• Annual birth cohort: 28,500
• Geographic area covered: State of Nevada
• Legislation: None
• Percentage of immunizations given in private sector: 35 percent
• Other sources of funding: Federal, state

Immunization registries don't constitute a large or profitable market for private vendors of registry software and in 1998, only a dozen or so registry software vendors served all the registries in the country. Unfortunately, the one vendor that served the largest number of health information projects—including three All Kids Count projects—went bankrupt in September 1998, resulting in a crisis for all of the registries using that vendor's registry products. Their options were limited: They could attempt to support their current software or choose to buy or develop new software.

Staff at the Nevada All Kids Count immunization registry project managed by BDCIS decided to buy new software and they worked through 1999 to install a new registry system in order to meet the goal of becoming functional by the year's end. Working with the state's Department of Information Technology (DoIT), registry staff identified the functional requirements of the registry and the hardware and software requirements. At the same time, the neighboring California Statewide Immunization Information System (SIIS) was evaluating six different software products, and Nevada chose to evaluate the same options. Ultimately, Nevada chose the Contra Costa, Calif., registry software, the same software that California now recommends for its regional registries. The advantage of this approach was that the two states could share development costs for application enhancements. It also would facilitate data transfer between the two states, which share a transient population.

Considerable groundwork had to be laid in preparation for launching the new software: file conversion for 250,000 individuals, application testing, training for staff, training for 150 users and beta testing of the software. A Contra Costa County California team was brought to Nevada for technical support, and a DoIT programmer/analyst performed the data conversion. On January 10, 2000, the system was officially rolled out to providers as the Nevada State Immunization Information System (NSIIS). By January 21, just three weeks after the final software installation and data conversion, providers in 16 of the 17 counties linked to the statewide registries were on-line with the registry. It was just in the nick of time: the old system was crashing as many as five times a day.

Following migration to the new registry software in January 2000, interest by private providers, rural health clinics, and managed care organizations blossomed. An interface with the Clark County (Las Vegas) registry, which will substantially boost the volume of providers, children, and immunizations included in the Nevada registry, was under development, funded by managed care organizations. A strong state immunization coalition was successfully getting out the word that the new registry was ready for business.