User-centered evaluation of the Vietnam National Immunization Information System — challenges and benefits.
Electronic immunization registries (EIRs) are defined as "confidential, computerized, population-based systems that collect and consolidate vaccination data from vaccination providers for better immunization strategies." And evidence suggests that EIRs can help increase vaccination coverage. This is mainly related to their ability to facilitate several things: (1) individual follow-up of vaccination status, (2) tracking defaulters (people who are overdue for a vaccine dose) and automatically generating messages for recalls (to alert people about overdue doses) and for reminders (to alert people about upcoming doses), (3) provider assessment and feedback, and (4) vaccination clinical decision support. This is in addition to facilitating the informed management of immunization programs.[1] These are all parts of the daily activities of immunization staff—whom EIRs are ultimately designed to support.
However, systems that suit their intended uses and users don't just happen. They are essentially products of a user-centered development process and a user-centered attitude during the development. Since the emergence of information systems more than two decades ago, a great deal of effort has been given to facilitate the development and implementation of usable systems—systems that support and engage users, rather than get in the way and hinder them. Likewise, the Vietnam National Immunization Information System (NIIS) has continued evolving to stand the test of time and bear the weight of users' criticism. PATH has worked with the Vietnam National Expanded Program on Immunization on the design, development, and implementation of NIIS, essentially since 2012, when testing its predecessors—ImmReg and VaxTrak—led to the idea formation for NIIS. PATH worked closely with immunization staff at all levels at piloted locations to identify and focus on real users and their needs, goals, context of use, abilities, and limitations to drive the development. It has been a decade-long process of growth, adaptation, learning, and overcoming challenges from both the NIIS and the immunization staff to bring about a system that truly serves users not only on their daily tasks but also on the overall national immunization program.
The Introducing Digital Immunization information systems–Exchange And Learning from Vietnam (IDEAL-Vietnam) project, funded by the Bill & Melinda Gates Foundation, in collaboration with the National Expanded Program on Immunization, has conducted a quick evaluation on NIIS from the immunization staff perspective. The evaluation explored staff challenges from the initial introduction to the system, and how they overcame them, as well as how the system impacted workload and efficiency.
[1] Danovaro-Holliday M, Ortiz C, Cochi S, Ruiz-Matus C. Electronic immunization registries in Latin America: progress and lessons learned. Rev Panam Salud Publica. 2014;35(5-6):453–457.
This case study presented the context of EIR implementation in Vietnam. Within that context, it featured immunization staff at the facility level of a commune health center, fee-based immunization facility, hospital, and clinic with a birthing room, as well as at the management level of a district, provincial, regional, and national Expanded Program on Immunization. Their challenges ranged from the insufficient infrastructure, lack of computer skill, excessive workload, frequent system updates, and interoperability, to resource and data management. Along with the challenges, the immunization staff also shared their effort to overcome these barriers and remain determined to transfer to a paperless system.
These findings emphasized again that tight collaboration among stakeholders with the user-centered approach to system design, development, and improvement was the key to successful EIR implementation and sustainability in Vietnam.
In the effort to reduce the burden of the administrative aspect for immunization staff, many countries have implemented the EIR system. It is important to understand how deployment of an EIR impacts the workloads of health care workers. This case study explores and compares the workloads and efficiency of immunization staff at different levels before and after the NIIS in Vietnam, aiming to present concrete examples for other countries with similar context.
This case study points out that it is essential to plan for the increased workload of immunization staff during the introduction and transition phase to build an appropriate timeline and allocate sufficient resources.
PATH is a global organization that works to accelerate health equity by bringing together public institutions, businesses, social enterprises, and investors to solve the world's most pressing health challenges. With expertise in science, health, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales solutions—including vaccines, drugs, devices, diagnostics, and innovative approaches to strengthening health systems worldwide. Learn more at www.path.org. For more information as well as publications on IDEAL-Vietnam, please visit our landing page at https://www.technet-21.org/ideal/index-medical.html.