbreak in a rural Minnesota community by identifying children at risk -- those who were nearly due for a DTP booster and those who hadn't been immunized because of medical or religious reasons -- so their parents could be informed of the disease threat.
The immunization rate for 700 low-income children at five Phoenix child care centers doubled to 90 percent this year when the organizations' nurse acquired access to the state's registry. Despite county-wide outbreaks of measles, pertussis and varicella during that time frame, cases of those diseases at the child care centers were reduced to zero.
How can you get involved in an immunization registry? Hinman suggests physicians contact their local health departments to find out whether a registry is available.
"All registries are anxious to recruit private providers," he said. "Most registries are housed in health departments, but health departments provide a minority of the immunizations in this country. More than two-thirds of immunizations are provided in private practice offices. So the utility of a registry is directly proportional to the level of participation."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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