PROBLEM/SITUATION: Children who miss necessary immunizations pose expensive health risks to themselves and their community.
SOLUTION: An immunization tracking system to help identify children who are due for immunizations.
JURISDICTIONS: Texas; Fort Worth, Texas; Tarrant County, Texas.
CONTACT: Tarrant County Data Services, 817/884-1180.
Most children are not fond of receiving shots. Naturally, they think more about the pain involved than protection from life-threatening diseases. Most children would probably do anything to avoid getting their recommended barrage of immunizations. But if those kids reside in Texas, they're finding out there's no longer anywhere to hide.
In a spirit of cooperation and collaboration, Tarrant County, Texas, and the city of Fort Worth developed a joint database to track children's immunization records. The system, called the Public Health Automated System Environment (PHASE), is now fully implemented and networked to 10 of 12 public health clinics in the county, with the remaining clinics to be connected soon. The system is designed to track and maintain immunization records and to provide statistics on children who have not received vaccinations so that families can be contacted and encouraged to bring their children in for the dreaded procedure.
Tracking immunizations is important not only because it keeps children healthy, but also because for each dollar spent on a vaccination program, up to $14 can potentially be saved on treatment costs. According to county officials, the immunization rate for two-year-olds who have received complete polio series vaccinations is just over 50 percent in Tarrant County. Most other immunizations (diphtheria, tetanus, whooping cough, haemophilus influenzae type B, measles, mumps, rubella and hepatitis B) are only in the 50 percent to 70 percent range. Unfortunately, statistics aren't much better in other major cities across the United States, making PHASE a system of impending importance.
In recognition of this fact, the National Department of Health recently urged states to help them achieve their goal of ensuring that, by the year 2000, at least 90 percent of the nation's two-year- olds have received the basic vaccination series. To facilitate the process, the Fort Worth/Tarrant County Public Health Department began formulating their plan for a shared database in mid-1994. Tarrant County allocated $150,000 for the project and the city of Forth Worth added another $89,000.
THE NEW PHASE
Using PHASE, complete immunization records of children residing in Tarrant County can be easily accessed by private and public health providers. "We can also produce tracking reports," explained Jim Harvey, project manager for PHASE. "So once a kid starts a series of shots and he doesn't come back, personnel can call the parents and even go out and see them to see what the problem is."
To ensure they gather as much data as they can, personnel at the Public Health Department enter records into the client/server system for those healthcare providers with no computer capability. Records already in electronic form can be uploaded to PHASE using a simple dial-up system. Healthcare providers can view and add data to the system for any child that resides in Tarrant County. Data can also be transmitted from the soon-to-be-completed state Department of Health's immunization tracking system, called ImmTrac, for children who reside in other counties.
"It appears PHASE will be the first system tied into ImmTrac," explained James Schander, director of data services for Tarrant County. "So we'll be able to share data back and forth and can automatically search the ImmTrac system when a client cannot be found on the PHASE system."
No longer will there be any uncertainty about whether a child has or has not received immunizations when due. Once ImmTrac is complete, the city, county and state will all work together using the latest technology to track immunizations across Texas.
Tarrant County found the system could solve additional problems. "We were able to develop a drug inventory system that keeps track of the vaccines that are given each day and tracks what we have in stock," said Harvey. "That way, we know when a clinic needs to reorder and they are always prepared when a child comes in."
Officials found that PHASE is also useful for tracking other health problems. "We've taken the approach that it's not just the immunization registry, it's a registry of everybody in Tarrant County that comes to the Public Health Department for whatever reason. So eventually it will be used to track and keep statistics on HIV, sexually transmitted diseases, tuberculosis and other things," said Harvey.
Tarrant County is looking into connecting private health clinics to PHASE to broaden their database. "Some of the big [healthcare] providers are looking at matching their data against ours and pulling our data into their system," said Schander. "Eventually, we hope all the doctors -- everybody that gives immunizations -- will use and feed new data to this system."
"The whole gist of this thing is the more kids you can get in and the more data you can gather, the more valuable it becomes," said Harvey. "We're working with the county hospital district right now. After that, there are several HMOs in town and they're very interested in tying into us too. They realize it can keep their costs down, because having a kid with whooping cough is very expensive for them."
TAKING IT TO THE STREETS
Tarrant County is working to organize mobile teams using laptops loaded with the entire immunization database. "We tried before to use cellular lines and modems to do this, but it was very unreliable," said Harvey. "Now we've got some powerful laptops and we can replicate our entire database and take it out on the streets where personnel can meet with people who are unable or unwilling to come in to the Public Health Department," he said.
Taking the system to the streets will help ensure that as many people as possible in the area are protected. "In that way I think it is accomplishing three major things at once," said Schander "First, it's the latest technology, second, the city and county are working together, and third, it's just a good project for the community."
All system programming for PHASE was done by programmer/analysts employed by the Tarrant County Data Services Department. The system uses an IBM 9672-R31 CPU utilizing IMS, DB2 and CICS. PowerBuilder was chosen as the visual application development language, and the county installed 56KB lines to each of the remote clinics to capitalize on reasonable speed at the lowest cost. T1 lines were used where more bandwidth was needed.
Enough PCs were placed in each city/county health clinic to give each nurse easy access to a computer. Laser printers were put in the vaccination rooms so the parents could get a hard copy of their child's immunization history.
According to Harvey, good documentation and training helped make the start-up at each clinic relatively trouble-free.
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