KEYWORDS:
computerized immunization registry
reminder/recall activities
AFIX activities
provider feedback

BACKGROUND:
Denver Health is an integrated health system consisting of a public hospital, a public health department, 11 community-based health centers, and 13 school-based health centers. In 1996 Denver health implemented a computerized immunization registry linking all sites delivering immunizations.

OBJECTIVE(S):
To utilize the registry to track childhood immunizations throughout Denver Health Sites.
To periodically assess childhood immunization rates using CASA.
To increase childhood immunization rates through provider feedback, reminder/recall activities and decreasing missed opportunities.
To create an electronic record that serves as the legal medical record of immunizations delivered.

METHOD(S):
The computerized immunization registry went live in 1996 and now is implemented at all Denver Health sites where childhood vaccines are delivered. At present there are 263,151 patients with 1,741,127 vaccines in the registry. The registry was pre-populated with vaccine histories from patient charges. Vaccine history is added as new patients enter the system and currently administered vaccines are documented in the registry. Reminder/recall reports, CASA assessments and clinic feedback reports are generated. CASA rates at 12 and 24 months have been monitored over time.

RESULT(S):
Childhood immunization rates throughout the community health centers have increased since prior to implementation of the registry (16% increase in CASA 3:2:2:2; 40% increase in CASA 4:3:1:3:3). Provider reliance on the registry for vaccine history has increased and missed opportunities for vaccine delivery have decreased.

CONCLUSIONS(S):
Use of a computerized immunization registry in an integrated health system setting is successful in improving vaccine delivery, increasing immunization rates and improving compliance with legal vaccine documentation.

LEARNING OBJECTIVES:
To identify advantages of a computeerized immunization registry.
To understand technical and management challenges of implementing an immunization registry in an integrated health system.
To understand programmatic elements required to change provider practice to increase immunization rates.