|
The First Electronic
Immunization Registry System in Iran, Iranian
Immunization Registry (IIR)
Halime Raeisi Sarbizhan (1)
Nahid Hatam (2)
Mehrdad Askarian (3)
(1) Student Research Committee, Department
of Community Medicine, Shiraz University of
Medical Sciences, Shiraz, Iran
(2) Department of Health Service Administration,
School of Management and Information Sciences,
Shiraz University of Medical Sciences, Shiraz,
Iran.
(3) Department of Community Medicine, Medicinal
and Natural Products Chemistry Research Center,
Shiraz University of Medical Sciences, Shiraz,
Iran
Correspondence:
Mehrdad Askarian,
Department of Community Medicine,
Medicinal and Natural Products Chemistry Research
Center, Shiraz University of Medical Sciences,
Shiraz, Iran. P.O.BOX: 71345-1737,
Shiraz, Iran.
Tel: +98-917-112-5777 Fax: + 98-713-2347977
Email: askariam@sums.ac.ir
|
Abstract
Introduction: A
national immunization electronic registry
system could improve Immunization levels.
This system of immunization coverage facilitates
shared experiences, information and specialized
consultation. The aim of this study is
to establish an immunization registry
system in the Health- Therapeutic center
in Shiraz city.
Method:
The study type is to set up a method or
academic-implementation system. The immunization
software design and implementation was
done in 2016 at one of the health centers
in Shiraz city. The study population is
the area covered by the health-Therapeutic
center. The research tool, flow chart
design and development of a data collection
form were developed prior to making the
immunization software.
Results: The
main and important result of this research
is construction and Setting up of electronic
immunization registry software in accordance
with country guidelines in 2016 (the latest
guidelines). The software has three phases
and stages including initial and daily
actions by the vaccinator (cold chain
control) before starting the process of
immunization, immunization registration
of children under 18 years of age and
immunization registration of adults (over
18 years), pregnant women and women of
childbearing age.
Conclusion:
The results showed that this web-based
system includes the following attributes
- timely immunization registration ability,
report of vaccine adverse events, report
of delayed cases, stocks of vaccine, requests
and appropriate distribution of vaccine,
ease of use of immunization and reducing
parents’ failure to follow the immunization
and by the adoption of a coordinated and
comprehensive system in the province and
the country, the possibility to compare
immunization coverage, report of shortcomings,
problems and risks of immunization program
are prepared.
Key words:
Immunization, Electronic registry of immunization,
Complications of immunization, Immunization
coverage, Registry
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The expanded immunization program of WHO (World
Health Organization) was considered to eradicate
smallpox in 1974 (Katz, 1993). At that time,
in accordance with the immunization program
and time schedule of EPI (Expanded Program of
Immunization) less than 5% of the world’s
children were vaccinated against diseases like
tuberculosis, polio, diphtheria, tetanus, whooping
cough and measles. By 1984, this figure rose
to 25 percent (Hueston et al, 1994 and Kelley,
2006).
Vaccines are the greatest successes and achievements
of biomedical sciences and public health, and
represent one of the most effective means for
the prevention of diseases (John, 2010). Continuous
efforts to improve the effectiveness and safety
of vaccines and vaccine coverage among all age
groups will provide overall benefit of public
health (Roush et al, 2007 and Zhou et al, 2001).
There are major and significant gaps in scientific
research for a complete description of how the
registers facilitate the most accurate effectiveness
of the vaccine studies based on population.
In addition, immunization information systems
preparation of IIS (Immunization Information
System) is a new field and it is under development
and major restrictions such as the disappearance
or loss of data, inaccurate data or the potential
inability of unrealistic data have not been
studied and explored fully (Adams et al, 2000
and Danovaro-Holliday et al, 2014).
However, without detailed information about
immunization coverage, we lack the data for
placing and initiating necessary systemic and
programmatic changes to achieve national Immunization
objectives (Morris et al, 2015, Lieu et al,
2015, Bates et al, 2003).
A computer and computer-based system is reliable
for maintaining immunization records and a register
presenting immunization dates and its reports
are printable for parents and schools and they
provide guidance for the time being and implementation
of immunization program (Young et al, 2015).
It provides clinically useful reports for children,
teens and adults like report of vaccination
coverage and next forecast immunization program
of people is possible (Garrido et al, 2016,
MacDonald et al, 2014).
All vaccines are registered and collected in
the form of a system. Immunization records,
and providing safe, accurate and updated immunizations
are for children who have been referred to the
service supply (Badgett and Mulrow, 2005). It
provides a reminder list and tags to people
who are delayed in keeping to the schedule.
For children and patients who are overdue in
their immunization, a reminder is sent and registration
and reminders, keeps their immunization schedule
up to date.
According to the above criteria we tried to
implement the outlook for childhood immunization
supply at public and private health centers
in the form of electronic data registration
based on immunization implementation authenticity
with the benefit of new and updated information
and communication technologies with high accuracy
at the individual level and the monitoring of
data accuracy, facilitate immunization coverage
and by developing of an immunization electronic
system and shared experiences and information
and expert advice, expand dramatically the immunization
program and develop an important step in data
management and implementation of health interventions
at the local and national level and also an
opportunity for education and research in this
field. Therefore, the aim of this study is to
establish an immunization registry system in
selective health-therapeutic centers of Shiraz
city.
