• Annual birth cohort: 34,000 in five counties; 70,640 statewide (the RWJF grant funded the registry for the five-county area; the system was then implemented statewide in July 1998)
• Geographic area covered: Five-county health jurisdiction and State of Washington
• Legislation: None
• Percentage of immunizations given in private sector: 80 percent
• Other sources of funding: Federal, state, other grants, fee-for-service

It is difficult to stand in another's shoes. Yet, that ultimately is what developers of registries must do to understand the perceptions of users of registries. In most states, that means that public health department staff must understand the perceptions of private sector doctors, nurses, administrative staff, and health plans. Such was the case in Washington State where an unusual approach to funding the registry had been adopted in 1997. In an effort to convert the CHILD Profile (Children's Health, Immunization, Linkages, and Development) from a public, grant-supported project to a fee-for-service model, a cost-based pricing structure for users of the system was established, based on the number of children in their client load under age 6. A private organization, Health Information Institute (later called Health Radius), licensed the software and assisted with the marketing of the registry's fee-for-service approach.

The goal was to have the registry "primarily supported" by fee-for-service as of January 2000. But it became clear that providers were resisting the fee-for-service arrangement, and that not only had fees contributed just 1 percent of the revenue budget, but they also had resulted in providers holding negative views of the registry. As of June 2000, only 25 percent of provider sites were submitting data to the registry, despite aggressive marketing efforts and enhancements to the registry to make it more useful, such as reminder-recall and vaccine inventory functions.

An in-depth study of providers' perceptions and motivations was funded by CDC and conducted collaboratively by CHILD Profile and Group Health Cooperative of Puget Sound. Among its findings: Providers believe a registry is a public good, the cost of which should be borne by the public sector.

A strategic planning process, conducted by an outside consulting firm and facilitated by the Foundation for Health Care Quality, concluded in March 2000. Its priority objectives included identifying potential sources of funding and/or operational support for CHILD Profile and finding ways to get large volumes of immunization data into the system—the value that providers who participate in the registry are seeking. Its recommendation that subscription fees for health care provider groups be eliminated was acted upon. Health plans, however, continued to pay fees for immunization data used in Health Plan Employer Data and Information Set (HEDIS) reporting.