TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.

Discussions tagged Registries

New articles: The BID Initiative featured in MMS Bulletin #148 "Digital Health - A Blessing or Curse for Global Health?"

The BID Initiative is featured in the most recent issue (December 2018) of the MMS Bulletin #148 "Digital Health - A Blessing or Curse for Global Health." "Marrying engineering with health policy to bring digital health to scale," by Steven C. Uggowitzer, Sima C. Newell, Dykki Settle, Alice Liu and David J. Hagan.  Just as medical doctors take the Hippocratic Oath as they graduate into their profession, so do many engineers solemnly promise to carry out work to the highest quality, recognizing that any errors may put lives at stake. Given this sharing of fundamental values, engineering is a profession that could be leveraged even further towards public health information systems to address opportunities created by the fusion of the early and relatively informal eHealth and mHealth paradigms into the more mature and complex one that is Digital Health. Recently, the World Health Assembly (WHA) adopted a key resolution on Digital Health, urging member states to assess and prioritise the scale-up of the implementation of digital technologies towards the “universal access to health for all”(WHA 71.1, 2018). For the full article, visit the MMS Bulletin. "The challenges of implementing a data use culture," by Hassan Mtenga, Dr. Alex Mphuru, Dawn Seymour, and Laurie Werner.  To increase coverage and equity of routine immunization services, the government of Tanzania is strengthening the data use culture through the implementation of a package of data quality and use interventions, including an electronic immunization registry, for immunization service delivery. Three key phases for achieving scale as a government-owned model emerged during the implementation: user-centered design and testing, PATH-led implementation, and government-led implementation with scale-up. A combination of factors contributed to achieving a government-owned model of implementation and ultimately showed significant time and cost savings, as well as greater ownership and ability to sustain and scale the interventions. For the full article, visit the MMS Bulletin. Other articles in the MMS Bulletin #148 can be found here.  

JUST RELEASED: Book Chapter on Information Systems for EPI (with special section on Electronic Immunization Registries)

A textbook from lectures we used to give at the “Ciro de Quadros Vaccinology Course for Latin America” just got published by the Sabin Institute: https://www.sabin.org/programs/training-education/vaccinology-book. The book is available in English and Spanish. My chapter on information systems for EPI (part of section 3) is attached.

Electronic Immunization Registry: Practical Considerations for Planning, Development, Implementation and Evaluation

This document is designed to support EPI managers and their teams in the implementation of EIR-related information systems, using the various experiences compiled at the global level – and, especially, in the Region of the Americas – as a foundation. Within this context, the main objectives of this document are as follows: 1) To generate knowledge related to information systems and immunization registries for immunization program managers at the national and subnational levels; 2) To provide teams, EPI managers, and experts in health information systems with relevant background and experiences for development, implementation, maintenance, monitoring, and evaluation of EIR systems, so as to support planning of their implementation; 3) To provide technical, functional, and operational recommendations that can serve as a basis for discussion and analysis of the standard requirements needed for development and implementation of EIRs in countries of the Region of the Americas and other regions; 4) To serve as a platform for documentation and sharing of lessons learned and successful experiences in EIR implementation. This document is structured into three major sections: background; EIR planning and design; and EIR development and implementation, taking into account the relevant processes and their structure. The content of the chapters is supported by a literature review of aspects related to EIR requirements and summarizes the experiences of the countries of the Region of the Americas and other regions that already have EIRs in place or are at the development and implementation stage. Many of the experiences presented herein have been shared during the three editions of the “Regional Meeting to Share Lessons Learned in the Development and Implementation of Electronic Individualized Vaccination Registries,” held in 2011 in Bogotá (Colombia), in 2013 in Brasilia (Brazil), and in 2016 in San José (Costa Rica), in addition to ad hoc meetings held by the Pan American Health Organization/World Health Organization (PAHO/WHO), Member States, independent consultants and other agencies such as WHO, BMGF, CDC, PATH, ECDC, AIRA, among others. We appreciate the technical and financial support from the Bill and Melinda Gates Foundation. Publication is also available in Spanish and French 

Is there a place for home-based records alongside electronic health records and/or electronic registries?

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 www.homebasedrecords.org.    Abstracted from information previously posted by David Brown on http://en.citizendium.org/wiki/Home-based_records.  

