Immunization information system opt-in consent: at what cost?

Immunization information systems (IISs) are confidential- population-based systems that contain immunization data for children- and- in some cases- adults- within a geographic area. There are generally two models for participation in an IIS- termed voluntary exclusion or opt-out" and voluntary inclusion or "opt-in." Using the Texas opt-in consent system and statewide IIS (ImmTrac) we describe the costs associated with obtaining opt-in consent in hospitals as part of the birth registration process and in provider offices for children without prior consent. We also estimate the costs associated with a hypothetical opt-out system. Between October 2006 and August 2007 project staff conducted on-site time studies for patients in 8 birthing hospitals (n = 281) 16 provider offices (n = 131) and ImmTrac state offices in Austin Texas (n = 100). Total costs per child and costs per year were estimated using a time-and-motion study in which the time associated with discussing ImmTrac and obtaining ImmTrac consent wa