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Perceptions of immunization information systems for collecting pandemic H1N1 immunization data within… Heidebrecht, Christine L.; Foisy, Julie; Pereira, Jennifer A.; Quan, Sherman D.; Willison, Donald J.; Deeks, Shelley L.; Finkelstein, Michael; Crowcroft, Natasha S.; Buckeridge, David Llewellyn, 1970-; Guay, Maryse; Sikora, Christopher A.; Kwong, Jeffrey C. Aug 31, 2010

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RESEARCH ARTICLE Open AccessPerceptions of immunization information systemsfor collecting pandemic H1N1 immunizationdata within Canada’s public health community:A qualitative studyChristine L Heidebrecht1*, Julie Foisy1, Jennifer A Pereira1, Sherman D Quan2, Donald J Willison1,Shelley L Deeks1,3, Michael Finkelstein3,4, Natasha S Crowcroft1,3,5, David L Buckeridge6,7, Maryse Guay8,9,10,11,Christopher A Sikora12, Jeffrey C Kwong1,3,13,14,the Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (PCIRN)Vaccine Coverage Theme GroupAbstractBackground: Immunization information systems (IISs) are electronic registries used to monitor individual vaccinationstatus and assess vaccine coverage. IISs are currently not widely used across Canada, where health jurisdictionsemploy a range of approaches to capture influenza immunization information. Conducted in advance of the 2009H1N1 vaccination campaign, the objectives of this study were to understand the perceived value of individual-leveldata and IISs for influenza control, identify ideal system functions, and explore barriers to implementation.Methods: In July and August 2009, semi-structured interviews were conducted with key informants engaged invaccine delivery and/or pandemic planning at regional, provincial/territorial and federal levels across Canada. Keyinformants were recruited using a combination of convenience and snowball sampling methodologies. Qualitativeanalysis was used to extract themes from interview content.Results: Patient management, assessment of vaccine coverage, and evaluation of safety and effectiveness wereidentified as public health priorities that would be achieved in a more timely manner, and with greater accuracy,through the use of an IIS. Features described as ideal included system flexibility, rapid data entry, and universality.Financial and human resource constraints as well as coordination between immunization providers were expressedas barriers to implementation.Conclusions: IISs were perceived as valuable by key informants for strengthening management capacity andimproving evaluation of both seasonal and pandemic influenza vaccination campaigns. However, certainimplementation restrictions may need to be overcome for these benefits to be achieved.BackgroundImmunization information systems (IISs) are electronicregistries containing individual-level vaccination infor-mation, usually including additional functionalities suchas adverse event reporting, linkage with other electronicregistries, or vaccine management [1], and are used tomonitor individual vaccination status and assess vaccinecoverage. Individual-level data collected in electronicform at the point of influenza immunization providepublic health practitioners, planners and clinicians withreadily accessible, high-quality information with whichto make decisions [2].User perceptions of electronic patient information sys-tems have been studied broadly [3-7]; however, thisresearch has primarily focused on the experiences andinsights of front-line care providers. Vaccination program* Correspondence: christine.heidebrecht@oahpp.ca1Department of Surveillance and Epidemiology, Ontario Agency for HealthProtection and Promotion, Toronto, CanadaFull list of author information is available at the end of the articleHeidebrecht et al. BMC Public Health 2010, 10:523http://www.biomedcentral.com/1471-2458/10/523© 2010 Heidebrecht et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.planners, policy makers and other public health profes-sionals all rely on immunization data, but little is knownabout these users’ perceptions of IISs for influenzavaccination.Canadian jurisdictions employ a range of approachesto capture seasonal influenza immunization information,including full IISs, physician billing records, paper sys-tems that maintain information in paper format eitherin aggregate form or at an individual level, and hybridsystems in which paper immunization records are trans-ferred to an electronic database. In advance of the pan-demic (H1N1) 2009 influenza vaccination campaign, wewere interested in learning about the perspectives ofindividuals from jurisdictions with access to IISs as wellas those from jurisdictions employing less comprehen-sive data collection methods. In this study we exploredthe perceptions of key informants from influenza vacci-nation programs at federal, provincial/territorial andregional levels, and we sought to answer the followingquestions: (1) What are the perceived benefits of