Inner City Community Physicians’ Use of a Private Immunization Registry M. Irigoyen, S. Findley, K. Stambaugh, O. Peña, R. Jenders, M. Chitu Northern Manhattan Immunization Partnership Columbia University, New York, NY

Importance of Immunization Registries Key tools for increasing and sustaining immunization coverage In 2000: 24% of US children <6 in registry Healthy People 2010 goal: increase to 95% Universal provider participation key to achieve this goal

Role of Private Physicians Private physicians administer most immunizations Inner city children have multiple immunizations physicians Immunization Record scatter

Northern Manhattan Immunization Partnership CDC demonstration project in Northern Manhattan in New York City Partner institutions: New York Presbyterian Hospital, Harlem Hospital Center, Renaissance Health Care Network, St. Luke’s Roosevelt Hospital, NYC DOH Child Health Stations

Northern Manhattan Immunization Partnership Registry EzVAC New York Presbyterian Hospital Ambulatory Care Network School Based Clinics NYC DOH Citywide Immunization Registry Community Providers

EzVAC Immunization Registry Private registry in Northern Manhattan Web-based and real time Launched March 1999 Currently at 30+ practices 110,000+ children in the registry 98% vaccine capture rate Types of clinics and settings

Implementing EzVAC to Private Physicians Offices EzVAC was successfully launched at the hospital and school clinics Next step launching EzVAC at private providers get buy in (marketing) deployment of EzVAC (technical piece) integration into practice and use EzVAC was successfully launched at the hospital clinic the next stepwas to launch EzVAC at private ddoctors office in the community providers First we had to get buy in (marketing) deployment of EzVAC (technical piece) integration into practice and use First step was to Now I will describe these steps and tell you how successful (or not) we were and the challenges we faced

Getting Buy In From Private Physicians Selling points: User friendly, web based interface Automated VFC reporting Reporting to NYC DOH Citywide Immunization Registry Automated school printouts Free hardware and services Computer, monitor, and printer DSL connection through Verizon DSL Staff training and technical support Monthly reports on the registry usage level

Characteristics of Physicians N = 14 volunteer physicians 14 (100%) served Medicaid patients 12 (86%) 40-60 y/o 11 pediatricians, 3 fam med 13 hospital appointments 12 solo practices 11 had 1 staff, 3 had 2 staff 80 children/week average 3 computer literate, 6 had office computers

Private Physician’s Use of EzVAC 23% RARELY NEVER 38% 39% FREQUENT

Use of EzVAC First 6 Months by Practice

Factors NOT Associated With Patterns of Use Physician’s age Solo vs group practice Physician computer literacy

Factors Associated With Patterns of Use Pediatricians > Fam Med Previously had computers in office More staff in practice Higher volume of patients

Factors Key to Success Physician champion Successful integration of registry into practice flow by: delegated data entry function to staff made staff accountable Physicians that took responsibility to enter data themselves rarely used the registry

Conclusion We successfully deployed EzVAC at private offices in New York City. Despite continued support and training use has been inconsistent. Further studies are needed to identify barriers to adoption of immunization registries in inner-city, private office settings.