True cases occurring in tertiary care centre’s - generating hidden immunization gap

Dear viewers  All of us are witnessing rapid multidimensional growth of routine immunization in the current decade. Keeping pace with the rapidly expanding / frequently changing schedule itself is a challenge faced by the service providers, more so in the private sector. Pilot study revealed dangerously poor operational knowledge among the Medicos who are the current and would-be programme managers at various levels. This is conspicuously accentuated by the absence of an uniform vaccination schedule and vaccines with no Vaccine Vial Monitor (VVM) in the private sector. We collected vaccination record cards of various private institutions, including Medical Colleges, providing vaccination services and found that no two vaccination cards are mutually matching either with IAP schedule or with National Immunization Schedule (NIS), whether essential vaccines of NIS or optional vaccines. This is creating divided opinion in the community and the caretakers generally have lot of faith and strongly believe what they were advised by the super specialists in the super specialty hospitals at the time of giving birth and insist administration of vaccines as per the vaccination card they have from the private Institution. India gives birth to ~2.7 core (27 million/270 Lakhs) live infants in a year. Even if 10% avail services from the private sector, absolute number is ~27 Lakhs per year in the country. Most of these children are from APL families (Above Poverty Line) – especially of Doctors / Nurses / Engineers / community leaders and the like who are deprived of receiving vaccines with known potency indirectly depicted by the VVM free of cost from the government. Though eligible, many are deprived of Mother and Child Protection Card [Tayi-card] in Karnataka and the vaccination data are not shared with the Government, even on sharing it cannot be “MCTiSed” = uploading to MCTS and making online. Please find the attached with only 3 examples though this number is more than a million for the whole country. This is beyond the scope of “Intensified Mission Immunization (IMI)” as of now. RI should become “peoples’ movement” as aptly iterated by the Honorable Prime Minister, which can address some of these issues to a large extent.           Solutions are with us – the deep lovers of RI, promoters of child health. Shelling out “my-self” from the “APATHY” itself is the first simplest and biggest step followed by empathy for the birthing children / future generation. Doing right things properly at the right time and by the authorized persons itself are the easiest and the most gratifying social service in any field, more so in medical field, that too vaccination – providing quality life-saving services to the newborns and the children. best wishes Holla and the team

PAHO highlights four immunization data related activities

PAHO highlights four immunization data related activities - please see the Global Immunization News (GIN) - September 2017 (http://www.who.int/immunization/GIN_September_2017.pdf?ua=1) for full articles: Training on monitoring vaccination coverage and preventive chemotherapy to eliminate lymphatic filariasis (GIN, Page 14) Workshop on Immunization Data Quality in Nicaragua (GIN, Page 15) Countries from Africa and the Americas share/exchange their experiences with the Electronic Immunization Registry (EIR) information system (GIN, Page 16) Workshop on Electronic Immunization Registries (EIRs) in Argentina (GIN page 17)

Vertical immunization information system or integrated one?

How vertical is the immunization service delivery and supply chain information managment system when they are migrated into electronic paltform? Should it be part of routine HMIS or LMIS system? or a separate one?

Immunisation Information systems - Special issue of EUROSURVEILLANCE - April 2017

On 27 April 2017, EUROSURVEILLANCE dedicated a special issue to Immunisation Information Systems (in attachment) with a focus on experiences in the EU and the outcome of an EU-wide survey on IIS implementation. The issue contains a nice ensemble of papers showing the various areas where an ISS can be used to positively impact on immunisation programmes and help steer important public health policies. // Tarik Derrough VPD team, ECDC, Stockholm, Sweden   Tarik.Derrough@ecdc.europa.eu     

American Immunization Registry Association (AIRA) - Presentations from 2017 National Meeting now available

Presentations from the American Immunization Registry Association (AIRA) 2017 National Meeting are now posted on AIRA’s website: http://www.immregistries.org/resources/iis-meetings/2017-national-meeting . Please click here: http://www.immregistries.org/events/past-events/annual-meetings/AIRA_2017_National_Meeting_-_Links_to_Presentations.pdf for a document with links to all presentations.