collect-ing individual-level data, for pandemic, as well as seaso-nal influenza immunization? (2) Which features andfunctionalities should an ideal immunization informa-tion system encompass? (3) What are the perceived bar-riers to collecting individual-level data? (4) What are theperceived barriers to achieving an ideal IIS?MethodsSampling and recruitmentThe breadth of information that was sought in thisstudy led us to identify key informants engaged in vac-cine delivery and/or pandemic planning in regional,provincial/territorial and federal jurisdictions. Toensure that the findings reflected perspectives fromacross Canada, recruitment was initiated by approach-ing members of a national committee representing allthirteen provinces and territories, as well as federalbodies, who are working towards creating a nationalnetwork of immunization registries. These memberswere approached electronically, through a recruitmentemail requesting their participation in a telephoneinterview. Snowball sampling was used to recruit addi-tional participants by asking interviewees to providenames of other individuals in their jurisdictioninvolved with pandemic planning, vaccine programdevelopment and/or vaccine delivery. Recruitment ofparticipants continued until broad geographic repre-sentation had been achieved to the extent possiblegiven the limited availability of our target populationduring a pandemic period. Ethics approval was grantedby the University of Toronto ’s Health SciencesResearch Ethics Board.Data collectionA semi-structured approach to data collection was cho-sen in order to focus each interview session on particu-lar topic areas while providing an opportunity forbroader participant insights to be expressed during thecourse of the dialogue. Key questions were developed bythe research team based on study objectives. All inter-views were conducted over the telephone by one mem-ber of the research team, and recorded with anelectronic voice-recorder once consent was obtained.Recordings were transcribed verbatim by an externaltranscriptionist for analysis purposes.Data analysisInterview data were assessed using conventional contentanalysis. This approach allows categories and ultimatelythemes within the data to be discerned [8,9]. Followingimmersion in the data through reading the transcriptsand listening to interview recordings, two members ofthe research team independently coded interview tran-scripts. Throughout this process they developed a cod-ing structure, which defined codes and described therelationship between codes and sub-codes when applic-able; this structure evolved as necessary to capture newand modified codes. Periodic co-coding, whereby sometranscripts were coded by both team members, as wellas regular meetings between the coders, ensured contin-ued consistency in creation and application of codes.Approximately 15% of transcripts were co-coded. Dis-agreement with respect to coding was rare and wasresolved through discussion to reach consensus regard-ing both the definition and scope of the code. Oncecoding was completed, the codes were imported intoqualitative analysis software (QSR NVivo Version 8.0).Informed by the study questions and designed based ontrends that were identified through the coding process(an approach both deductive and inductive), a series ofqueries was created and executed in order to examine,sort, and categorize and the coded text. From these ana-lyses, key themes in the data emerged. Consensusregarding the key themes was reached between the twocoders, after which two verification phases were com-pleted: (1) The themes were first reviewed by a teammember who had not participated in the coding processbut who was familiar with all of the interview transcriptsin order to corroborate the findings. (2) Further, obser-ving a process called member checking [10], key infor-mants were asked to review a summary of the themes inorder to ascertain the validity of the interpretations.Twelve participants responded to this request, and allindicated that the findings reflected their recollection ofthe interview content.Heidebrecht et al. BMC Public Health 2010, 10:523http://www.biomedcentral.com/1471-2458/10/523Page 2 of 8ResultsA total of 31 telephone interviews were conducted dur-ing July and August 2009. When participants wereapproached for approval to include their interview datain an analysis for publication, however, five participantsdeclined this request. The findings presented here reflect26 interviews conducted with 29 participants (threeinterviews were conducted with more than one indivi-dual); 19 of these participants were recruited throughsnowball sampling. Saturation was reached before theend of the interview process; no new categories orthemes were identified after the 13th interview butbecause of our desire for geographic representation wecontinued recruitment until this had been achieved.Respondents included community health nurses, infec-tious disease