How complete are immunization registries? The Philadelphia story.

OBJECTIVE: To assess accuracy and completeness of Philadelphia, Pa, registry data among children served by providers in areas at risk for underimmunization. METHODS: Philadelphia's Department of Public Health selected a simple random sample of 45 children age 19-35 months (or all children age 19-35 months if there were <45 children in the practice) from each of 30 private practices receiving government-funded vaccine and located in zip codes where children are at risk for underimmunization. Chart and registry data were compared with determine the proportion of children missing from the registry and assess differences in immunization coverage. RESULTS: Of 620 children reviewed, 567 (92%) were in the registry. Significant differences (P < .05) were observed in immunization coverage for 4 diphtheria-tetanus-acellular pertussis vaccinations, 3 polio vaccinations, 1 measles-mumps-rubella vaccination, and 3 Haemophilus influenzae type b vaccinations between the chart (80% coverage) and registry (62% coverage). Providers submitting electronic medical records or directly transferring electronic data to the registry had significantly more children in the registry and higher registry-reported immunization coverage than those whose data were entered from billing records or log forms. All practice types experienced difficulties in transferring complete data to the registry. CONCLUSIONS: Although 92% of study children were in the registry, immunization coverage was significantly lower when registry data were compared with chart data. Because electronic medical records and direct electronic data transfer resulted in more complete registry data, these methods should be encouraged in linking providers with immunization registries.

Practice-based electronic billing systems and their impact on immunization registries.

Many providers rely on electronic billing systems to report information to immunization registries. If billing data fail to capture some administered immunizations, the registry will not reflect a child's true immunization status. Our objective was to assess differences between immunizations administered and immunizations reported to a registry from electronic billing systems. Philadelphia's Department of Public Health conducted chart audits in 45 providers serving 50 or more children aged 7-35 months and using electronic billing systems to report data to Philadelphia's immunization registry in 2001-2003. Chart records were compared to registry records to identify immunizations administered in these practices but not reported to the registry. The study practices administered 256,969 immunizations to 20,611 children. Of these 256,969 administered immunizations, 62,213 (24%) were not in the registry. The electronic billing systems submitted data for all administered immunizations for 69% of immunization visits, some but not all for 11% of visits, and none for 20% of visits. Immunizations administered but not billed cost these providers up to $980,477 in lost revenue from administrative fees alone. Improvement of billing data quality would result in more complete registries, higher reported immunization coverage rates, and recovered revenue for immunization providers.

Do laws bring children in child care centers up to date for immunizations?

BACKGROUND: Pennsylvania state law requires licensed child care centers (CCCs) to document that each enrolled child is up to date (UTD) for routine immunizations within 60 days of enrollment. This study evaluates the law's impact on immunization coverage among children aged