Costs of Implementing an Immunization Registry in Private Clinics National Immunization Conference Chicago, IL March 18, 2003 Tina Higginbotham Director, Research Administration Iowa Health System - Des Moines

Overview Assess the costs of implementing the Immunization Registry and Information System (IRIS) IRIS in 6 private clinics (pediatric & family practice) Project Period: Nov 2001 - Sept 2002 Project Director designed project, recruited clinics and coordinated implementation

Purpose To determine whether the implementation and use of a population based immunization registry is both cost- and time-effective in the private providers’ clinics.

Pre-Study Considerations Site Selection Implementation

Site Selection Criteria Location of the clinic Size of the practice Type of practice Current hardware in use Level of enthusiasm of clinic personnel

Implementation Site interviews Staff training Data collection/entry off-site Data collection/entry types of data personnel

Study Design Variables Models Analysis

Variables Number of New Records Number of Updated Records Number of Patients Number of Immunization Reports Requested Time to Create a New Record Time to Update a Record Time Saved (by IRIS) with Immunization Reports Personnel Expense Discount Factor

Models Longitudinal Model Start-up Model Cost of IRIS for a patient, from birth through age 5 (routine use of IRIS over time) Start-up Model Initial costs associated with implementation of IRIS and resulting benefits to the clinic

Longitudinal Model Base case assumptions: creation and updates of an IRIS record according to the CDC-recommended immunization schedule 1.5 requests for immunization reports

Longitudinal Model

Longitudinal Model Base Case Results Creating & Updating Records Cost $5.33 per patient Savings $5.27 per patient Savings Represent 98% of Cost

Start-Up Model Timeframe for model is six years Base case assumed: all patients would require an average of 1.25 updates over the next five years patients would request an average of one immunization status reports

Start-Up Model

Start-Up Model Base Case Results Costs: Creating & Updating Records in Current Year - $11,148 Creating & Updating Records in Future Years - $5,304 Total Cost - $16,452 Savings Current & Future Years - $21,582

Comparative Data

Comparative Data

Supporting Studies Horne, et. al. Five clinics Modeled the cost of a registry for a preschool child Estimated 95% of costs were recovered through savings in retrieving and reporting immunization data

Supporting Studies Rask, et. al. Three clinics Two different registries (no automated data entry) Comparison of demographic and immunization transactions Savings were not reported in this study

Conclusion Qualitative assessments revealed generally positive impressions of IRIS Costs incurred in short-term generate savings in long-term increased efficiency in generating reports greater efficiency with vaccine inventory possible decrease in missed or duplicated immunizations

Acknowledgements Iowa Department of Public Health Bureau of Immunizations Wellmark Foundation Lon Larson, PhD