coordinators, vaccine program managers,epidemiologists, medical officers of health, and otherpublic health and communicable disease specialists. Par-ticipants represented nine provinces and two territoriesas well as two federal bodies; we were unable to recruitparticipants from one province and one territory. Themajority of participants were involved with pandemicplanning, either at a regional, provincial/territorial, orfederal level.4/26 interviews were conducted with users of electro-nic information systems that captured all vaccinees, and4/26 systems used by respondents maintained paperrecords of individual-level data. 6/26 participants’ sys-tems retained aggregate counts of vaccinees, and 10/26systems captured individual-level data electronically forcertain sub-populations or in certain jurisdictions. Tworespondents had experience with or knowledge aboutmany different approaches to immunization datacollection.Perceived benefits of collecting individual-level dataBenefits of individual-level influenza immunization dataexpressed by participants included both observed andenvisioned capabilities, depending on whether or not aninterviewee had experience capturing electronic data.Most participants perceived IISs to be valuable, while asmall number expressed the view that they were of lim-ited use. The benefits of collecting individual-levelimmunization data electronically that were shared bythe largest number of respondents included assessmentof vaccine coverage and patient management. Thesewere expressed as important strengths for both seasonaland pandemic influenza vaccination data.Access to comprehensive vaccination informationwithin an IIS facilitates in-depth evaluation of vaccinecoverage and immunization programs overall. Respon-dents explained that individual-level immunization dataallow (or would allow) them to assess progress towardscoverage targets and to create a response plan, if neces-sary, to improve coverage. Further, access to electronicimmunization data meant that respondents would beable to engage in more timely analysis and reporting.I just find it interesting to actually analyze that dataand then use it to see what you can do to - as a tar-get, you know, to increase your rates...Are we reach-ing who we want to and those populations defined atrisk?In terms of generating a report, you could do it muchfaster. Because right now we have to physically gothrough and count all of these things... In terms ofthe reporting and the records and everything else, itwould be a really big time saver.The added benefit of being able to look at longitudinalcoverage data was also noted.We found it very valuable over the years becausewe’ve been able to determine trends, who’s getting thevaccine and who isn’t. And that’s allowed us to tar-get specific risk groups where we feel we need toimprove coverage.Respondents felt that maintaining electronic immuni-zation records allowed them to better manage patientcare both at the point of vaccination and during subse-quent patient visits. Immunization records that wereaccessible to other providers were thought to furtherimprove clinical care.When there’s an immunization registry present, ifsomebody goes to enter the information, they knowthat that person’s had an adverse event ‘cause it’sflagged automatically. So they know not to immunizethat individual.We had people coming to our health unit saying,“...They won’t let me come to work unless I haveproof.” We would go through boxes of paper consents...and then retrieve that information manually. Now it’sjust a couple of keyboard clicks and we’re there.The ability to record and track dose number was iden-tified by a large proportion of respondents as an impor-tant feature of IISs during a pandemic immunizationcampaign. (When the interviews were conducted it wasbelieved that a two-dose schedule would be required forall individuals.) Respondents felt strongly about the needto have accessible information at the point of service toassess a client’s prior vaccination history and providethe appropriate service, observing the need to properlyspace doses in order to ensure effectiveness.Heidebrecht et al. BMC Public Health 2010, 10:523http://www.biomedcentral.com/1471-2458/10/523Page 3 of 8But in terms of pandemic, because it is the two doses,whatever they determine, 21, you know, 28 daysapart, then to ensure that the time period is accu-rate, that would be important. Because otherwiseyou’re depending on that individual to come backwhen they’re supposed to and, you know, that oftendoesn’t work.Other perceived benefits of the collection of indivi-dual-level data were expressed by fewer participants.Some respondents described the importance of monitor-ing adverse events following immunization, especially inthe context of a new vaccine containing an adjuvant,and felt that IISs are/would be particularly useful forthis, although others noted that it was possible to moni-tor adverse events without individual-level