A method for measuring performance of outreaches

This report explains Shifo's approach and solution - MyChild Outreach, to strengthen outreach services to reach the fifth child and reduce equity gaps in vaccination services in rural and hard to reach areas:https://shifo.org/doc/MyChildOutreach.pdf/

Advances on Electronic Immunization Registries in Latin America Highlighted in the Global eHealth Report

One interesting post from PAHO in the Global Immunization Newsletter (GIN), January 2017. The Global eHealth report, recently released includes a case study on Electronic Immunization Registries (EIR) in Latin America. This case study highlights the fact that Latin America is home to some of the oldest computerized immunization registers in the world. Also, that to date, many countries in Latin America have been working toward implementing electronic immunization registries, seeking to improve immunization data quality and facilitate better data availability at all levels of the immunization programme. It also mentions that EIR are considered as potentially useful tools to reach the goals stated in the Regional Immunization Action Plan [of the Americas]. The eHealth Report highlights the “Improving Data Quality for Immunization (IDQi)” Project, a PAHO initiative to help countries decide whether, when and how to introduce and/or expand EIRs. Best practices on EIR development and implementation, identified from various countries in the context of the IDQi initiative, include the following: Objectives and the scope of the EIR should be clearly established before development; Implementation of the EIR should be monitored in order to address problems as soon as possible; Data flow and processes should be clearly identified at the start of the project; An unique identifier should be used or created, as well as capturing the entire target population; EIRs need to be flexible enough to accommodate new vaccines, new schedules, etc; and EIRs require investments in time and financial commitments during their entire life cycle.[AGFG1] “Global diffusion of eHealth: making universal health coverage achievable. Report of the third global survey on eHealth. Geneva: World Health Organization; 2016. Licence: CC BY-NC-SA 3.0 IGO.” Available at: http://apps.who.int/iris/bitstream/10665/252529/1/9789241511780-eng.pdf – pages 22-25. [AGFG1]These are verbatim quotes from the document itself. Maybe leave them as they are?

VaxTrac's New Project in Sierra Leone!

Dear Colleagues, VaxTrac is excited to announce our new project in Sierra Leone, in partnership with eHealth Africa (eHA)! The pilot phase of the project will launch this month, starting with the first-round of training in Freetown, and will run until May 2017. We are thrilled to be working with eHA, the Ministry of Health and Sanitation, and Africell on this new project! For more information, check out our official project announcement attached to this email. For more information about VaxTrac's digital immunization recording system and our other projects in Nepal and Benin, please check out our website: http://vaxtrac.com/ For more information about eHealth Africa, please check out http://www.ehealthafrica.org/ Best, Aly Azhar Program Associate VaxTrac

For people working on Electronic Immunization Registries - Updated Clinical Decision Support for Immunizations (CDSi) resources

The US CDC has updated their Resources for tools for Clinical Decision Support for Immunization. These tools can help persons adding CDSi to their Electronic Immunization Registries. CDS algorithms help the registry determine a person's eligibility for a given vaccine based on their age, vaccination history (especially when there is delayed vaccination) and contraindications/precautions. Although these resources are very United States-specific, they type of tool can be adapted to other schedules and recommendations. Version 3.0 of Clinical Decision Support for immunizations resources is here: www.cdc.gov/vaccines/programs/iis/cdsi.html


Expanding Digital Immunization Registry in Vietnam

PATH has been collaborating with Vietnam National EPI to pilot the Digital Immunization Registry in one district in a Southern province under Optimize Project since 2012. In 2014, this system was expanded in all 164 Commune Health Centers in that province. It can help to reduce workload burden, increase data accuracy and more importantly increase on-time vaccination rates. This intervention has been awarded the Health Innovation Award, a partnership between GSK and Save the Children in 2015. PATH is working closely with Ministry of Health and the local biggest telecom company to integrate this system into national health information system and scale up nationwide. Please find more information via the link below
http://www.technet-21.org/en/resources/technet-resource-library/2742

Third Regional Meeting to Share Lessons Learned in the Development and Implementation of Electronic Immunization Registries

Date:4 - 6 April 2016
Purpose:To share lessons on the planning, development and implementation of Electronic Immunization Registries (EIRs), as well as to socialize a draft document on the planning, design, development and implementation of a national EIR.
Summary:During this two and a half day meeting, participants discussed and shared their experiences and lessons learned regarding the development and implementation of EIRs. Furthermore, the meeting participants reviewed the proposed contents of a draft document under development by PAHO’s Improving Data Quality for Immunization (IDQi) Project.
Besides sharing experiences and discussing needed EIR functionalities, different EIR scopes and options for their development and implementation, meeting participants focused on making EIRs sustainable and useful to improve Immunization Program performance and efficiency, as well as a tool for better accountability. Issues regarding governance, legal frameworks, financial and human resources as well as how EIR and other immunization information systems fit into the countries’ overarching eHealth strategies were emphasized.
As mentioned in the objectives, PAHO is developing a practical guide on the planning, design, development and implementation of an EIR. This document responds to recommendations and regional mandates that support adopting information and communication technologies in health, and particularly EIRs and is drawing from successful experiences and lessons learned from countries of the Region. To this end, this third regional meeting to share experiences was very useful.
Participants:Representatives from 20 countries of the Americas, three from African countries (Gambia, Tanzania and Zambia), World Health Organization (WHO), the Bill and Melinda Gates Foundation, PATH and both the United States’ and European Union’s Centers for Disease Control and Prevention. ‏

