VaxTrack Immunization Registry Provider Management Database

State: CA Type: Model Practice Year: 2005

Riverside County is the fifth largest county in California, covering more than 7,200 square miles and more than 200 miles across. In July 2000, Riverside County joined with San Bernardino County to form the VaxTrack Regional Immunization Registry (VaxTrack), one of nine regional registries serving California. San Bernardino had been actively enrolling providers since 1994, and Riverside staff sought to match San Bernardino's provider participation levels in the shortest amount of time possible. This led Riverside VaxTrack staff to develop the Provider Management Database (PMDB). The initial goal of the PMDB development project was to enable registry staff to collect, store, and easily retrieve large volumes of provider data, accelerate provider recruitment and enrollment by allowing for more organized, efficient outreach, improve provider retention by improving the quality and timeliness of follow-up, and allow registry management to quickly assemble meaningful data for program and staff evaluation. Successful design and implementation of the PMDB resulted in dramatic improvements in provider participation. Enrollments were up by more than 460% in the first year and more that 600% in the first 18 months. The PMDB has also increased the efficiency of VaxTrack Help Desk and program evaluation procedures. Although originally intended for use only by VaxTrack staff members, the PMDB has gained popularity among the registry community in California and across the nation. Since its debut in 2002, the PMDB has been distributed to all regional registries in California as well as registries in seventeen other states and one territory. It has also been adapted for use by other public health programs that engage in outreach activities.
Healthy People 2010 set a goal "to prevent disease, disability, and death from infectious diseases, including vaccine preventable diseases." Recognizing that immunization registries are an important part of achieving this goal, it also set an objective "to increase to 95% the proportion of children aged <6 years who participate in fully operational population based immunization registries." According to the 2002 Immunization Registry Annual Report, approximately 43% of children aged <6 years participated in immunization registries. The participation rate in California was less than half the national rate, at only 19%. To achieve the Healthy People 2010 objective, it is essential that the vast majority of public and private health care providers exchange data with their local immunization registries. Since California does not mandate that health care providers report immunization data to registries, registry staff must be proactive in seeking provider participation. The challenge of this task is that in each registry, there are hundreds -if not thousands - of potential participants and a relatively small number of registry staff members. Without a customized contact management system such as the PMDB, the number of providers that can be recruited, enrolled, trained, and maintained as active registry participants in a given time period is significantly reduced, and progress toward the Healthy People 2010 objective is hindered. At the time the Provider Management Database (PMDB) was being planned, no contact management software products were on the market that met the unique needs of an immunization registry. An informal survey of systems used by other regional registries in California revealed that either no contact management system was in place or the system consisted of a disorganized series of spreadsheets or tables that were often out-of-date.
Agency Community RolesIn Riverside County, immunization registry staff members are employees of the Department of Public Health (DOPH). The collaborative relationships that exist between the DOPH and other community stakeholders have played an important part in the development of both the registry and the PMDB. As VaxTrack was being implemented in Riverside County, stakeholders such as the local Medi-Cal Managed Care Plans and the Riverside County Medical Association were invited to serve on the VaxTrack Advisory Committee. These partners were present for discussions related to the PMDB from the beginning. Supplying provider contact information to populate the PMDB was a natural extension of their work with the registry. The local Medi-Cal Managed Care Plans continue to provide VaxTrack staf with updated physician lists. VaxTrack staff members also participate in the Riverside County Immunization Coalition for Kids and Infants (RICKI) meetings. These meetings are attended by school nurses, Vaccines for Children (VFC) program representatives, pharmaceutical companies and other DOPH program staff. The relationships fostered at these quarterly meetings have provided additional sources of data for populating the PMDB.  