BACKGROUND:
Tennessee maintains a registry for children receiving immunization services through public health clinics and private practitioners participating in the Medicaid(TennCare) or VCF programs. Accurate immunization records are essential to providing optimal primary care. Pertinent data were not readily available to practitioners at all points of service, resulting in incomplete care, duplication of services and fragmentation of the medical home for this high-risk patient population. Problems were compounded by a federal court decree requiring documentation of substantial compliance with EPSDT standards and by a major shift in care venue favoring the private sector.

OBJECTIVE:
An Internet-based registry could consolidate pertinent records at a single, secure, readily accessible site, decrease over/underutilization of services, accurately document EPSDT compliance,facilitate school/daycare attendance, and foster public health research.

METHOD:
The Tennessee Web Immunization System (TWIS) was developed using commercial software (PTBMS; QS Technology). Information from State records was combined with that obtained from Blue Cross-Blue Shield, the largest TennCare contractor. State personnel encoded the initial data. Key stakeholders participated in TWIS development. The Tennessee Chapter-American Academy of Pediatrics performed beta-testing and promoted utilization of TWIS by its members. Development and implementation costs ($100K) was paid from a CDC grant.

RESULT:
TWIS became operational 09-01-03. To date, 500K children with 6M immunization events have been indexed. 115 sites are enrolled, 95 public and 20 private; 2K "hits" are recorded daily. Informal responses underscore universal user satisfaction. Results of formal outcome studies are pending.

CONCLUSION:
TWIS promises to increase compliance with recommended immunization schedules and improve system utilization for at-risk children in the context of the medical home. Costs may be reduced. Partnership amongst key stakeholders at every stage is crucial to its success.

LEARNING OBJECTIVES:
List benefits of an interactive, web-based registry
Understand how the registry supports the medical home
Identify key partners for registry development