BACKGROUND:
The Rhode Island Department of Health has implemented KIDSNET, a statewide, multi-program, Internet based pediatric public health information system. Recently an immunization algorithm developed for the California Regional Immunization Registries (CAIR) has been integrated into the KIDSNET registry.

OBJECTIVE:
Implement and maintain a full-featured immunization algorithm to evaluate doses administered, recommendations by vaccine category, and decision support information. Vaccine recommendations must be continuously adjusted based on updated patient information (e.g. doses administered) and enhancements to vaccines and immunization schedules.

METHOD:
Consultants were engaged to review available options. Factors considered included algorithm features, cost, and ease of integration. After analyzing available options, integration of the CAIR algorithm was selected to be the best solution. This choice leverages a proven software algorithm and allows for integration of components on disparate computer systems providing flexibility and reduced cost.

RESULT:
An adaptable and extensible architecture was developed to integrate the CAIR immunization algorithm into the RI KIDSNET registry. Web service technology and a reusable client software library provide the programmatic interface. The KIDSNET Immunization web page now displays evaluation and recommendation information for each patient utilizing RI's customizations to the ACIP schedule, as well as messages and data elements tailored to RI processes. A detailed description of the algorithmic process is available for decision support and instruction. Enhanced online reminder-recall reporting will assist providers to more effectively administer vaccine.

CONCLUSION:
Integration of the CAIR algorithm in RI was a challenging endeavor that was mitigated by the previous testing against the ACIP recommendations in California. The process of maintaining this algorithm when new ACIP recommendations are made will test the ability to leverage joint ownership of unique systems while maintaining system uniqueness.

LEARNING OBJECTIVES:
A robust immunization algorithm can be leveraged across customized applications in different registries while maintaining the core algorithm.