BACKGROUND:
For 20 years in Pennsylvania, school immunization information was recorded through a labor-intensive manual keypunch process.

OBJECTIVE:
Electronic reporting would eliminate months from the current time schedule and reduce processing costs as well as assure accurate data and production of various reports.

METHOD:
Division of Immunization staff met with programmers to establish criteria for a reporting system that would be accessible by school nurses via the internet and functional for Division staff to maintain. The reporting card is mandated by state law so the website had to resemble this card. Over 5,000 schools in Pennsylvania report their student's immunization records for kindergarten through 12th grade and school nurses may not possess advanced computer skills. Security was an issue. Although student names are not associated with any school report, the Division needed to ensure that only school nurses or their designee entered immunization information for their respective school. Finally a failsafe had to be included for schools without internet access such as Amish schools or for nurses that were unable to utilize an internet website.

RESULT:
Registration and log on procedures were ineffective during an internal pilot. After many changes to the functionality of the database, the card and the data entry instructions were mailed to all school districts listed in the database through an automated mailer. Many schools that had never received a card in the past due to the first time merge had difficulty completing the requested information. School nurses that attempted to enter information within the last 2 weeks of the reporting time were unsuccessful in electronic submission and were forced to send a manual card to the Division.

CONCLUSION:
The first year of the electronic submission was unsuccessful with more than 80% of the schools unable to report immunization status on the Pennsylvania Department of Health's website due to database issues.

LEARNING OBJECTIVES:
The database for the upcoming school year will be reviewed more extensively prior to a go-live date.