immunizationdata. Facilitating the evaluation of vaccine effectivenessthrough the availability of definitive information aboutwho had been vaccinated and who had not was alsoexpressed as a benefit of an IIS, as was improved effi-ciency at the point of care.Two respondents pointed out that there are manyunknowns associated with a pandemic - including a newvaccine - and explained that the greater the availabilityof individual-level data, the more in-depth the analysesthat could be conducted when and if needed.With pandemic vaccine there’s so much that we don’tknow about it. We don’t know will we have a lot ofadverse reactions, will we have enough to give twodoses immediately, will we have to recall later whenwe have some more vaccine available... So I feel it’salmost more crucial to have the individual informa-tion with pandemic than it is with seasonalinfluenza.A small number of participants felt that the increasedeffort required to collect individual-level data did notoutweigh the benefits, and that resources would bemore appropriately applied to other elements of the vac-cination program. Assuming that individual-level datawould have to be collected and captured electronicallyin two separate phases (which, depending on the type ofsystem, is not necessarily true), they believed that stafftime could be better spent engaged in clinical work.Another individual was appreciative of the value of IISs,but cautioned that: “You have to be careful that, youknow, the management of the system doesn’t outweighwhat you can actually get out of it.”Features of an optimal systemIt was important to understand which system featureswould allow key informants to realize the benefits ofIISs. Prior to each interview, participants were providedwith a proposed set of critical and optional IIS function-alities about which we requested feedback during theinterview. Responses described in the following sectionwere based on participants’ experiences and supplemen-ted with reactions to this list. Again depending onexperience, respondents described features of currentsystems that were already performing well, or desiredcharacteristics that they perceived as critical to achievingan ideal IIS.Many key informants described the same several fea-tures and functionalities as important for an optimal IIS;system flexibility, rapidity of data capture, and universal-ity were common themes. System portability and wide-spread accessibility were identified as being key tofacilitate consistency of reporting in a range of immuni-zation settings. Web-based systems, as well as systemsthat could operate in a disconnected mode and subse-quently be reintegrated with the central system, wereviewed as advantageous for maintaining comprehensivepatient registries.[What] stands out right away for me is portability,the ability to take that system into remote areas or,you know, school gymnasiums and be able to usethat system.The operation in the disconnected mode is essentialbecause, you know, like, when you look at our ruralpopulation in [province], we do many clinics out inthe rural areas and it’s really necessary to have that.Reporting functionalities were critical to key infor-mants, and many mentioned the value of customizablereporting software. In addition, rapid, efficient data col-lection and entry was an important consideration forrespondents. Features mentioned included pre-populateddata fields and bar-code scanning of lot number and cli-ent health insurance cards. Lastly, the availability ofreal-time or close to real-time data was described asideal by several key informants.Obviously it’d have to be easy..., a swipe of the healthcard, you know, to populate demographics, thosekinds of things. I think it’s really important that it bequick because where you often get your bottleneck isright at the registration desk... It has to be able togenerate reports, those reports that the Ministryrequires.We want to be able to look and see how we’re doingon an ongoing basis, not just quarterly or whatever...I really think it’s important to have real-time connec-tivity to a central database.Many key informants felt that a universal IIS would beof high value both to vaccine administrators as well asHeidebrecht et al. BMC Public Health 2010, 10:523http://www.biomedcentral.com/1471-2458/10/523Page 4 of 8vaccinees. Some respondents described the usefulness ofa national IIS, while others explained that even a stan-dard system within one health region that was used byall vaccine providers would be an improvement. Uni-versality would allow consistency of immunizationrecords to be maintained to accommodate patients whorelocate, and would also permit broader and more com-prehensive analyses, including cross-jurisdictional cover-age assessment. IISs that were either integrated with orcould be linked to other health registries or full electro-nic health records were mentioned as being particularlyideal.Whatever the system is, everybody that has access tothe vaccine needs to