Good work done on Good Friday by 3 Aces – 25 March 2016: Birth of Common simpler tool cum Immunization register: “SARAL IMMUNOGRAM” incorporating IPV

Dear Viewers Dr Rajendra KV, I.A.S, Assistant Commissioner of Puttur, Dakshina Kannada, in his speech on the occasion of Silver Jubilee Celebration of KVG Institute of Nursing, wholeheartedly expressed that he learnt many bedside operational procedures from the staff nurses, expressed his gratitude to the nurses and iterated that it is a noble profession. All over world, many doctors up to the Director General of WHO have expressed the same whether it is curative service or preventive service from control to eradication, their active dedicated and sustained participation is indispensable. By working together & learning mutually; the objectives can be rapidly achieved and sustained. Following is the current example as to how the grass-root level workers have easily solved the biggest problem: sharing what took birth on Good Friday at the eve of IPV era (Inactivated Polio Vaccine). Good work on Good Friday Necessity is the mother of invention. Addressing following 5 issues gave birth to a homogenous Tool cum register to the heterogeneous team providing common immunization services to the common beneficiaries, lubricating and catalyzing inter-sectoral coordination. I feel honored and privileged in facilitating their activity. Onset of IPV era, 2 doses to be administered subcutaneously along with 1st dose (6 weeks) and 3rd dose (14 weeks) of OPV and Pentavalent, recommendations made by the central consultants on seeing ASHA’s immunization register during their visit in Nov 2015, ASHA/AWW and ANMs’ dreaming and crazing for a common standardized register for uniform documentation to avoid data miss match, Service providers to make necessary modification locally for entering the vaccination data till the supply of new registers. Feedback from the participants of recent State Task Force meeting/workshop that development partners support MI, but State to sustain the achievement for long term. Supporting bottom up approach and innovations by health care providers who practically operationalize the programme is the key to success. With this we are attaching the multipurpose innovation which can address all the above issues for further editing for scaling up and wider application. with best regards Holla and team

Community engagement in immunization

Delivering immunization is essentially a technical task: it would seem quite inappropriate to expect community members to vaccinate or maintain the cold chain. Yet there is growing evidence (e.g. from RED evaluations in Africa and the ARISE study) that the participation of community leaders, community-based workers, and community members can result in improved coverage and protection. Potentially, community members can be engaged in planning services, social mobilization, raising community understanding and reducing concerns, monitoring services and coverage, providing essential feedback on services, and even in delivering services (in supportive roles, e.g. in counseling on side effects and the next visit). A recent article in Global Health: Science and Practice (http://technet-21.org/en/resources/documents/immunization-delivery-strategies/2006-engaging-communities-with-a-simple-tool-to-help-increase-immunization-coverage) describes experiences in India and Timor-Leste with a promising tool that facilitates community participation in monitoring the vaccination status of every infant in the community.

In Pictures: Online immunization registry transforms work in Albania

To accompany the article “Online immunization registry transforms the work of health staff in Albania” in this month’s newsletter, project Optimize has publishedhttp://www.flickr.com/photos/projectoptimize/sets/72157630314080396/" target="_blank"> a photo set on Flickr that reveals how the new tool has benefitted health staff in the pilot region of Shkoder. The photo set is divided into two: “Before” and “After.” The “Before” photographs describe how health workers used the previous paper-based registry, while the “After” photographs describe how they are now using IIS, a computerized immunization registry. The photo set includes several screenshots of the IIS tool itself. http://www.flickr.com/photos/projectoptimize/sets/72157630314080396/show/" target="_blank">Access the photo slideshow directly. Click “Show info” in the top-right corner to view/hide photograph descriptions, and click the following button in the bottom-right corner to view the slideshow in full-screen mode: To comment, make sure you are logged in and click Reply.

