Using an immunization registry: effect on practice costs and time

INTRODUCTION: Immunization registries can consolidate immunization records scattered among different providers- allowing immunization documentation for legal purposes- generation of needed-immunization lists- inventory management- and outreach for underimmunized children. They have been endorsed by the Centers for Disease Control and Prevention and health professionals as a means of sustaining high immunization rates. However- some providers perceive the cost of registry use as a barrier to participation. We sought to determine the effects of registry use on cost and time. METHODS: We used a pre-post design and a cost-accounting approach to measure labor costs and time for immunization-related activities possibly affected by registry use before development of a regional registry in Colorado and after the registry was being fully used. Two rural family practices- 2 rural community health centers (CHCs)- 3 urban pediatric practices- and 2 rural public health agencies participated in both periods. RESULTS: Cost per shot increased slightly in the postregistry period for private practices and CHCs (\$0.56 per shot in 2001 dollars) and public health agencies (\$0.38). Since costs can increase for several reasons- including salary increases above inflation- we analyzed time spent per shot and found that staff time decreased for private practices and CHCs but increased substantially for public health agencies. CONCLUSIONS: The study findings suggest to private practices that registry participation can provide a net benefit by making the vaccination process more efficient and- absent above-average salary increases- less costly. Public health agencies- however- would have to rely exclusively on the registry and eschew the use of paper vaccination records to realize efficiencies seen by other practice types.