A decentralized, community-based design for statewide immunization registries in Minnesota.

Incomplete immunization records and an increasingly complex immunization schedule make it difficult for parents and providers to know what shots their children or clients need. Complete and accurate immunization records are needed for day care, sports, camp, and school, but this is difficult--especially when previous immunizations have been received at different clinics. Population-based immunization registries help make complete and accurate records more easily available to parents and health care providers. Registries foster the timely sending of reminder notices for children who are due for immunizations and make it possible for providers to quickly assess immunization rates in their clinic. Public health officials use registries to determine immunization rates, to identify pockets of need where immunization rates are low and to target resources. In Minnesota, over 85% of immunizations are delivered in the private sector. Minnesota is also extensively covered by managed care organizations with an estimated 75% of the total population enrolled in some type of managed care. Strong local community public health agencies in each county also drive local solutions to community needs. These factors and others led to a de-centralized approach to the implementation of registries. The "Minnesota Model" is based on the development of community-based registries which link together local clinics, hospitals, health plans, public health departments, and schools in each region. Each community-based registry is designed to link to a state hub. This decentralized open architecture design is based on standards for data, not hardware or software. The building begins, not by implementing a state registry into which all immunizations are entered, but at the community level. Currently, 38% of Minnesota counties (representing 52% of statewide births) are involved in implementing a community-based registry, and 53% (representing 43% of statewide births) have initiated discussions with private providers. Only 9% of counties (5% of statewide births) have no current registry activity. This paper describes the steps which have been taken towards developing a decentralized statewide immunization information system for Minnesota, based on recommendations put forth by The State Immunization Practices Task Force Work Group on Immunization Registries.