be reporting in the same way, inreal time.People move around and so it would be very helpfulto have something that you could really track people,people’s immunization no matter where they are andyou’d get much better– higher quality information ifyou had it all in one place.The biggest shortcoming right now is that our vacci-nation system is not integrated with the client’shealth record. That’s the number one thing. If wecould have all the information we currently collectrelated to vaccination but have that as a part ofthe– one client, one health record concept.Additional features that were described by a smallnumber of respondents as being ideal included clinicand inventory management components, reminder tools,flags for missed doses and previous reactions, and theability to print off immunization records.Barriers to implementationWhile respondents described many benefits of collectingindividual-level immunization data, few public healthjurisdictions in the country rely exclusively on IISs forinfluenza vaccination data collection. Many use IISs orother registries to capture data for certain populationsbut the capacity of these jurisdictions to assess coverageand conduct other program evaluation exercises is lim-ited. Interview informants consistently described thesame key barriers to the implementation and operationof an ideal IIS.Financial and human resource constraints were identi-fied as barriers by the majority of respondents. Althoughthese constraints were often mentioned generally, manyrespondents went on to describe system elements thatwould be particularly resource-intensive. These includedthe requisite hardware and software, the combination ofclinical and technological expertise required to developand manage an IIS, and the intensity of staff trainingthat would have to be involved to ensure thatindividuals with clinical responsibilities could interfacewith the IIS appropriately. The difficulty and expense ofensuring continual remote system access for on-goingdata collection was also mentioned as a barrier.It’s hard for me to picture even having that level ofinformation put into an electronic system onlybecause of the amount of PCs that would be neededand the amount of staff training, you know, to getthat together. It’s a lot easier to have someonetrained how to fill in a piece of paper ...and itrequires a lot less dollar input.Very few people who know a lot about immunizationand a lot about what happens on the front lines anda lot about what analysis could be done, are comfor-table enough with the IT components that arerequired... Similarly, on the IT or the vendor side,they often understand so poorly how immunizationworks and how the information will be analyzed,they themselves have no idea whether what they’reoffering makes sense or not. And there’s a need tohave people who can serve to translate between thetwo groups and there aren’t– there just aren’t verymany people like that in the system.Some respondents expressed concern about competingfinancial and political priorities within their jurisdictions.Investing time and resources to develop and implement anew IIS, especially when a national system may be forth-coming, can be difficult to justify. (A new public healthsystem with IIS functionality is being developed in Canada,and while it is anticipated that this system - Panorama -will meet some of the immunization surveillance criteriathat are presented here, few details regarding time toimplementation are publicly available at the time of thispaper’s drafting.) Among the participants who felt morestrongly about the value of IISs for pandemic influenzathan for seasonal, some had trouble with the idea of devot-ing the resources that would be required toward some-thing that would be most useful for a relatively shortperiod of time.I think that the bulk of the funding towards immuniza-tion has always been towards purchasing of vaccinesand just distributing it. And not a lot of thought’s beenput to monitoring the records and monitoring coverage.I think that it’s just not been a priority. Unfortunately,Panorama, which would have been the answer becauseit would be a single type of registry that could havebeen modified across the country for all– and accessibleto all provinces and territories, I’m not sure if it’s goingto meet all of the requirements.To implement a new system needs a lot of adjust-ment and a lot of preparation. I think if it’s doneHeidebrecht et al. BMC Public Health 2010, 10:523http://www.biomedcentral.com/1471-2458/10/523Page 5 of 8[during] an already difficult situation with lack ofresources and extremely high level of emergency, like,pandemic immunization, it adds to the difficulty...Patient privacy and confidentiality were identified byseveral respondents as important issues that must beconsidered; personal health information legislation -especially when it differs across jurisdictions - maymake the implementation of an IIS difficult, or maymean that data may only