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Full Project – Design and implementation of an online childhood immunization record system

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CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Computerized immunization record or Immunization registries are computerized information systems that collect vaccination histories and help ensure correct and timely immunizations, especially for children (CDC-INFO, 2016). Online immunization record tracking system can:

Track individual immunization records, helping health workers identify defaulters and find out why some children are not fully immunized.
Track vaccine stock and cold chain conditions, helping managers make sure that vaccines are being kept in the right conditions and made available when they are needed( Grevendonk & Wilson,2013).

Keep permanent records of children’s immunizations (shots)

Let doctors keep track of their patients’ immunization histories in a computerized database
Give parents their children’s immunization histories for daycare, school, and camp.
Provide parents with immunization information in the future even if they move away from Connecticut or their baby’s doctor retires ( Chile, 2011).

Today, most health workers at the service delivery level use paper-based systems to track individuals who have been vaccinated and the vaccines and other resources used during the process of immunization. Health workers then report these data through monthly, aggregated reports to supervisors who use them to monitor and evaluate key performance indicators such as immunization coverage, child dropout rates, and vaccine wastage ( Grevendonk & Wilson, 2013).

This paper-based reporting system is labor intensive, is prone to errors, and can lead to the over-reporting of vaccine coverage rates. Increased pressures from migration and urbanization also lead to an overburdened system, making it much harder for health care workers to track child vaccinations. In addition, paper-based information system is unreliable and allows policymakers to perform only limited analyses. Furthermore, reporting systems do little to help health care workers in their day-to-day work and have no impact on the everyday management of the health facility—meaning that there is not much motivation to improve them( Kluwer, 2015).

At the same time, there is an increasing demand for accurate, relevant, and timely data to support decision-making at the national and global levels. For example, programs that rely on performance-based funding find it exceedingly hard to rely on data as reported by countries. Better immunization information systems are needed.

Computerized immunization registries track each child’s vaccinations and feed that information into a national database (Diego, 2013). This personalized recording system allows for individualized follow-up, helping to ensure that children receive all necessary vaccinations even if the children move to another area of the country. By tracking this information, immunization programs can reduce the number of defaulters (people who do not return for immunizations when they are due), find the unimmunized, and ensure that the right vaccines are distributed when and where they are needed. This minimizes vaccine wastage, loss, and stock outs. This system also allows for lot tracing down to the individual child receiving the vaccination, which is essential for vaccine safety and management of adverse events following immunization (Lowery et al, 2010).

That system is now in use by nurses in one pilot district. Newborns are registered in the system by staff at the maternity hospital and assigned to one of the district’s health centers. A schedule of future immunization appointments is then automatically generated, and when the appointments are due, children are included in the monthly plan of the health center that will be responsible for each child. As children then visit the health centers, their vaccinations are registered.

In general, the system simplifies the monthly planning and reporting that nurses need to do. More importantly, by tracking individual children, the system can 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 yet received all their doses. This allows nurses to easily identify those who have not returned for follow-up visits. Nurses can then use the system to send short message service (text message) reminders to parents and caregivers.

Computerized Records of Immunizations is also used to assist medical providers and other approved agencies to track and review immunization and TB test record information.

The system also manages the stock of vaccines and consumables, which allows the Institute of Public Health to monitor the expiry dates, distribution, and usage of increasingly expensive vaccines. By linking vaccine lots to 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 (Onugwu, 2007).

Information that Can Be Stored in the Registry are:

Name, sex, and place of birth
Parents’ or guardians’ names (for a child under 18 years of age)
Information allowed by law to help identify a person
Details about shots and TB tests (skin or blood tests, chest x-rays) given to you or your child
Height and weight information (which only your doctor and the health department can see)

Only doctors, nurses, health plans, and public health departments may see a person’s address or phone number in the registry. Other programs cannot see a person’s address or phone number. The information in the registry, like other private medical information, is protected by law. Only your doctor and the health department can see height/weight information, (Wolters, 2015).

You can request a copy of your child’s immunization record. Or, you can find out if your child’s immunization record is in an Immunization Information System (IIS). An IIS is a computer system that your doctor or public health clinic may use to keep track of immunizations your child has received. Most states have an IIS; contact the IIS in the state where your child received their last shots to see if records exist (CDC- INFO, 2012).

Many high-income countries in Europe and the Americas have already implemented nationwide electronic registries, yet their use in low-resource countries has not been feasible until recently. One of the barriers in this system is the lack of “last-mile” Internet connectivity, which is not commonly available in many developing countries. However, mobile technologies may have the ability to bring information systems to even the most peripheral locations. In Nigeria, nurses in remote locations without good Internet access and stable electricity will shortly be able to access the system through a software application on Android phones (Katib, 2010).

