CDC molds nationwide collaboration of immunization databases

The Centers for Disease Control and Prevention estimates that slightly more than three-quarters of the nation's children are properly vaccinated by the age of 2. As part of an effort to increase that figure to 90 percent by 2000 the agency is developing a nationwide "mosaic" of immunization databases maintained by state and local public health entities.

Although it is not positioned as a regulator of state and local immunization efforts CDC's National Immunization Program (NIP) maintains a role as a "catalyst" in the development and use of technology to support vaccination efforts. NIP's Data Management Division recently awarded five nonmandatory indefinite-delivery indefinite-quantity Immunization Information Systems Software (IISS) contracts open to all public health agencies using CDC direct-assistance funding.

Direct assistance is the process in which local public health departments in lieu of actual federal dollars can opt for a certain amount of CDC-acquired products (usually vaccines negotiated at lower rates) toward their federal grant limits. CDC recently extended that privilege to computers and related equipment used in constructing registries."We put the contract process into motion about a year ago when we identified the fact that it was a challenge for states to acquire software through traditional state processes. We wanted to allow states to be able to access registry software by using grant funds and not have to go through the lengthy [request for proposals] process " said Beverly Ashton the program's manager.

Ashton explained the process of using the program: "What happens is that a state which wants to come in and purchase registry software will be able to come to us with their requirements " and CDC officials will translate those requirements into a "letter of interest" sent out to all five vendors. States can then evaluate responses and select the one they consider to be their best value.

"One of the things this solves is a financial problem for state and local agencies. They can now spend direct-assistance dollars " said Jeff Cronon president and chief executive officer of Public Health Software Systems Norcross Ga. one of the companies in the pool.

In awarding the pacts CDC ensured that solutions met minimum functional requirements established by NIP but Ashton stressed that the products are not certified or endorsed by CDC. Other awardees include Computer Data Systems Inc. Rockville Md. JK Inc. Denver Q.S. Inc. Greenville S.C. and Ann Arbor Mich.-based Vector Research Inc.

CDC officials also underscored the fact that the IISS program like other NIP endeavors will not lead to a central immunization registry.

"We want this mosaic of registries to speak with each other. There will be no national database " said Cathy Stout assistant chief of NIP's systems development branch. CDC estimates however that only 13 of 50 states have operational registries in all public sites. CDC's efforts will be geared toward raising that figure and promoting the incorporation of technology.

"We will be making recommendations and providing advice and technical assistance as best we can " Stout said. "There are not any right or wrong ways to develop a system."

Interoperability is an issue the agency also is looking to explore through cooperative agreements under the Immunization Registry Target Research Project. Specifically the agency wants to break down four barriers it sees as hampering the success of automated registries: duplication of immunization records among disparate systems the cost of developing records the participation (or lack of) among private providers such as doctors' offices and the integration registries in patient management and billing systems.CDC hopes to further the idea of a computerized immunization algorithm that would be linked to a child said Rob Linkins acting chief of the systems development branch.

"It would look into his history and take into account current recommendations from the Advisory Committee on Immunization Practices" and also combine information on the child such as allergies to medication Linkins said.