Computer Immunization Registry: Effective tool for National Immunization

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Introduction

            Diseases over the past few decades have been slowly being prevented successfully, if not being eradicated. This has been brought about by the advents in medical technology and breakthroughs in the field of medicine. Before, diseases that are not considered that lethal as of today caused much scare to the world wherein medical science is not yet that developed. Examples of these diseases are typhoid, chicken pox, rabies, and others.

            Discovery of vaccination has widely prevented diseases. These diseases are known as vaccine-controllable diseases. While there is a few number of diseases that no longer existed due to success in vaccination such as the cowpox. Vaccination works on the principle of boosting the immune system. Thus, the term Immunization came to use. With the massive support of government groups on active immunization of people especially children, cases of diseases dropped more so mortality with certain diseases.

            Though the program on immunization is being supported by government of different countries, not all are able to acquire a complete set of vaccination. In some areas, people were not able to afford the vaccines. The vaccines may also be inaccessible. Other factors also may arise as a cause of inability to be vaccinated. With this, the government launched vaccination campaign and lectures about diseases and vaccination. Government health workers are sent to far flung places inaccessible before in order to take into action the vaccination of an entire herd of population so as to be able to completely put into extinction or to minimize much more the percentage of disease occurrences.

Another project which is deemed to have a good use on immunization is the construction of a program or a database on vaccination. Improving immunization service and rates with an easy to use computer program at the point of service delivery is helpful in

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helping monitor vaccination records of individuals in different places and increase efficacy and efficiency of vaccines with a regular reminder on follow- ups or booster shots on time.

Definition and Scope

            At present, it may be said that there has been a great advance in rate of immunization and service. But, this improvement is still not a hundred percent. There is still a great proportion in which service and rate of immunization may be advanced.

            Computer Immunization Program is one among the conceived plan to lead immunization still one step ahead. This computerized registry is a confidential computer program in which vaccination records of patients are recorded from various service providers. It also includes the date of recall and schedules for boosters. It generates notices for vaccination to notify who needs to be administered next and when. With this record, it may also be kept for determining the efficacy of a vaccine by assessment (http://www.cispimmunize.org/mediapgs/facts/pdf/Registries_Fact_Sheet.pdf, 2007).

            The program includes the patient’s personal records including name, age, address, sex and other relevant personal profiles. It also includes programs on shots administered to patient and the provider of the shot in which the patient acquired the vaccine. In totality, the computer immunization program of registry is a consolidation of vaccinations given to individuals. Presently, there are many different existing computer immunization programs in America. These are South Dakota Immunization Program (SDIP) in South Dakota, Iowa Immunization Registry Information System (IRIS), and other such programs (http://www.idph.state.ia.us/adper/immunization_programs.asp, 2007).

            These existing programs may be seemed enough but in reality is not. The problem with certain computer registry programs is that they are not connected to a certain database in

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which other hospitals or service providers may be able to access to know a patient’s immunization record.

            In Manitoba, the computer registry is known as the Manitoba Immunization Monitoring System (MIMS). It is a population-based program which provides monitoring and reminders for high immunization level. Status of patient’s vaccination is monitored by comparison with that of the existing data and to that of the recommended return of patient for the next shot. Children’s immunization is scheduled during the first, second, fifth, and sixth birthday. Incorrect, incomplete, and missing records of immunization are subject to notice and letters are sent to patient for correction and filling out of information necessary for the database (http://www.umanitoba.ca/centres/mchp/concept/dict/Man_Immunization_db.html, 1997).

            Records in MIMS include those born on the first day of the year of 1980. The records include  information like registry data, code of vaccine administered, vaccine sequence and schedule, service dates, and identifiers of provider of the vaccination. The primary aim of the program is the timely and full immunization of children in Manitoba (http://www.umanitoba.ca/centres/mchp/concept/dict/Man_Immunization_db.html, 1997).