In this research, study type is to set up a
method or academic-implementation system. The
immunization software design and implementation
was done in 2016 at one of the health centers
in Shiraz city that is a subsidiary of the city
health center (Engelab). It has the ability
to expand to other health-therapeutic centers,
health homes, public and private hospitals and
link with headquarters of health center of the
city and other provinces and cities of the country.
The method in the project consists of two phases.
To start the process, first the flowcharts and
guidelines were provided that were based on
a program and immunization guide approved by
the National Committee in 2016. The first stage
started with the vaccinator, health workers
or social workers who have responsibility for
inoculation and injection of vaccine, and by
controlling the cold chain, temperature of vaccine
refrigerator and charting temperature, decide
whether vaccine is to be kept at refrigerator
temperature or not? Subsequent decisions would
be taken (based on VVM and cold chain monitoring
indicators) and entered into the beginning of
immunization stages.
To initiate and carry out immunization, refrigerator
vaccine inventory should control with full specifications
of vaccines, including vaccine types, the number
of vials, serial numbers, expiration date, factory
or company of manufacture. Registration and
layout of vaccine was conducted according to
the National Committee and accordance with the
type of person (children or adults), (new or
duplicate), date of birth, gender, disease history,
effect of the vaccine, an appropriate form is
designed, selected and immunization process
starts.
In this regard if the visitors have complications
or adverse reactions to the vaccine, it can
design and select an appropriate form in accordance
with the drawn flowchart and based on the immunization
process, which will continue. If the child is
a delayed visitor, delayed forms would be designed
according to child’s age and national Committee
guidelines, and the selection and immunization
program continues. Also for patients older than
18 years (male or female), the form will be
designed according to the immunization guidelines
of the National Committee and having qualification,
standard of selection and immunization will
be done (hepatitis, Diphtheria-tetanus, MMR).
Thus, according to a steps summary of the outlined
flowcharts, the data collection form was designed
and developed. This form that was designed by
the researcher, included variables such as vaccinator
profile, vaccines important features, visitor
specifications, information relating to child
immunization, immunization of people over 18
years of age, pregnant women and women of childbearing
age. This form was designed for age groups under
18 and over 18 years under the National Immunization
Program Committee.
Our target registry population, is the area
covered by the health center and people with
the age group mentioned, Iranian and non-Iranian
nationality and all the people who have moved
to this area who have no immunization prohibition
and are referred to health center with satisfaction
(including children, adults of both genders,
pregnant women and women of childbearing age).
Explanations were given before completing the
form for collecting data in compliance with
health research ethics and informed consent
of the visitor or parents to register their
full details.
It should be noted that for design of the software,
it is used first by searching for articles and
resources of various databases from the countries
which have electronic immunization registry
program, because Iran has not have an electronic
immunization registry program. The data collection
form, collection samples form were separated
and from target population until the initiation
and progression stages of software development,
at least 50 samples were collected for software
testing (images as sample of the data collection
form).
Table 1: Properties of vaccine
Table 2: Daily actions of vaccinator
(Vaccine stock)
Table 3: Visited people Profile
Table 4: Type of visit
Figure 1: Visit due date and on time
The second step (build software) was based
on the technical specifications of the registry
immunization system. Registry System of the
software is Web-based and it is designed and
developed based on PHP server technology Version
5.6, MySQL database and HTML 5 world standard
and Ajax technology. In this software, minimum
hardware requirements are processor: 2x2GHZ,
Memory: 4GB, storage space: 20GB for the OS
+ 500 KB for each data item.
A
major
result
of
this
research
project
was
construction
and
setting
up
of
electronic
immunizations
registry
software
according
to
the
National
Committee
in
2016.
The
immunization
data
from
50
individuals
were
collected
and
developed
in
accordance
with
the
data
collection
form,
and
entered
into
the
software
as
a
pilot
and
test.
Entering
data
into
the
software
was
according
to
different
criteria
like
the
cold
chain
control,
daily
actions
of
vaccinator
of
refrigerator
temperature
controlled
vaccine,
full
registration
of
vaccines
information,
and
the
immunization
data
of
children
under
18
years
of
age,
their
gender,
the
type
of
vaccine
and
also
registration
information
of
adults
(over
18
years
of
age),
pregnant
women
and
women
of
childbearing
age
in
terms
of
the
type
of
vaccine
used
and
information
gathering.
The
software
has
three
phases
and
stages:
initial
and
daily
actions
of
vaccinator,
immunization
registration
of
children
under
18
years
of
age,
immunization
registration
of
adults
(over
18
years),
pregnant
women
and
women
of
childbearing
age.
Images
of
application
performance:
Figure
2,
Figure
3,
Figure
4.
Click
here
for
Table
1:
Properties
of
vaccine
Click
here
for
Table
2:
Daily
actions
of
vaccinator
(Vaccine
stock)
Click
here
for
Table
3:
Visited
people
profile
Click
here
for
Figure
1:
Type
of
visit
Click
here
for
Figure
2.
