Glazner JE et al. 2004 "Using an immunization registry: effect on practice costs and time."

Glazner JE, Beaty BL, Pearson KA, et al. Using an immunization registry: effect on practice costs and time. Ambulatory Pediatrics 2004;4(1):34-40.
"Introduction: Immunization registries can consolidate immunization records scattered among different providers, allowing immunization documentation for legal purposes, generation of needed-immunization lists, inventory management, and outreach for underimmunized children. They have been endorsed by the Centers for Disease Control and Prevention and health professionals as a means of sustaining high immunization rates. However, some providers perceive the cost of registry use as a barrier to participation. We sought to determine the effects of registry use on cost and time. Methods: We used a pre-post design and a cost-accounting approach to measure labor costs and time for immunization-related activities possibly affected by registry use before development of a regional registry in Colorado and after the registry was being fully used. Two rural family practices, 2 rural community health centers (CHCs), 3 urban pediatric practices, and 2 rural public health agencies participated in both periods. Results: Cost per shot increased slightly in the postregistry period for private practices and CHCs ($0.56 per shot in 2001 dollars) and public health agencies ($0.38). Since costs can increase for several reasons, including salary increases above inflation, we analyzed time spent per shot and found that staff time decreased for private practices and CHCs but increased substantially for public health agencies. Conclusions: The study findings suggest to private practices that registry participation can provide a net benefit by making the vaccination process more efficient and, absent above-average salary increases, less costly. Public health agencies, however, would have to rely exclusively on the registry and eschew the use of paper vaccination records to realize efficiencies seen by other practice types."
To determine the effects of immunization registry use on costs and time.
Tools Used
Type Clinic
Primary care
Type Specific
Family practice, and pediatrics
Small, medium and large
Urban and rural
Other Information
Two rural private practices and two rural community health centers in Colorado participated in the study after the registry was implemented. Three urban pediatric practices in the Denver area also participated in the study.
Type of Health IT
Immunization registry
Type of Health IT Functions
"The registry consolidates multiple immunization records scattered among different providers into complete immunization histories, allowing documentation of immunizations for various legal purposes, generating list of children needing immunizations, managing vaccine inventory and support of outreach to underimmunized children."
Workflow-Related Findings
In private practices and community health centers after implementation of the registry, "nursing time spent on vaccinations (both immunization-related and non-routine activities) declined markedly (4.8 minutes or 40%), more than making up for the average of 3.4 minutes per shot spent on registry-related activities."
In public health agencies after implementation of the registry, "time spent on immunization activities increased by an average of 6 minutes. Registry activities themselves took nearly 6 minutes per shot, 67% more than the time spent by private practices and CHCs. Immunization administration time remained about the same as in the pre-registry period, suggesting that registry participation did not improve efficiency of immunization administration as it appeared to do in private practices and CHCs."
"The time required for giving vaccinations could be affected by registry participation because of ready electronic availability of each child's immunization record for appointments and consequent elimination of the need to search the medical record for immunization information at the time of the visit, as well as the ability to immediately retrieve complete immunization records for purposes such as day care and school inquiries (often responded to by nursing staff.)"
"Private practices used the registry alone for determining vaccinations needed by children at their visits, thereby reducing time needed for other immunization-related activities, whereas public health agencies used both the registry and paper files to determine needed immunizations, pulling paper records and printing registry reports for each appointment. After vaccinations are given, data are entered in both the registry and the paper record."
"Another reason for spending more time on registry activities is slow network connection time in the rural areas we studied (the...registry is internet based)."
Study Design
Pre-postintervention (no control group)
Study Participants
The study participants included 610 children receiving 1,335 immunizations in preregistry period and 991 children receiving 2,244 immunizations in the postregistry period.