Online immunization registry transforms work in Albania

An interview with Silvia Bino, Albania Institute of Public Health The Institute of Public Health in Albania recently developed an online immunization registry to replace their existing paper-based system. In May 2011, the new system—named IIS—was piloted in Shkoder district. One year later, Op.ti.mize talks to Silvia Bino about how it has transformed the way vaccinations are scheduled and recorded. Before IIS was launched, how were immunizations scheduled? Nurses and the district head of vaccinators worked together using a paper-based system to make sure that all children received the vaccinations they required. Each month, the nurse made a list of all the children due to be vaccinated that month in her health center by carefully going through the health center’s immunization and cohort registries. She used this list to schedule each vaccination, notify parents, and work out how much vaccine to order. She did all this using pen and paper. Were immunization records kept in the same way? Yes. The nurse had to record the details of every child vaccinated on up to six forms and registers. At the end of each quarterly period, she had to review this information to produce a vaccination coverage report. This report was compiled by hand and compared the number of children scheduled for vaccination with the actual number of children vaccinated. The nurse would then send this report to the district head of vaccinators, who would review and aggregate the figures. What problems did nurses have with this system? The nurses spent a lot of time recording and reviewing immunization data. And despite their hard work, some errors in data collection and reporting were inevitable. We needed to automate as much of this administrative work as possible and help them get on with the more important parts of their jobs. Were there any other problems? The lack of detailed data was another big problem. At the national level, we only received aggregated data that wasn’t helpful to manage or improve the program. For example, we only received coverage estimates by district, when we needed to know the vaccination coverage by community, who the unvaccinated children were, where they lived, and why they had not been vaccinated. The old system could not give us this information. Other problems were that we could not control the distribution of vaccines in the way we needed to and that there was no easy way to keep track of children who moved to another part of the country. How has the work of health staff changed? A lot of the nurses’ work has been automated. For example, as soon as children are born, the maternity nurse enters their data into a central database. A schedule of their future immunization appointments is then automatically generated. When the appointments are due, the children are automatically included in their local health center’s monthly plan. The nurses no longer need to go through the immunization registries to find the children who need to be vaccinated. Instead, they use the monthly plan to organize their vaccination schedules. The monthly plan also calculates the total number of vaccine doses required, and this information helps nurses to determine the exact vaccine quantities to order. I have to say that IIS has also improved the quality of nurses’ work. For example, they can spend more time with parents and caregivers to answer questions or address any concerns they may have. And with IIS they are now better able to access and share information. Has the new system improved stock management? Absolutely. As children are vaccinated, nurses with access to a computer can update their immunization status directly into the monthly plan by entering the vaccination date and the vaccine lot they used. Because IIS is used for stock management, the system can show which vaccine lots are stored at every health center and can deduct their balance every time a nurse uses a certain lot for immunization. With IIS, the district head of vaccinators prints out a monthly plan for every health center and health post and distributes them to nurses together with the vaccines. In this way, he can easily make sure that the requested amounts are correct. Village health nurses who don’t have access to a computer can use the paper plan to organize their work and report back on the vaccinations they have administered by taking note of the vaccination date and the lot they used in the columns provided on the form. What are the main benefits? IIS simplifies the monthly planning and reporting that nurses need to do. But there are other benefits to tracking individual children. Firstly, IIS doesn’t just generate coverage reports automatically by comparing actual vaccinations with planned vaccinations, it can also show exactly which children have not been vaccinated—those who have been registered but have not received all their doses yet. This enables nurses to quickly identify any defaulters and to check that access to vaccination is equitable across communities. IIS also manages the stock of vaccines and consumables which allows the Institute for Public Health to monitor the expiry date, distribution, and usage of ever more expensive vaccines. By linking the vaccine lots to the individual child records, lots can be traced through the stores and eventually to any children who have received a dose from a particular lot. This is essential for vaccine safety. Are there any benefits for parents? Parents will shortly be able to access IIS themselves to view their child’s vaccination history and download a vaccination certificate for their child, required for school and visa applications. Are there plans to scale up the pilot? Yes. We plan to start using the system in other districts in Albania later this year. If all goes well, we will be able to implement IIS nationwide by the end of 2014. In the meantime, we are also adding new features to IIS, such as the tracking and reporting of adverse events following immunization. In May this year, we also hosted a workshop for the countries of the South East European Health Network. We hope to collaborate further with these countries in the future as we are all looking to improve our health information systems. For more information on Albania’s implementation of IIS, please contact Silvia Bino. Note: Optimize will provide a full report on the implementation of IIS in 2013. To comment, make sure you are logged in and click Reply.