            However, MIMS is not yet a complete program for ease in immunization determination. It only collects data which are very primary in nature such as name and dates. There should be a more in-depth program which will harness data such as allergies, remind and recall systems, individual upcoming schedule for the next vaccination and others which may be relevant for a more in-depth analysis. There should be advocacy towards the clients and community to improve these type of services as it will be able to bring about much relevance in terms of health, not only of individual, but of the whole population.

Benefits

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            If the computer immunization registry program would be improved there are loads of benefits that citizens will be able to get from it. This system will allow for greater extension of health care service provided by health workers. It will also be able to improve citizens resistance to certain diseases and help prevent epidemics once an infectious disease attacks. There are of course broad spectrum of benefits from a computer immunization program once used to its full extent effectively. This will enable the government to take good care of its citizens to the utmost levels.

            One of the benefits one would get from an improved computer immunization registry program is that it will be able to increase immunization rates. In the US, there is about 85 per cent in the children’s population who are vaccinated yet there are pockets of problems in rural areas wherein people especially those of the low income earners were not able to afford a complete set of immunization (http://www.cdc.gov/nip/publications/pink/strat.pdf, 2007). In the system, it makes use of the reminder/ recall system which allows for greater improvement of immunization rate as well as overall health care service. This system in the program keeps track of a patient’s record of immunization and produces notices with the name of the patient who will be or is in need of a vaccine at that point of time. The reminder system is the one that tracks future appointments with the physician for future vaccinations that will be given to a certain patient. While, the recall system in the program keeps track of missed appointments and generate notices for follow-up on that patient. Together when used, the reminder and recall system will be very effective feature in the program for computerized immunization registry. This reminder and recall system will be able to bridge the immunization information gap between the parents and physicians. This is due to a problem wherein some service providers are not able to notice when and who needed another immunization due to a crude system of record-keeping. On the other hand, parents are not knowledgeable that much about immunization and which vaccines should be given to their

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children. With the aid of this program, both parties will be given notice of when should a vaccine be given and to whom shall it be given      (http://cispimmunize.org/pro/Medical%20Home%20Supplemental%20Materials/AAP%20Professional%20Immunization%20Resources/ReminderRecall_FactSheet.pdf, 2007).

            Another benefit from implementation of a program that is effective is that it will enable saving of time with the use of up to date data entry and data sharing. This is enabled in a program’s database where it should make use of a Health Level 7 message standard in sharing, creating and processing files. More so, it should contain all the basic information of a patient where it would be categorized by the program itself to different sub groups. More so, the program is able to provide access to information at the time needed and allows sharing of files from different locations with the use of a common data base. This enables one to save time from traveling places to places to be able to acquire patient information. Instead, they will just make use of a computer to access into the data base whenever and wherever health care providers are (http://www.immregistries.org/know/standards.phtml, 2007).

            In addition to the benefits is the improvement of the quality of service that will be able to be provided by health care workers and specialists and other such service providers. This is done by the features in the program. One of these features is the reminder/ recall system, the recommend system, inventory control, reduces paper works, and of having permanent records.

The recommend and recall system has been discussed in the previous paragraph. This is basically a notice given to parents and service providers for follow up and reminder on vaccination’s when and whom. The recommend system, on the other hand, is a feature in the program wherein it will be able to analyze a patient’s immunization record and recommend which vaccine should be given. This is based on schedule set by American Academy of Pediatric (AAP) and in which the computer base its recommendation. The inventory control

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system tells a health care provider of stock quantity and of the dates in which stocks will be expired and is able to recommend to order a new inventory when stocks are low (http://www.idph.state.ia.us/adper/iris.asp, 2007).

More so, the program is able to reduce health care providers the tedious task of paper works allowing them to focus more on patients. The task of writing immunization certificates for day cares and schools is automatically done by the computer in which it will also print the certificate itself (http://www.idph.state.ia.us/adper/iris.asp, 2007).

Another is the presence of a permanent record. The database is able to save permanently copies of immunization histories of patients. With this, hassle is lessen as there is one place to contact for people’s copy of immunization history (http://www.idph.state.ia.us/adper/iris.asp, 2007).