legally be shared with certainparties. Consent laws in some jurisdictions may limitthe accessibility of patient data for linkage or analysis.It’s certainly the privacy and confidentiality. I hatesaying that they’re barriers but they– but it is, in away...There are criteria that have to be met in orderfor them to agree to allow us to populate this data-base that we’re trying to develop. So we have to meetthose regulations.As it stands we cannot have access to the healthinsurance database where we would have a commondenominator and after it would be easier to put into[immunization registry], but it cannot for the timebeing work this way...Because of individual consentlaws. It’s very sensitive.The last barrier to the implementation of an IISdescribed by study participants is the fact that in somejurisdictions multiple providers administer influenzavaccines. Key informants pointed out that some provi-ders have no incentive to collect electronic individual-level immunization information, or may not be willingto share their data or to report into a shared electronicsystem. Even with acceptance by all providers, ensuringthat a system is compatible across the full range ofhealth systems in a jurisdiction is challenging.We are not the biggest provider of flu vaccine interms of– who gives the actual immunizations...pri-mary care providers and other agencies are. Andthey’re notoriously bad for giving information...Wehave many different systems going on here...you haveone hospital system, the physicians are probably look-ing at an electronic record. We’re looking at Panor-ama in public health ...Would there be some way ofcoordinating so that we’d be one?DiscussionIn recent years there has been a strong push in Canadafor the establishment of electronic health records[11,12], and while the country is moving in the directionof a network of provincial/territorial electronic patientregistries, the completion of these registries is likelymany years in the future. Findings from this study sug-gest that the immunization component of these regis-tries will be welcomed by and useful to many publichealth planners and decision-makers, and that theimplementation of systems that permit individual-levelinfluenza immunization information to be captured elec-tronically in the interim would be valuable. Key benefitsof collecting data at this level of granularity using anelectronic platform as expressed by participants in thisstudy include assessment of vaccine coverage across arange of population groups, care management, andrapid availability of data for reporting and analysis.There are important distinctions between the collec-tion of individual-level data and a full IIS [1], and inthis study we were interested in experiences with andperceptions of both. We observed that the perceivedpotential usefulness and barriers to implementation varydepending on the approach to data collection that anindividual knows of or has experienced. Participantsfamiliar with collection of information on paper fol-lowed by manual entry into an electronic system (cur-rently a common approach in Canada) were concernedabout how time consuming this process could be andwere supportive of system features that would expeditedata entry. In contrast, some systems are fully electronicat the point of care and although this implies intensiveinfrastructure requirements (a computer at every regis-tration and nursing station, for example), it also reducesdata entry requirements considerably while providingreal-time or close to real-time access to data. Dependingon the population size and resources of a particular jur-isdiction, the appropriateness of these approaches willvary.Patient privacy was an important theme that emergedas a barrier to a comprehensive IIS. While it varies byprovince and territory, privacy legislation in Canadaappropriately limits which parties can be custodians ofpersonal health information, and this may mean thatindividual-level data cannot be shared with particulargroups. Further, in order to build a more completehealth profile for clients, immunization data from multi-ple providers must be linked to a common file. Toaccomplish this, a unique identifier must be sufficientlywidely used to be attached to records in multiple envir-onments but adequately flexible to be used across theseenvironments with the appropriate privacy controls.With a growing commitment to the establishment ofcomprehensive patient registries these are not insur-mountable challenges; linkage can be carried out by par-ties with the authorization to possess personal healthinformation, and de-identified datasets and aggregateddata can then be shared among other public healthusers. When data are required for research purposes,however, navigating multiple jurisdictions’ data sharingHeidebrecht et al. BMC Public Health 2010, 10:523http://www.biomedcentral.com/1471-2458/10/523Page 6 of 8and approvals processes can prove time-consuming evenwhen patients have given