The next step involves developing a more robust and generic system that can be easily adopted and customized by a range of countries and that would be accessible by both mobile phone and the Internet. That way, health care workers could use the technology that is most appropriate for their context. In district offices and large urban clinics, computers with Internet access and printers may be most appropriate, while mobile phones or paper reports may make more sense for remote villages.

1.2 Statement of Problem

Immunization records are not accurately recorded
Many individual health practices and health plans use information systems to track patient immunizations, their medical records are not protected confidentially and information are not securely stored or recorded.
Paper-based reporting system is labor intensive, is prone to errors, and can lead to the over-reporting of vaccine coverage rates.
Paper-based reporting system can lead to the over-reporting of vaccine coverage rates.
Increased pressures from migration and urbanization also lead to an overburdened system, making it much harder for health care workers to track child vaccinations.
Paper-based information system is unreliable and allows policymakers to perform only limited analyses.
Lack of “last-mile” Internet connectivity
Paper-based immunization records lack accurate, relevant, and timely data to support decision-making at the national and global levels

1.3 Aim of Objectives of the Study

The aim of this study is to develop an online system to track childhood immunization record that serves as a source of complete and accurate immunization histories.

The following are the objectives of the study:

To obtain a complete, accurate immunization history for a new or continuing patient.
To ensure appropriate protection of privacy and confidentiality for individuals and security for information included in the registry.
To produce database for immunization records.

1.4 Significance of the Study

To reduce paperwork.
It helps to obtain an accurate, official immunization history for personal use and for daycare, school, or camp entry requirements
It helps ensure that a child’s immunizations are up to date
It helps to ensure timely immunization for children if families move or switch healthcare providers
It helps prevent unnecessary (duplicative) immunization
It helps to make sure that a person is immunized by sending reminders when you or your child need shots
It allows one to get a current copy of the shot/TB test record from your doctor quickly
It helps doctors, nurses, health plans, and public health agencies use the registry to protect you, your child, and the public from diseases.
It increases the accuracy and timeliness of immunization records.
Immunization registries track individual immunization records, helping health workers identify defaulters and find out why some children are not fully immunized

1.5 Scope of the Study

This research is limited to online childhood immunization registration, which includes the records of the card number, child’s name, date of birth, gender, parent’s phone numbers, and immunization type.

1.6 Limitation of the Study

There were insufficient materials schools at the library to research on.
Cost of sourcing of information from relevant journals, the internet was very exorbitant.
Interviewees were unwilling to respond during the interview.
During the research, the cost of buying transportation was very expensive.
Lack of Internet connection and inconsistent access to electricity are other potential barriers during the research.

1.7 Definition of Terms

AFIX: is a quality improvement program used by awardees to raise immunization coverage levels, reduce missed opportunities to vaccinate, and improve standards of practices at the provider level.

CITYWIDE IMMUNIZATION REGISTRY (CIR:) is an electronic registry that maintains immunization records for those vaccinated in New York City

CHILDHOOD: is the age span ranging from birth to adolescence, childhood consists of two stages: preoperational stage and concrete operational stage

COMPUTER PROGRAM: is a collection of instructions that perform a specific task when executed by a computer.

DATABASE: is a collection of data that is organized so that its contents can easily be accessed, managed, and updated.

DEMOGRAPHIC: the statistical data of a population, especially those showing average age, income, education, etc

CIRM (COMPUTERIZED IMMUNIZATION RECORD MANAGEMENT): These are confidential, population-based, computerized systems that record all vaccination doses administered by participating providers to people within a given area.

GENERIC SYSTEM: A generic computer system is one not sold under a particular brand name, according to Northern Territory Consumer Affairs. They are generally similar to branded computers, but they have some advantages and disadvantages.

HEDIS: Health Plan Employer Data Information Set

IMMUNITY: Protection from microbes recognized as foreign. The immune system is composed of organs & specialized cells that protect the body by identifying harmful substances & destroying them using antibodies, and other specialized substances & cells.

IMMUNIZATION: A process of artificial induction of immunity in an effort to protect against infectious disease.

IMMUNIZATION INFORMATION SYSTEMS (IIS): are confidential, population-based, computerized databases that record all immunization doses administered by participating providers to persons residing within a given geopolitical area.

IMMUNIZATION REGISTRY: is a confidential, population-based, computerized information system that attempts to collect vaccination data about all persons within a geographic area.

METHODOLOGY: A set or system of methods, principles, and rules for regulating a given discipline, as in the arts or sciences.

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