Going digital: Upgrading Vietnam’s paper-based immunization registry

by Dr. Nguyen Van Cuong, NEPI and Joanie Robertson, PATH Vietnam’s National Institute of Hygiene and Epidemiology is collaborating with project Optimize to demonstrate the benefits of a computerized immunization registry. In January 2012, a new computerized immunization registry was piloted by Vietnam’s National Institute of Hygiene and Epidemiology. Dr. Nguyen Van Cuong of Vietnam’s National Expanded Program on Immunization (NEPI) and Joanie Robertson of PATH provide an update on its performance. Think for a moment of the information associated with a child’s immunization. Who is the child? Where does she live? When was she born? Who are her parents? What vaccine will she receive? When and where will she be immunized? Did she actually receive the vaccine? And did she suffer any adverse reactions as a result? Now multiply this information by one and a half million—the number of children born in Vietnam every year. Next, add the five visits each child must make to fulfill the dozen-dose immunization schedule of Vietnam’s NEPI, administered at more than 11,000 commune health centers throughout the country. At this point, you begin to understand just how much data are captured and reported in the immunization program. In Vietnam, all of these data are meticulously recorded by hand in special notebooks. The country’s immunization registry is composed of thousands of such books, each containing a list of children born in the catchment area of a particular commune health center. Every child is recorded by name, along with their gender, date of birth, address, and the name of their parents. When a child receives an immunization, the date of that immunization is recorded in the book. Every month, health workers painstakingly flip through the pages of the book and count the immunizations delivered at the health center that month. This is the only way to obtain the aggregate number of immunizations delivered for each vaccine. Once these statistics have been gathered, they are passed on to the district health center, which aggregates the numbers for all of its communes. The district health center then passes these figures on to the province, which in turn aggregates the data and reports to the regional and national level. What if this information was digitized? If immunization data were kept in a database rather than a book, the computer could do all the counting and aggregating, leaving the health workers with more time to care for patients. And instead of waiting for the paper reports to come to them, the district, province, and national program staff could use a web-based interface to access the data at any time. This would help program staff to monitor, supervise, and plan immunization activities. Vietnam’s National Institute of Hygiene and Epidemiology is collaborating with project Optimize to start making this happen. In November 2010, an experienced local software developer was hired to build the system. It was important to work with a local developer who could speak the language of the NEPI administrators and commune health workers to understand their requirements, processes, and priorities. Working closely with NEPI and Optimize, the developer built the four components of the digital immunization registry: -A database to securely hold information on each child. -A mobile phone application that can download and upload data to/from the database, such as information about immunizations administered and aggregated report information on key indicators. -A desktop PC application that Expanded Programme on Immunization officers at district, regional, and national levels can use to generate reports from the database. -A short message service (SMS) feature to send text messages to parents of children with scheduled immunizations. In January 2012, the new immunization registry was piloted in Mo Cay Nam district in Ben Tre province. Health workers from all 17 communes in Mo Cay Nam came to the provincial health center for two days of training. The software performed well, but some health workers unfamiliar with computer programs and mobile phone applications found it difficult to use. And with only one day a month to practice (immunization days occur only once a month in Vietnamese communes), it was noted that becoming proficient in the new tool would present a challenge to such health workers. With further support, users are now beginning to enjoy the benefits of the new system. Assessment data are still incomplete, but it is already clear that in communes where health workers are successfully mastering the immunization registry, the system is helping to increase data availability. It is also helping to reduce the time needed not only for reporting, but also for immunization day planning and preparation. In particular, the new system has shortened the time needed to screen patients prior to vaccination because health workers have access to more information about each child. Additionally, the relationships between health workers and children’s parents have benefitted, since the parents are impressed with the reminder SMS they receive from the system prior to immunization day. All of these things are having a positive effect on the immunization program in the community. A small pilot such as this cannot answer every question that needs to be asked when designing a national immunization registry. However, the findings add further weight to the case for harnessing the power of digital technologies to track and store immunization data. The lessons learned in this demonstration will help to increase the strength and robustness of future computerized registry systems. Optimize will publish an evaluation of the immunization registry demonstration in Vietnam later this year. For more information, please email [email=jrobertson@path.org]Joanie Robertson[/email]. To comment, make sure you are logged in and click Reply.