consent for their health infor-mation to be used in this way [13].Lack of common interest in collecting individual-levelinfluenza immunization data and data sharing betweenpublic health organizations and other vaccination provi-ders were perhaps the most daunting barriers to theimplementation of complete, electronic immunizationrecords revealed by respondents. This is especially chal-lenging in jurisdictions where the majority of vaccina-tions are administered by community physicians.Participants explained that it is often very difficult toobtain vaccination information from primary care provi-ders (even when this data is recorded electronically),which makes accurate assessment of vaccine coveragenearly impossible. However, these barriers have beenovercome in many jurisdictions globally [14-18], as wellas within Canada [19,20], through the development ofprovincial, state and national registries that are designedto receive data from multiple providers. In some areas,financial incentives have been helpful to encourage datasharing; for example, in Australia an ‘information incen-tive’ is offered to all vaccine providers who report com-pleted vaccination schedules to the AustralianChildhood Immunisation Register [16].LimitationsAs a result of our sampling approach, the individuals werecruited were almost all representatives of public healthorganizations. It would be valuable to gain insights intothe perspectives of primary care practitioners and othervaccine administrators. Further, because our originalsample comprised members of a committee workingtowards creating a national network of immunizationregistries, it is not surprising that these individuals weresupportive of the collection of individual-level influenzaimmunization data. Other key informants to whom wewere referred by the initial respondents - and who madeup the majority of the study population - were not partof this network, however, and thus provided a morebalanced perspective. Nevertheless, we acknowledge thatthis sampling approach may have introduced bias intothe work.This work was conducted between the first and sec-ond waves of an influenza pandemic, and results mayhave been different if we had not interviewed at a timewhen there was an increased sense of urgency related toimmunization data. Likely due in part to the timing ofour research, we were unable to recruit participantsfrom two jurisdictions. Respondents from these areaswould have added unique and valuable perspective tothis work. Further, although they initially consented tocontribute to this research as key informants, five indivi-duals from provincial and federal immunizationprograms declined our request to include their inter-views in this analysis. However, other representationfrom these jurisdictions was included in the analysis.ConclusionsFurther research is required to evaluate whether there isa link between detailed influenza immunization record-keeping and improved health outcomes. Based on theperceived benefits revealed by this work, however, werecommend that health jurisdictions across Canada con-sider supporting the implementation of mechanisms toelectronically capture individual-level influenza immuni-zation data, and work to improve dialogue between pub-lic health and other vaccine providers regarding thecollection and sharing of immunization information.AbbreviationsIIS: immunization information system.AcknowledgementsPCIRN Vaccine Coverage Theme Group members are: David Allison, JulieBettinger, Nicole Boulianne, Stephanie Brien, David Buckeridge, Larry Chambers,Natasha Crowcroft, Shelley Deeks, Michael Finkelstein, Julie Foisy, Effie Gournis,Maryse Guay, Jemila Hamid, Christine Heidebrecht, Donna Kalailieff, FaronKolbe, Jeff Kwong, Allison McGeer, Jane Nassif, Jennifer Pereira, Susan Quach,Sherman Quan, Beate Sander, Chris Sikora, and Don WillisonThis study was supported by an operating grant from the Public HealthAgency of Canada and the Canadian Institutes of Health Research. TheCanadian Association for Immunization Research and Evaluation providednetworking assistance. We are grateful for the contributions and support ofthe individuals who participated in the interviews. We thank Susan Quachand Stephanie Brien for reviewing the manuscript and providing valuablefeedback.Author details1Department of Surveillance and Epidemiology, Ontario Agency for HealthProtection and Promotion, Toronto, Canada. 2University Health Network,Toronto, Canada. 3Dalla Lana School of Public Health, University of Toronto,Toronto, Canada. 4Toronto Public Health, Toronto, Canada. 5Department ofLaboratory Medicine and Pathobiology, University of Toronto, Toronto,Canada. 6Department of Epidemiology, Biostatistics, and OccupationalHealth, McGill University, Montréal, Canada. 7Direction de santé publique deMontréal, Vigie et protection, Montréal, Canada. 8Département des sciencesde la santé communautaire, Université de Sherbrooke, Longueuil, Canada.9Institut national de santé publique du Québec, Montréal, Canada. 