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Development and Utilization of Best Practice Operational Guidelines for Immunization Information Systems

Williams, Warren MPH; Lowery, N. Elaine JD, MSPH; Lyalin, David PhD; Lambrecht, Nichole MSc; Riddick, Sherry MPH, RN; Sutliff, Cynthia BA, MPA; Papadouka, Vikki PhD, MPH

Journal of Public Health Management and Practice: September/October 2011 - Volume 17 - Issue 5 - p 449–456
doi: 10.1097/PHH.0b013e31821138fe

Objective: To describe collaborative efforts to develop best practice operational guidelines for immunization information systems (IIS) and discuss awareness, acceptance, and utilization of the guidelines by the IIS community.

Design: Business analysis and facilitation techniques were used to support collaboration among IIS stakeholders who analyzed existing practices, brainstormed new approaches, and developed consensus-based recommendations. The guideline development process and its impact on IIS were evaluated using a postworkshop questionnaire, the IIS Annual Report, and an online survey for one of the guidelines.

Setting: Immunization information systems domain in the United States.

Participants: Staff from IIS; federal agencies; state, regional, and county health departments; privately run registries; and vendors/consultants.

Main Outcome Measure(s): These included (1) completion of best practice guidelines; (2) degree of satisfaction among the participating IIS stakeholders with the work process and outcomes, interest, and willingness to implement best practice guidelines in their own IIS; (3) awareness and use of, as well as satisfaction with, the guidelines for patient active/inactive immunization status among IIS; and (4) acceptance and implementation of best practice guidelines across the US IIS.

Results: Since 2005, operational guidelines (that contain best practice recommendations) have been developed for 5 IIS functional areas: reminder/recall notifications, data quality assurance, vaccination level deduplication, management of patient active/inactive status, and adverse events reporting. Immunization information systems stakeholders who participated in the development of the recommendations expressed a high level of satisfaction with the process and the recommendations. Based on IIS Annual Report data, from 2007 to 2009 use of the guidelines increased from 46% to 80% of IIS.

Conclusions: Best practice recommendations offer practical guidelines on the most challenging operational areas for IIS. Initial evidence indicates adoption of the recommendations and satisfaction with the development process. Additional studies are needed to assess the degree of guidelines use across the IIS community.

This article describes the development of best practice recommendations for immunization information systems.

Lead Public Health Analyst, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Mr Williams); Senior Public Health Consultant, Independent Consultant, Public Health Informatics Institute, Decatur, Georgia (Ms Lowery); Consultant, Northrop Grumman—CDC Information Technology Support Contract, Atlanta, Georgia (Dr Lyalin); Project Manager, Kansas Immunization Registry—KSWebIZ, Topeka, KS (until September 2010) (Ms Lambrecht); Immunization Registry Operations Manager, CHILD Profile, Seattle, Washington (Ms Riddick); Executive Director, American Immunization Registry Association (AIRA), New York (until September 2010) (Ms Sutliff); and Director of Research and Evaluation, NYC Department of Health and Mental Hygiene, New York (Dr Papadouka).

Correspondence: Warren Williams, MPH, Immunization Information Systems Support Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-62, Atlanta, GA 30333 (

The authors recognize the valuable contributions to developing best practice recommendations for immunization information systems from numerous experts of the Modeling Immunization Registry Operations Workgroup (MIROW) of the American Immunization Registry Association (AIRA), members of the MIROW Steering Committee, AIRA staff, external reviewers of the MIROW documents, and facilitation teams. The authors would like to thank Dr. Jane R. Zucker for her helpful comments on earlier drafts of this article.

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency.

Disclosure: The authors report no conflicts of interest.

© 2011 Lippincott Williams & Wilkins, Inc.