Albania pilots electronic immunization registry

by Erida Nelaj, Albania Institute for Public Health and Jan Grevendonk, PATH In May 2011, the Albanian Institute for Public Health (IPH) launched a new web-based immunization registry and vaccine ordering system in the district of Skodra. Based on the acceptability and success of the system in Skodra, the government is deciding when and how to roll out the software nationwide. After an initial training with nurses, the system appears to be working well, and acceptability is high. [Click photo to enlarge] The project began in 2009 when IPH asked project Optimize to help develop a strategy for an electronic immunization registry and vaccine stock management system. Working with a local software developer, IPH and Optimize documented the key processes and requirements for the system and referred to them throughout the development process to ensure the project was on track. A year later, after several rounds of preliminary testing with users, the software and training materials are complete and have been deployed at 24 health centers in Skodra. In many ways Albania is a difficult place to deploy a web-based information system. Few health centers are equipped with computers, electricity is unreliable in many areas, Internet access is limited, and even mobile networks do not reach the more remote areas of the country. However, the system was designed to work around these issues by providing access through mobile phones and, when needed, paper-based reporting systems to complement online access. After a month of use in the district, IPH and Optimize staff checked in with nurses in health centers across the district to learn how they liked the new system. They found that nearly everyone understands the system and finds it highly functional. Despite some frustrations with Internet access and electricity, nurses clearly see the value in the system, noting that it will save them a tremendous amount of time creating their monthly plans and make it easier for them to track and monitor vaccinations, even among families that move to and from other districts. For now, nurses are simply playing with the system, and data are not being collected for use. In September, the system will be used for actual data collection, monitoring, and ordering. Over time, additional features and capabilities will be added to the system, including the mobile-phone component that will allow nurses to download immunization schedules for children associated with their health post, find any child in the database, and register the vaccinations they administer from any location with connection to a mobile SMS (short message service) network. Nurses have also requested that the system be expanded to include additional functionality such as adverse events reporting and disease reporting. As the Government of Albania prepares for nationwide introduction in the coming years, neighboring countries, too, are taking an interest in the system. In the fall, representatives from these countries will be invited to visit health centers in Skodra to understand how the system works. Optimize will monitor the system for up to a year and conduct multiple evaluations, including a functional evaluation of its use and acceptability, impact on supply chain performance, and cost. For IPH, the success of the pilot will be measured by how well it can improve the quality of the monitoring system for immunization coverage, increase ordering accuracy, and decrease the administrative burden on health workers. [Click photo to enlarge] For nurses who currently record each vaccination session on five different paper records, the benefits of the system are obvious. After completing the first training session, one nurse asked, “okay, just tell me when it is going to start.” For administrators, the system will also bring value. Not only will coverage data be more accurate, but the data are disaggregated, which means that district officers and nurses can see that not only do five percent of children need vaccination, but they can see the individual names and locations of children who are due or overdue for vaccination. Combined, these benefits will accrue to families whose children will receive all the vaccines they need right on schedule. To learn more about the software system or comment on its use in Albania, please click reply at the bottom of the page.