10Agencede la santé et des services sociaux de la Montérégie, Longueuil, Canada.11Centre de recherche de l’Hôpital Charles LeMoyne, Longueuil, Canada.12School of Public Health, University of Alberta, Edmonton, Canada.13Institute for Clinical Evaluative Sciences, Toronto, Canada. 14Department ofFamily and Community Medicine, University of Toronto, Toronto, Canada.Authors’ contributionsJF, SQ, MF, NSC, DLB, MG, CAS and JCK designed the study; JF conductedthe interviews; and CLH and JAP developed and applied the codingstructure, supported by JF, SQ, DJW, SLD, MF, NSC, DLB, MG, CAS and JCK.CLH and JCK drafted the manuscript with contributions from JAP, JF, SQ,DJW, SLD, MF, NSC, DLB, MG and CAS. All authors read and approved themanuscript.Competing interestsThe authors declare that they have no competing interests.Received: 16 March 2010 Accepted: 31 August 2010Published: 31 August 2010Heidebrecht et al. BMC Public Health 2010, 10:523http://www.biomedcentral.com/1471-2458/10/523Page 7 of 8References1. Canavan BC, Kurilo M, Moss T, McLaren R, Berry K, Thomas C, Rasulnia B,Kelly J, Urquhart G: Immunization information systems progress - UnitedStates, 2005. MMWR Morb Mortal Wkly Rep 2006, 55:1327-1329.2. Writing team for the Public Health Agency of Canada/Canadian Institutes ofHealth Research Influenza Research Network Vaccine Coverage ThemeGroup: Why collect individual-level vaccination data? CMAJ 2010,182:273-275.3. Ammenwerth E, Mansmann U, Iller C, Eichstadter R: Factors affecting andaffected by user acceptance of computer-based nursing documentation:results of a two-year study. J Am Med Inform Assoc 2003, 10:69-84.4. Christakis DA, Stewart L, Bibus D, Stout JW, Zerr DM, MacDonald JK, Gale JL:Providers’ Perceptions of an Immunization Registry. Am J Prev Med 2010,17:147-150.5. Kossman SP, Scheidenhelm SL: Nurses’ Perceptions of the Impact ofElectronic Health Records on Work and Patient Outcomes. ComputInform Nurs 2008, 26:69-77.6. Likourezos A, Chalfin DB, Murphy DG, Sommer B, Darcy K, Davidson SJ:Physician and Nurse Satisfaction with an Electronic Medical RecordSystem. J Emerg Med 2004, 27:419-424.7. Poissant L, Pereira JA, Tamblyn R, Kawasumi Y: The Impact of ElectronicHealth Records on Time Efficiency of Physicians and Nurses: ASystematic Review. J Am Med Inform Assoc 2005, 12:505-516.8. Hsieh H, Shannon S: Three approaches to qualitative content analysis.Qual Health Res 2005, 15:1277-1288.9. Priest H, Roberts P, Woods L: An overview of three different approachesto the interpretation of qualitative data. Part I: Theoretical issues. NurseRes 2002, 10:30-42.10. Creswell J: Research Design: Qualitative, Quantitative, and Mixed MethodsApproaches Thousand Oaks, CA: Sage, 2 2003.11. Canadian Medical Association Journal: Have paper records passed theirexpiry date? CMAJ 2005, 173:725.12. Flegel K, Hébert PC, Stanbrook MB, Sibbald B, MacDonald N, Attaran A:Getting to the electronic medical record. CMAJ 2008, 178:531.13. Kephart G: Barriers to Accessing & Analyzing Health Information in CanadaOttawa, Ontario: Canadian Institute for Health Information 2002 [http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=GR_282_E].14. Begum F, Pebody R: Vaccination uptake among the 65 years and over andunder 65 years at risk in England 2007-08: Influenza Immunisation UptakeMonitoring Programme London: Health Protection Agency 2008 [http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1213083216553].15. Centers for Disease Control and Prevention: Progress in ImmunizationInformation Systems - United States, 2008. MMWR - Morb Mortal Wkly Rep2010, 59:133-135.16. Hull BP, Deeks SL, McIntyre PB: The Australian Childhood ImmunisationRegister - A model for universal immunisation registers? Vaccine 2009,27:5054-5060.17. Hviid A: Postlicensure epidemiology of childhood vaccination: theDanish experience. Expert Rev Vaccines 2006, 5:641-649.18. New Zealand Ministry of Health: Overview of the National ImmunisationRegister 2004 [http://www.moh.govt.nz/moh.nsf/0/FA74067C640C0F0FCC256E58000B2089/$File/OverviewoftheNationalImmunisationRegister.pdf ].19. Manitoba Health and Healthy Living: Manitoba Immunization MonitoringSystem (MIMS) Annual Report 2007 2007 [http://www.gov.mb.ca/health/publichealth/cdc/docs/mims/mims07.pdf].20. Tuchscherer R, Palmer C, Norman CA: SIMS: One Time on Line.[conference abstract]. 43rd National Immunization Conference, Dallas, Texas2009 [http://cdc.confex.com/cdc/nic2009/webprogram/Paper18049.html].Pre-publication historyThe pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/10/523/prepubdoi:10.1186/1471-2458-10-523Cite this article as: Heidebrecht et al.: Perceptions of immunizationinformation systems for collecting pandemic H1N1 immunization datawithin Canada’s public health community: A qualitative study. BMCPublic Health 2010 10:523.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitHeidebrecht et al. 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