Costs and ExpendituresVaxTrack is funded primarily by grants from First 5 Riverside (48%) and the California Department of Health Services, Statewide Immunization Information System (SIIS) Program (52%). In-kind funding covers much of the indirect costs. Costs associated with the PMDB can be broken down into initial development and on-going maintenance. Other than staff time, the initial PMDB development costs were limited to the purchase of two reference books for the registry staff member responsible for the programming ($96.91). Specific salary costs cannot be associated with the PMDB's development since time spent on development was not specifically tracked. It is estimated that staff costs for the first year of PMDB development was about $11,000. Approximately 50% of the Health Educator's time was spent on programming during the first three months. In the six months following PMDB implementation, the health educator spent no more than 10 hours a week modifying existing features and adding new features. On-going maintenance of the database, as determined by the need for new reports, takes less than 2 hours per week.  ImplementationThe first step to developing the PMDB was to decide what data to collect and how to use that data effectively. Discussions were held during one of the weekly Manager Health Educator meetings. It was determined that registry staff needed to:Know who and where potential registry participants were  Streamline the provider outreach process  Have a tickler system to ensure quality short- and long-term follow-up  Be able to document the many details of the provider recruitment, enrollment, training, and retention process  Automate the Help Desk and committee management functions  Be able to retrieve a comprehensive clinic profile easily  Be able to produce reliable program and staff evaluation data quickly. The database framework was created next. This task was performed by the registry's Health Educator using Microsoft Access. The bulk of the programming was completed within three months. However, major development continued for an additional six months as the PMDB was fine-tuned. Modifications are still required periodically due to the continuous growth and change of the registry. Concurrent to database framework development, VaxTrack staff began to gather information needed to populate the database. Since the PMDB was designed to be used as a provider recruitment tool in addition to a system for managing enrolled providers, the database needed to include all potentially eligible providers in Riverside County. Initially, this amounted to approximately 350 private practice facilities and 50 public health facilities. Registry staff obtained provider directories from Riverside County Medical Association (RCMA), Inland Empire Health Plan (IEHP), Molina Healthcare, the VFC program and the Child Health and Disability Prevention (CHDP) Program. The local telephone directory ("Yellow Pages") was also used. Later, school district web sites and the Community Care Licensing Division (CCLD) web site were used to add more than 700 child care centers, pre-schools, elementary schools, and other eligible programs to the PMDB. Once the initial version of the database was finalized, database population began. This took two to four weeks and was done via both batch load procedures and manual data entry. The final step was to design forms and reports that would produce relevant data for program and staff evaluation. PMDB reports were separated into "Health Educator Functions," "Management Functions," "Help Desk Functions," and "Other/Special Request." The PMDB currently contains more than 30 reports, many of which can be run according to specific region and staff assignment. New reports continue to be developed as the needs of the registry change.
PMDB has helped VaxTrack achieve program goals and has exceeded expectations. Since its implementation in July 2002, it has grown from a basic contact management tool used by one registry staff member into a fully mature program management resource used by all staff members. As a result of using the PMDB, the registry has experienced dramatically increased productivity in the areas of provider recruitment, enrollment, training, and retention. In addition, Help Desk functions and program evaluation procedures have become fully automated, significantly increasing efficiency and accuracy.  
Initially as other regional registries in California requested copies of the PMDB, VaxTrack paid for the CD-ROM, envelopes and postage to mail copies of the database. As more requests for copies of the database came in, however, the registries requesting copies were asked to mail a blank CD-ROM and return envelope with postage. Since these other immunization registries would only need to make minor modifications and populate the database, their overall costs would be much less than what was estimated for VaxTrack. The PMDB has become the primary data management system for the registry's clerical staff, Help Desk staff, Health Educators, and Program Manager. It has saved countless hours of staff time when collecting data needed for program evaluation and progress reports. There is sufficient reliance on the PMDB that there is no doubt as to its continued use. As staff turnover occurs, the PMDB User Manual, along with Access training, if applicable, will ensure that subsequent staff will be able to use and maintain the database. To sustain the practice over time, financial resources for computer training are included in the annual budget to ensure that at least one registry staff member has sufficient training in Microsoft Access programming at all times. If PMDB growth necessitates migrating the database to another software program, sufficient funds will be set aside to ensure availability for purchase and programming.