Using mobile phones to track immunizations

Using mobile phones to track immunizations by Jørn Ivar Klungsøyr on behalf of http://www.openXdata.org (http://www.openXdata.org) and Jan Grevendonk, PATH In August 2010, the Norwegian Research Council approved funding for a new project that will allow countries to manage immunization programs with increased accuracy and reliability by enabling health workers to record and register individual immunizations using mobile phones. The project, called Mobile Innovations in Recording Child Vaccination and Health Data in Immunization Registers (mVAC) builds on the work of its many partners and applies existing technologies in a fresh and innovative way that could radically improve the way vaccines are managed. The goal of the three-year mVAC project is to develop an end-to-end mobile phone-based solution to create a fully digital system for recording immunizations at the individual level: one that can be implemented in almost any country with or without a public unique person identification structure or system. The project uses an open-source software package called openXdata that allows users to create their own forms on a web-based interface and deploy that to mobile phones or devices. OpenXdata is being actively used in many different fields and will soon be implemented in Albania with Optimize and others. The software is constantly enhanced with input from users and developers on almost every continent. OpenXdata is a collaboration between many different institutions, companies, and individuals. As a result, openXdata software has the flexibility and simplicity to make it a good fit for different geographic environments and management systems. How it works Primary health care workers will be equipped with a low-cost, Java-enabled mobile phone with an integrated camera (approximately US$40) to record and submit vaccination data to a central vaccination registry. Child health cards with 2-dimensional bar codes will serve as the primary identifier for individual children. Using the camera on the phone, health workers will scan the card on each visit to see a list of immunization tasks scheduled for that particular child. When the immunization is given, the health worker documents it on the mobile phone and on the card and digitally signs the encounter. Children who have migrated from other areas can be tracked by their card, and children who have lost their card can be looked up by name and other key identifiers, such as location, mother’s name, sibling names, etc., in the central register. The health worker can then issue a new card on the spot. When the system is fully operational, the registry can generate lists of children in specific catchment areas who are overdue for vaccination and give it to the health worker prior to a session. Taking this a step further, the system can send automated SMS (short message service) text messages with reminders to parents that have signed up for this feature. At the central level, the immunization registry allows the supply chain management system to deliver exactly the right amount and kind of vaccines to each individual facility based on monthly consumption data. Why it is needed Too often, decision-making that affects the lives of a large portion of the population depends on unreliable and fragmented data. Most reporting and documentation efforts today are based on pen and paper-based systems of past centuries that are error prone and preclude rapid aggregation and analysis of data. In the context of immunization, distribution planning is often based on demographic data. Stock levels are maintained to allow for immunization of 100 percent of the theoretical population plus a buffer stock. Since there is, at best, limited up-to-date knowledge of consumption data at lower levels, managers maintain high levels of buffer stock to compensate for a lack of data. With the introduction of pricier and bulkier vaccines, this is quickly becoming increasingly unfeasible and uneconomical. A centralized immunization register addresses these problems and transforms supply chains from inefficient supply-driven systems to accurate and reliable demand-driven systems. To learn more about the mVAC project, visit http://www.openXdata.org (http://www.openXdata.org). Questions about the project can be directed to [email=contact@openxdata.org]contact@openxdata.org[/email]([email=contact@openxdata.org]mailto:contact@openxdata.org[/email]). We invite you to comment on or post a question relating to this article by clicking the “post reply” button on this page. You will have to log in or register; the process is very simple. Return to the Optimize newsletter.

Albania explores computerized immunization registries

Albania explores computerized immunization registries by Jan Grevendonk, PATH, and Olivier Ronveaux, WHO In early 2009, the Albanian Institute for Public Health (IPH) asked Optimize, a WHO-PATH collaboration, to develop a strategy for a computerized national immunization registry and vaccine ordering system. Working with IPH and other large stakeholder groups, Optimize assessed the existing paper-based system this summer and developed a strategy for implementing a small-scale pilot under IPH management in one district (Skodra). In Albania, health workers are expected to record vaccinations for children in their catchment area on five different paper records. In order to determine vaccine orders, these records are compiled at the end of each month into two different reports that are aggregated at the district and national levels. The existing system, while functional, places a tremendous administrative burden on health workers and does not provide enough detail about populations that could be falling through the system’s cracks. The benefits of an online centralized registry linked to vaccine ordering are potentially enormous. Most importantly, a central registry would allow health workers to accurately track each child’s vaccinations even if that child moves between catchment areas. The system could also facilitate more accurate forecasting and improved inventory records of the vaccines needed in each area of the country. The success of the pilot will be measured by how well it can: • Improve the quality of the monitoring system for immunization coverage by providing access to more accurate and more relevant disaggregated data at the central level in a more timely fashion. • Increase ordering accuracy—using the information collected through the immunization registry, vaccine inventory and wastage can be better assessed enabling the right quantity of vaccines, diluents, syringes, and safety boxes to be available at each level of the system. This could possibly reduce the need for buffer stocks. • Decrease the administrative burden on health workers. The proposed system will integrate the immunization registry with the functionality of the basic logistics management information system. In the future, the two functions can be integrated further and expanded to accommodate other applications such as disease and adverse events following immunization surveillance. Albania, like many lower-resource settings, has varying levels of access to consistent electricity, internet access, and mobile-phone service. The pilot will therefore use a combination of three modes of communication: internet access with personal computers at the national and district levels as well as in large health centers; mobile phone access in other health centers and village outposts; and paper-based access in areas without access to mobile technology. The pilot system will role out in mid-2010 with the goal of expanding the program nationally after evaluating and revising the pilot system. We invite you to comment on or post a question relating to this article by clicking the “post reply” button on this page. You will have to log in or register; the process is very simple. To link back to the Optimize e-newsletter, click here.
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