LaVenture M, Wicklin N, Schillo T, Gatewood L
Minnesota Department of Health, Minneapolis, USA.
Proc AMIA Annu Fall Symp. 1997:388-92.
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.
免疫记录不完整以及免疫接种计划日益复杂，使得家长和医护人员难以知晓他们的孩子或客户需要接种哪些疫苗。日托、体育活动、夏令营和学校都需要完整准确的免疫记录，但这很难做到——尤其是当之前的免疫接种是在不同诊所进行的时候。基于人群的免疫登记系统有助于家长和医疗服务提供者更轻松地获取完整准确的记录。登记系统有助于及时向应接种疫苗的儿童发送提醒通知，并使医护人员能够快速评估其诊所的免疫接种率。公共卫生官员利用登记系统来确定免疫接种率，识别免疫接种率较低的需求区域，并将资源集中用于这些区域。在明尼苏达州，超过85%的免疫接种是在私营部门进行的。明尼苏达州也广泛覆盖了管理式医疗组织，估计75%的总人口参加了某种形式的管理式医疗。每个县强大的地方社区公共卫生机构也推动针对社区需求的地方解决方案。这些因素以及其他因素导致了免疫登记系统实施的分散化方法。“明尼苏达模式”基于社区免疫登记系统的开发，该系统将每个地区的当地诊所、医院、健康计划、公共卫生部门和学校连接在一起。每个基于社区的登记系统都设计为与一个州中心枢纽相连。这种分散式开放架构设计基于数据标准，而非硬件或软件标准。建设工作不是从实施一个录入所有免疫接种信息的州登记系统开始，而是从社区层面开始。目前，明尼苏达州38%的县（占全州出生人口的52%）参与了基于社区的登记系统的实施，53%的县（占全州出生人口的43%）已开始与私营医疗服务提供者进行讨论。只有9%的县（占全州出生人口的5%）目前没有登记系统相关活动。本文描述了根据州免疫实践工作组免疫登记系统工作小组提出的建议，为明尼苏达州开发一个分散式全州免疫信息系统所采取的步骤。