This is like the previous paragraph about the presence of permanent record and data base. This universal system would provide access to service providers for ease of administering services and reaching far-flung places that may seem to be unknown yet there are still citizens there that need immunization. The efficiency of this program may also depend on knowledgeability of health-care providers. Thus, being user-friendly of the program is very necessary to enable every service providers to use it to its full efficacy.

Furthermore, it will also reduce the errors in services provided and increase patient safety. Errors that are committed in manual record-keeping may now be dealt with in computer immunization program in which it would be able to notice errors. More so, due to the recommend feature, one would know which vaccine should be given thus, efficacy of vaccines is used. It also reduces the risk of harm to patient as personal records and history of patient is present. Like for example, when a patient is allergic to a certain substance ten the doctor would be able to prevent allergic reaction from happening. With this, patient safety

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and welfare is promoted by a greater increase in errors that may be committed as compared to that of manual works.

Challenges

            Hand in hand with the benefits that the computer immunization program or registry may provide are the challenges that we would face that we should face before we would be able to benefit to this proposed system. Of course, there are difficulties in implementing the program especially on a level wherein every health service providers will be able to access information of every citizen and implement the system in a wider range of coverage.

            First is the cost of implementing and maintaining such program. This also includes training of service providers. It has always been a problem, the economic aspect, in every project that should be implemented. Perhaps, it is most daunting the sustenance of the proposed system to be implemented for computer immunization program. The economic aspect affects the nation’s medic aid coverage and providing service to all its citizens due to a limited budget. When the program is to be implemented, a high cost on renewing the existing system, pay to personnel that will conduct the revision of program, pay to those who will be collecting data and other miscellaneous expenses should be considered. Also, a training to all service providers should be conducted on a wider level so as to ensure the optimum use of the program. For if the program is not used to its optimum, more finances will be wasted. As such, collection of funds for the proposed computer immunization program wherein there would be a universal system existing must be conducted though it will still pose a great challenge to those in charge as a great cost is necessary for them to arrive at for its complete implementation (DeFriese et.al., 1997).

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            Another is the presence of outside barriers. These include the socio-economic barrier, the educational level of clients, the remoteness of the community with no on-site service available and transportation.

            A socio-economic barrier affects the ability of clients to be able to afford a vaccination or they were unable to afford a complete set of immunization. These factors are poverty and other such barriers. Indeed, poverty does not enable one to acquire a vaccine more so in private service providers due to high cost of pays. The government launched programs in which they are able to provide free vaccine to the poor. But even so with this, those in far places that are not reached by the program are not also able to acquire the free vaccine due to their inability to travel to the urban places wherein the program is implemented (http://www.sociology.org/content/vol8.1/test.ixml, 2001).

            Another factor is the educational level of the clients. This is also a major factor in which immunization rate is hindered even with the aid of a computer immunization program. Educational level prevents a client from being cooperative in the national program of increasing immunization rates. Those of low educational levels are unable to comprehend vaccination purpose or also with the complexity of function of vaccines they are unable to comprehend its importance. Add to this is their prejudice that any medicine has side effects that are harmful to their body. More so, some are also unable to learn that there is an existing program on national immunization as such they miss out on it.

            Another one is the remoteness of communities with no on-site service available and availability of transportation to reach such areas. This will hinder information dissemination as service providers are unable to reach the area or will take them a long time to reach such areas. More so, due to absence of disseminated information, people on areas with no on-site service are not able to know about the value of being immunized and the schedule of immunization. Thus, not a hundred percent is achieved in the campaign for massive

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immunization of citizen. Also in scope with this is the lack of knowledge of people who misses on vaccination. There is also the challenge that no health care service provider is able to be available on site to implement the immunization program due to its remoteness and lack of transport.

            Lastly, the fear of technology of staff and patients will also gravely affect the success of implementing such a computer immunization program. Being phobic to change and upgrading of technology is brought about by an irrational thought that something might happen wrong or that there is a subliminal implication in such an implementation especially this covering a national scope. This may be prevented by training of staff with the use of the technology and information dissemination too for patients.

