Challenges to private provider participation in immunization registries

Background: For immunization registries to be effective, all providers (both private and public) of childhood vaccines must be willing to participate. The purpose of this study was to identify and fully understand the (1) benefits of the North Carolina Immunization Registry (NCIR), (2) barriers to participation by private practice physicians, and (3) potential incentives to address the barriers identified. Methods: We conducted a statewide series of 13 focus groups (6 with pediatricians, 5 with family physicians, and 2 with office managers). Participants represented the full range of nonpublic practice settings (e.g., solo, small, and large group practices, HMOs, and university clinics). Many participants questioned the need for an immunization registry and wanted evidence that it is a cost-effective intervention. We compared our findings with those found in other All Kids Count (AKC) sites. Results: The benefits of the NCLR commonly identified included having access to a complete and accurate history of a child's immunizations, thus eliminating the need for phone calls to other practices for immunization records and eliminating the need to document immunization information in multiple sites, thus automatically producing immunization forms for daycare, school, etc., and decreasing missed immunization opportunities. Barriers to participation included the following: the staff time needed to submit and obtain data, direct and indirect costs to practices (e.g., computer software, hardware, upgrades, data entry time), accuracy of data, liability for errors, and access to and security of data. Conclusions: Physicians must be convinced that the NCIR will be simple and inexpensive to use, flexible, and easy to integrate into their existing office systems. Public health officials should not underestimate the effort that will be required to achieve full participation by private-practice providers.