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| Practice Type: |
Model |
| Program Name: |
VaxTrack Immunization Registry Provider Management Database |
| Organization: |
Riverside County Department of Public Health |
| Web site: |
www.rivcoph.org/disease/disease.htm#immreg |
| Overview: |
Riverside County is the fifth largest county in California,
covering more than 7,200 square miles and more than 200
miles across. In July 2000, Riverside County joined with San
Bernardino County to form the VaxTrack Regional
Immunization Registry (VaxTrack), one of nine regional
registries serving California. San Bernardino had been
actively enrolling providers since 1994, and Riverside staff
sought to match San Bernardino's provider participation levels
in the shortest amount of time possible. This led Riverside
VaxTrack staff to develop the Provider Management Database
(PMDB). The initial goal of the PMDB development project
was to enable registry staff to collect, store, and easily
retrieve large volumes of provider data, accelerate provider
recruitment and enrollment by allowing for more organized,
efficient outreach, improve provider retention by improving
the quality and timeliness of follow-up, and allow registry
management to quickly assemble meaningful data for
program and staff evaluation.
Successful design and implementation of the PMDB resulted
in dramatic improvements in provider participation.
Enrollments were up by more than 460% in the first year and
more that 600% in the first 18 months. The PMDB has also
increased the efficiency of VaxTrack Help Desk and program
evaluation procedures. Although originally intended for use
only by VaxTrack staff members, the PMDB has gained
popularity among the registry community in California and
across the nation. Since its debut in 2002, the PMDB has
been distributed to all regional registries in California as well
as registries in seventeen other states and one territory. It
has also been adapted for use by other public health
programs that engage in outreach activities.
|
| Year Submitted: |
2005 |
| Responsiveness and Innovation: |
Healthy People 2010 set a goal "to prevent disease, disability, and death from infectious diseases, including vaccine preventable diseases." Recognizing that immunization registries are an important part of achieving this goal, it also set an objective "to increase to 95% the proportion of children aged <6 years who participate in fully operational population based immunization registries." According to the 2002
Immunization Registry Annual Report, approximately 43% of children aged <6 years participated in immunization registries. The participation rate in California was less than half the national rate, at only 19%.
To achieve the Healthy People 2010 objective, it is essential that the vast majority of public and private health care providers exchange data with their local immunization registries. Since California does not mandate that health care providers report immunization data to registries, registry staff must be proactive in seeking provider participation. The challenge of this task is that in each registry, there are hundreds -if not thousands - of potential participants and a relatively small number of registry staff members. Without a customized contact management system such as the PMDB, the number of providers that can be recruited, enrolled, trained, and maintained as active registry participants in a
given time period is significantly reduced, and progress toward the Healthy People 2010 objective is hindered.
At the time the Provider Management Database (PMDB) was being planned, no contact management software products were on the market that met the unique needs of an immunization registry. An informal survey of systems used by other regional registries in California revealed that either no contact management system was in place or the system consisted of a disorganized series of spreadsheets or tables that were often out-of-date.
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| Agency and Community Roles: |
In Riverside County, immunization registry staff members are employees of the Department of Public Health (DOPH). The collaborative relationships that exist between the DOPH and other community stakeholders have played an important part in the development of both the registry and the PMDB. As VaxTrack was being implemented in Riverside County, stakeholders such as the local Medi-Cal Managed Care Plans
and the Riverside County Medical Association were invited to serve on the VaxTrack Advisory Committee. These partners were present for discussions related to the PMDB from the beginning. Supplying provider contact information to populate the PMDB was a natural extension of their work with the registry. The local Medi-Cal Managed Care Plans continue to provide VaxTrack staf with updated physician lists. VaxTrack staff members also participate in the Riverside County Immunization Coalition for Kids and Infants (RICKI) meetings. These meetings are attended by school nurses, Vaccines for Children (VFC) program representatives, pharmaceutical companies and other DOPH program staff.
The relationships fostered at these quarterly meetings have provided additional sources of data for populating the PMDB.
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| Costs and Expenditures: |
VaxTrack is funded primarily by grants from First 5 Riverside (48%) and the California Department of Health Services, Statewide Immunization Information System (SIIS) Program (52%). In-kind funding covers much of the indirect costs. Costs associated with the PMDB can be broken down into initial development and on-going maintenance. Other than staff time, the initial PMDB development costs were limited to the purchase of two reference books for the registry staff member responsible for the programming ($96.91). Specific salary costs cannot be associated with the PMDB's development since time spent on development was not specifically tracked. It is estimated that staff costs for the first year of PMDB development was about $11,000. Approximately 50% of the Health Educator's time was spent on programming during the first three months. In the six months following PMDB implementation, the health educator spent no more than 10 hours a week modifying existing features and adding new features. On-going maintenance of the database, as determined by the need for new reports,
takes less than 2 hours per week.
|
| Implementation: |
Healthy People 2010 set a goal "to prevent disease, disability, and death from infectious diseases, including vaccine preventable diseases." Recognizing that immunization registries are an important part of achieving this goal, it also set an objective "to increase to 95% the proportion of children aged <6 years who participate in fully operational population based immunization registries." According to the 2002
Immunization Registry Annual Report, approximately 43% of children aged <6 years participated in immunization registries. The participation rate in California was less than half the national rate, at only 19%.
To achieve the Healthy People 2010 objective, it is essential that the vast majority of public and private health care providers exchange data with their local immunization registries. Since California does not mandate that health care providers report immunization data to registries, registry staff must be proactive in seeking provider participation. The challenge of this task is that in each registry, there are hundreds -if not thousands - of potential participants and a relatively small number of registry staff members. Without a customized contact management system such as the PMDB, the number of providers that can be recruited, enrolled, trained, and maintained as active registry participants in a
given time period is significantly reduced, and progress toward the Healthy People 2010 objective is hindered.
At the time the Provider Management Database (PMDB) was being planned, no contact management software products were on the market that met the unique needs of an immunization registry. An informal survey of systems used by other regional registries in California revealed that either no contact management system was in place or the system consisted of a disorganized series of spreadsheets or tables that were often out-of-date.
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| Sustainability: |
Initially as other regional registries in California requested copies of the PMDB, VaxTrack paid for the CD-ROM, envelopes and postage to mail copies of the database. As more requests for copies of the database came in, however, the registries requesting copies were asked to mail a blank CD-ROM and return envelope with postage. Since these other immunization registries would only need to make minor modifications and populate the database, their overall costs would be much less than what was estimated for VaxTrack. The PMDB has become the primary data management system for the registry's clerical staff, Help Desk staff, Health Educators, and Program Manager. It has saved countless
hours of staff time when collecting data needed for program evaluation and progress reports. There is sufficient reliance on the PMDB that there is no doubt as to its continued use. As staff turnover occurs, the PMDB User Manual, along with Access training, if applicable, will ensure that subsequent staff will be able to use and maintain the database. To sustain the practice over time, financial resources for computer training are included in the annual budget to ensure that at least one registry staff member has sufficient training in Microsoft
Access programming at all times. If PMDB growth necessitates migrating the database to another software program, sufficient funds will be set aside to ensure availability for purchase and programming.
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| Lessons Learned: |
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