Demographic
information
Click
here
for
Figure
3:
Record
vaccine
information
Click
here
for
Figure
4:
Referral
at
due
time
The
collected
data
was
entered
into
the
software.
During
data
entry
we
have
concluded
that,
as
data
entry
to
the
software
is
needed
to
complete
information,
this
is
contrary
to
the
manuscript
notes
and
paper,
which
can
be
changed
at
any
time
and
line
correction
and
the
noted
information,
is
not
complete
(Kolasa
MS
et
al,
2006).
On
the
other
hand,
with
the
lack
of
a
coherent
system,
each
person’s
immunization
program
had
an
immunization
registration
record
in
various
health
units
in
each
immunization
time
and
through
improvement
of
design
of
the
form
of
data
collection,
items
were
very
complete
that
is
background
of
data
entry
to
the
software
and
the
software
also
confirmed
its
authenticity.
A
system
of
simulated
immunization
registry
of
immunization
status
of
children
was
conducted
in
county
of
Olmsted
in
1995
for
children
up
to
the
age
of
24
months
(Rousseau
et
al,
2014).
Immunization
records
taken
from
a
population-based
sample
in
this
county
are
secure
by
summarizing
Immunization
data,
collected
from
provincial
health
care
centers
and
they
were
analyzed
by
the
software
system
(Rousseau
et
al,
2014).
The
results
show
that
9.1
percent
of
all
children
were
updated
until
to
the
age
of
20
months
and
this
increased
to
74.2
percent
until
24
months
of
life
(Rousseau
et
al,
2014).
The
24-month-old
child
immunization
rates
registered
in
the
health
care
system
were
changed
from
24.3
to
79.5
percent.
Added
data
from
health
care
centers
to
simulated
registry
immunization
system
has
increased
rate
of
immunization
in
each
location.
An
increase
of
27.7
percent
while
they
had
the
lowest
rates
of
registered
immunization
had
an
increase
of
6.9%
when
the
immunization
rate
was
the
highest.
(Rousseau
et
al,
2014).
Setting
up
of
a
software
system
in
medical
centers
and
health
care
facilities
can
report
only
immunization
within
the
scope
of
the
health
unit
and
this
is
only
one
step
of
the
immunization
improvement
process
(Rousseau
et
al,
2014,
Des
Roches
et
al,
2010).
The
availability
of
a
population-based
registry
system
is
a
solution
to
the
health
service
provider’s
data
uncertainty
and
a
guide
to
strengthen
the
immunization
program
to
Immunization
Information
Systems
(IIS)
(Rousseau
et
al,
2014,
Des
Roches
et
al,
2010).
Immunization
data
should
be
collected
ultimately
in
a
central
electronic
database
that
has
capabilities
of
storage,
retrieval
and
analysis,
because
parents
are
not
good
sources
for
a
centralized
database
and
they
are
often
unable
to
report
even
basic
information,
such
as
number
and
timing
of
immunizations
and
their
information
and
report
accuracy
is
not
more
than
50
to
60
percent
(Rousseau
et
al,
2014).
However,
short-term
and
long-term
potential
benefits
of
an
immunization
registry
system
should
be
weighed
against
the
costs,
because
it
requires
the
purchase
and
installation
of
hardware
and
software
and
networking
capabilities
and
requires
planning
and
development
of
a
series
of
standardized
data
and
privacy
rights
of
individuals
should
be
considered
(Rousseau
et
al,
2014,
Des
Roches
et
al,
2010,
Janet
et
al,
2015).
Creating
a
system
of
immunization
registry
does
not
change
the
immunization
rate
in
a
community,
but
it
allows
authorities
to
collect
gradually
immunization
report
cards
and
prevent
the
extreme
and
excessive
effects
of
missed
opportunities
to
(Rousseau
et
al,
2014).
The
advantages
of
this
web-based
system
are
on-time
registration,
reports
of
adverse
events,
stock
of
vaccine,
requests
and
appropriate
distribution
of
vaccines,
ease
of
immunization
and
reducing
the
failure
of
parents.
In
the
case
of
employing
a
coordinated
and
comprehensive
system
at
province
and
country
level
it
is
possible
to
compare
immunization
coverage,
report
shortcomings,
problems
and
risks
of
the
immunization
program
which
can
be
helpful
in
policy-making
and
getting
the
final
decision
for
the
process
of
immunization.
It
is
proposed
to
improve
the
immunization
program;
this
web-based
system
expanded
first
in
Fars
province
and
then
other
provinces,
so
that
ultimate
data
collection
could
be
made
available
to
the
Ministry
of
Health
and
be
considered
by
policy-makers,
managers
and
practitioners.
Acknowledgments:
The
Vice
Chancellor
for
Research
at
Shiraz
University
of
Medical
Sciences
funded
this
project.
This
research
was
performed
by
Halime
Raeisi
Sarbizhan
in
partial
fulfilment
of
the
requirements
for
certification
as
a
specialist
in
community
medicine
at
Shiraz
University
of
Medical
Sciences
in
Shiraz,
Iran
with
grant
number
of
95-7686.
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