An Exegesis of Investigation into the Utilization of Immunisation Information Systems in Public Health

This exegesis is the culmination of research performed over the last seven years for the Doctorate of Health Science program that was completed while I worked at the Centers for Disease Control and Prevention (CDC). In order to help form the direction of the research for this project, I began with a high-level review of the immunisation information systems in the United Kingdom and Australia. Since I worked as an immunisation information systems consultant at the time, this comparison of the immunisation information systems in Australia and the United Kingdom provided me with a new view of how this type of system could function and helped to determine the approach a study of the systems in the United States. While the UK and Australia were able to gain general acceptance of the idea of the government operating a computer system that contained patient data, the US Congress forbade the CDC from developing a similar system. This resulted in a range of issues that had to be addressed that were very different from the Australian or UK experience. The US program was directed at developing state level systems that could interact across state boundaries. As a result, the multitude of systems created their own difficulties. These included interstate privacy concerns, problems of funding duplicate systems in multiple states in an era of shrinking federal public health budgets, as well as the fact that the technology involved in managing physician's offices and patient records were rapidly outpacing the IIS program. After 2001 the focus of the federal government was also shifting and directing funding to technology areas related to terrorism. 7 The problem that was chosen as the focus for further research was related to the issue of proper support for these systems.