CDC asks Missouri to pilot inoculation-tracing net

The Centers for Disease Control and Prevention in Atlanta could model a national
immunization network after Missouri’s growing inoculation-tracking system.

CDC recently gave Missouri a three-year grant worth $660,000 a year to create the
system, which centralizes inoculation and other health records.

Depending on how well the Missouri system works, CDC might use it as part of a federal
blueprint for a chain of immunization databases nationwide.

The blueprint is part of a July 1996 mandate from President Clinton to Health and Human
Services Department Secretary Donna Shalala calling for a national immunization network.
The CDC plans to finalize and present its blueprint to Shalala this fall.

The National Immunization Program will create a chain of databases to maintain
children’s immunization records from birth. State or regional databases, which will
also link to a CDC database, will cut duplicate records, alert physicians to
under-immunized children and let physicians track how well communities are being immunized
against disease.

Keeping better records would also improve the management of vaccines nationwide, a CDC
official said.

“We’ve had kids who have received five measles vaccines when they only need
two, so we are concerned about hyper-immunization,” said Joe Henderson, acting team
leader for the National Immunization Registry Clearing House at the CDC. “It is not a
major safety risk, but it is costly.”

CDC regularly tracks Missouri’s growing immunization program under the auspices of
the state’s Public Health Department.

Missouri’s system links immunization records at three of the state’s largest
cities and their surrounding counties—St. Louis, Kansas City and Springfield—to
a central database.

The system lets a health care worker key patient immunization information onto a form
that is linked directly to the central database in Jefferson City.

The database then displays the patient’s immunization record and other medical
history to the health worker. The database also stores any updated patient information
sent by the doctor.

Missouri’s city and county health centers are linked to state health offices in
each of the metropolitan areas by frame relay, with speeds ranging from 56 Kbps to 284
Kbps. From there, the links run over a T1 backbone to the department’s central
database.

The central database server is an IBM Corp. SP-2 parallel processor with 1G of RAM that
holds a rack of eight nodes and runs AIX. Missouri hopes to store all its state
immunization information on an Oracle 7.3 database by the time the project is finished.

The state wants to connect as many hospitals, private physicians and other health
providers to the system as possible, said Rex Peterson, director of data processing at the
department.

The department uses a WebFocus server-based reporting engine from Information Builders
Inc. of New York. It operates in tandem with standard Web browsers.

IBI’s WebFocus Suite is comprised of the WebFocus application server; the WebFocus
Report Broker, a Java-based scheduling and distribution application that centralizes the
distribution of reports over the Web and manages e-mail, printers and faxes; and Managed
Reporting, the WebFocus reporting engine.

Most Missouri health departments use 133-MHz or greater IBM and Compaq Computer Corp.
PCs with at least 16M of RAM and Microsoft Windows 95, said Kevin Quinn, director of IBI
Internet product marketing.

Missouri’s three-year, statewide technology contract with IBI includes all 15 of
the state’s public agencies. IBI’s Enterprise Data Access software also lets the
health system’s disparate mainframes and Unix systems communicate with each other.

CDC’s blueprint will set standards for states building similar immunization
networks. Health Level Seven, the national standards-setting body, is writing the
standards for data exchange points between health providers.

State agencies “can take this information to the companies they are looking to
contract with and say, ‘Can you build this for us?’ ” CDC’s Henderson
said.

But, Henderson said, state systems should protect the privacy of citizens.

“Providers are going to have to have a certain authority to look for that record,
and the only way is to have the local agencies involved to act as a moderator … to
act in exchange for that information,” Henderson said. “We are very concerned
that we not have a system that is clumsy and can give out a child’s home address;
demographic information is very sensitive,” he said.

Fourteen other states, including Oregon, Maine and New Hampshire, have computerized
immunization registries.

An additional 30 states and the District of Columbia have registries in one or more
public sites but have not yet linked them statewide.

For more information on the National Immunization Program, visit http://www.cdc.gov/nip/registry.