            This challenges are but few of those conceivable. Yet, even faced with this, there are possible solutions to overcoming such difficulties. Persistent coming up with solutions to such difficulties is but helpful to be able to bring this program to run to its success.

Recommendations

            With this program, the campaign for national immunization will be more effectively done than before. More areas will be covered by service providers including far-flung places which are previously hard to reach. In addition, the over all wellness of the citizen in America will be able to live a life free from scare of infectious diseases that are preventable from vaccination. These are numerous and some are fatal by nature.

            I would like to present a proposal to every key stake holders in communities and at the provincial and federal level of our country to please fund a pilot project for this type of computer immunization program which would be linked from a single data base accessible to health care providers. This pilot project, I would recommend, should include at least five different communities of differing population sizes in which people are of differing

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immunization profiles. Communities to be included in this project should most probably be those of remote origins. Benefits would be much as perceived when test is done empirically. It would uplift health status of these communities that will be involved. More so, they will be able to acquire vaccine at a greater percentage than before as health care providers would be able to learn who and where vaccines are needed. Though challenges may be posing like remoteness of subjects, transportation and others as such that may arise, we would be able to bridge these gaps in no time when the computer immunization program is taking place. It will be easier for us to determine which specific areas need more concentration when it comes to immunization and we would be able to focus on them more. Funding may also be a problem that is why I am appealing to financers and those who are willing to help in the project. We would obtain estimates from computer companies who created programs somewhat similar to it and have what is involved in the project to be outlined. Also, potential changes that may be done to meet each community’s differing needs shall be addressed. The new program should be integrated with MIMS or at least have the computer generate an automatic entry into that system. And like any other health programs, security of clients is very important and should be upheld as well as their welfare.

Conclusion

            A computer immunization program implemented at the point of service delivery can improve rates and quality of service in immunization. It will ease things with respect to health care providers and allow lesser time utilization due to a universal data base present. As per recommendation, stakeholders need to be involved and provide the best services available to their clients as well as direct health care providers.

References:

Manitoba Immunization Monitoring System [Electronic (1997). Version]. Retrieved May 17, 2007 from http://www.umanitoba.ca/centres/mchp/concept/dict/Man_Immunization_db.html.

Social Barriers [Electronic (2001). Version]. Retrieved May 17, 2007 from http://www.sociology.org/content/vol8.1/test.ixml.

What Are Immunization Registries? [Electronic (2007). Version]. Retrieved May 17, 2007 from http://www.cispimmunize.org/mediapgs/facts/pdf/Registries_Fact_Sheet.pdf.

Immunization programs [Electronic (2007). Version]. Retrieved May 17, 2007 from http://www.idph.state.ia.us/adper/immunization_programs.asp.

Immunization Registry Minimum Functional Standards [Electronic (2007). Version] Retrieved May 17, 2007 from http://www.cdc.gov/nip/registry/st_terr/tech/stds/min-funct-stds2001.pdf.

Immunization Reminder/ Recall System [Electronic (2007). Version]. Retrieved May 17, 2007 from http://cispimmunize.org/pro/Medical%20Home%20Supplemental%20Materials/AAP%20Professional%20Immunization%20Resources/ReminderRecall_FactSheet.pdf.

Immunization Registry Functional Standards [Electronic (2007). Version]. Retrieved May 17, 2007 from http://www.immregistries.org/know/standards.phtml.

Immunization Registry Information System [Electronic (2007). Version]. Retrieved May 17, 2007 from http://www.idph.state.ia.us/adper/iris.asp.

Gordon H. DeFriese, Kathleen M. Faherty, Victoria A. Freeman,
Priscilla A. Guild, Delores A. Musselman, William C. Watson, Jr., Kristin Nicholson Saarlas.  Developing Child Immunization Registries. [Electronic 92007). Version]. Retrieved May 17, 2007 from http://www.rwjf.org/files/publications/books/1997/chapter_09.html.

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