TechNet-21 - Forum

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  1. David Brown
  2. Immunization information systems & coverage monitoring
  3. Monday, 22 January 2018

In some communities, electronic health information systems (a topic discussed here in TechNet periodically and within the Immunization Information Systems Group), including electronic nominal immunization registries, are being implemented. Some believe that electronic health information systems and electronic health records will replace the idea of keeping a physical, paper copy of the home-based record (HBR) that includes the individual's vaccination history and perhaps other recorded primary health care information. Others (myself included) believe that there is a place for physical HBRs to co-exist with electronic health records.

It is useful to keep in mind that in many countries, electronic health information systems remain in their infancy. As these systems continue to mature, and perhaps even beyond, a physical HBR system is important to maintain in case the electronic system is interrupted or is not fully functional across an entire country. In some countries, the necessary infrastructure (electricity, connectivity, health worker computer literacy, etc) for a reliable electronic information system remains years away. In other settings, reliable electronic information systems exist, but systems may not be fully interconnected across sub-national units to allow for health information exchange (e.g., a health worker in one state can query and edit records in the electronic system in her state, but she cannot access the information system of a neighbouring state). Health information exchanges between public and private providers, between health agencies and educational departments and schools as well as across national borders are also a challenge in many places.

In communities like Monrovia, Liberia where caregivers frequently change healthcare providers in search of high quality care, a physical HBR is a necessary information source for care providers to know what immunization services an individual has and has not received since they will likely not have seen the child before and thus have no existing facility-based record. In Lesotho, where caregivers may take their children into South Africa for healthcare services, a HBR is necessary given the absence of health information systems that communicate seamlessly across national borders between the two countries. And in the United States of America, where electronic immunization registries exist in all states with a range of participation levels and where one-in-five children have visited more than one health provider by the age of two years, HBRs remain an important tool for providers and caregivers in monitoring immunization services received.

These issues, and others not noted here, provide a basis for maintaining a physical HBR system while continuing to pursue and improve upon efficient, effective and nationally owned health information systems. So, in response to the question posed in the title to this posting, YES!!! there is a place for HBRs alongside electronic health records and nominal electronic registries.


Please do not forget to visit the TechNet HBR page at


Abstracted from information previously posted by David Brown on


Yes, I think there is, as well.

In my view, EIR and HBR have different functions. I see HBR, among other things, as the right of health services users to have documented proof of what has been done to them. This is essential to facilitate their capacity to claim for good quality services, to transparently follow up on their health care needs, to be aware of safety of health care interventions and eventually to have administrative or legal proof of a health care event.

I think, it is always helpful to distinguish between data items and data support tools. Most of the usual data handling can be done manually and electronically, and in many different ways within those two big groups of tools. To handle data manually may be cumbersome in some circumstances, but always possible; but handling data electronically can simply be impossible in other circumstances.

Finally, what I think it is essential is to understand that interventions targeting data support tools may improve precisely those (the data tool), but not necessarily data quality, data use or health outcomes. The assumption that ‘more technology’ leads to better decisions has yet to be proved.

We need HBR, on paper or electronic (does it really matter? We don’t know), at the very least, because we need an invoice when we pay someone.


I would say that yes, there is a place for home-based records (HBRs) everywhere, including when using electronic immunization registries (EIRs). In China, even though many provinces have well-funtioning EIRs, they complere the passport-like HBR and even print a small paper with info on the next visit. In Colombia they also continue giving HBRs and the country has a done several efforts to enusre the use of a unique type of HBR; at least in the Bogota HBR, parents/users can themselves download a copy of their vaccination records. 

Have any of the readers of TechNet-21 seen a setting using an EIR that is not giving out HBRs?


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