June 2002

Grant Results

National Program

All Kids Count

SUMMARY

  • Annual birth cohort: 133,649
  • Geographic area covered: State of Michigan
  • Legislation: 1997 legislation establishes MCIR, the transmission of birth record information to the MCIR, mandatory reporting of immunizations to for children born after December 31, 1993, by immunization providers, and ability for a parent or guardian to opt their child out of the MCIR
  • Percentage of immunizations given in private sector: 60 percent
  • Other sources of funding: Federal, state

Michigan represented All Kids Count's largest, and in many ways, most complex project. At the project's conclusion in June 2000, MCIR reported impressive statistics: it included 1.7 million child records and 14 million immunization records. Eight hundred of the 1,600 enrolled providers were active users, and 500 of them regularly queried the registry for reports. As many as 200 users accessed MCIR in the course of a business day. The sheer volume of data and number of providers, compounded by the large geographic region of the state, could have been paralyzing. Instead, a regional approach that resulted in responsiveness and adaptability in developing, managing, marketing, and implementing the state-developed and maintained technology, resulted in a highly functional state registry poised for success.

MCIR was developed across six regions of the state, ranging from very rural areas with few, geographically scattered solo providers (Region VI, the Michigan Upper Peninsula) to densely urban settings with complex, constantly changing, managed care systems, (Region I, Detroit). Detroit, which had drawn attention in 1995 for having the country's lowest immunization rates, had been the first region to begin registry development.

The regional approach proved very effective because it enabled local registry staff, including technical support, to be highly responsive to the unique needs of the local health care environment, including individual providers, managed care organizations, local community organizations, and parents. Within each region, extensive provider input was sought to determine the barriers to provider use of the registry, and efforts were focused on removing each of those barriers. It enabled local registry staff to provide tailored training and support for each provider, despite the large numbers of them. In addition, this approach fostered trust in the registry because users' suggestions for enhancing the system could be acted upon. A sense of local control was maintained through active regional advisory boards.

MCIR was fortunate to have stable substantial political and financial support for the registry that enabled its technology, registry enhancements, and marketing.
The project's technology reflected this regional approach at its outset, using a distributed database with a series of six regional servers to mirror data to a central server. However, the volume of legacy data and the need to replicate data to all the servers overloaded the system causing delays in data submission as well as delays in system enhancements. MCIR consolidated to a single "super server" in January 1999. The central server dramatically sped up legacy loads, increased system response, and enabled roll-out of two key registry enhancements valued by providers: a vaccine inventory module (VIM) in March 1999 and reminder/recall in October 1999.

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GRANT DETAILS & CONTACT INFORMATION

Project

Michigan Childhood Immunization Registry (MCIR)

Grantee

State of Michigan Department of Community Health (Lansing,  MI)

  • Amount: $ 699,346
    Dates: February 1998 to June 2000
    ID#:  033688

Contact

David J. McLaury
(517) 241-7135
mclauryd@michigan.gov

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Program Director: David A. Ross, Sc.D.
Former Program Director: William H. Foege, M.D., M.P.H. (December 1991 through July 1997)
Former Program Director: William C. Watson, Jr., M.P.A. (August 1997 through July 2001)

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