Immunization intranet

This summer Lifespan officials plan to launch a private intranet site, which could help doctors make sure the 10,000 or so children who visit the health care system’s facilities each year receive necessary immunizations.

“If you look at the issue of immunization, about a fifth of two-year-old kids have not received all their shots,” said Dr. Patrick Vivier, a pediatrician who is involved with developing the immunization Web site. “The problem with under-immunization is disease breaks out again.”

So Vivier and some colleagues in Lifespan’s Medical Computing department have been developing a Web-based program, which could help them in the battle to protect children from serious illnesses such as polio and hepatitis.

Part of the reason it is so difficult to make sure every child gets exactly the shots he or she needs is that immunization schedules tend to change and new shots are regularly introduced, Vivier said.

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“It’s become very difficult for physicians to keep track of the schedule, it’s even harder for parents,” he said.

Among the vaccinations children are supposed to receive by age two: Four doses of the diphtheria, tetanus toxoids, and pertussis vaccine; three polio shots; three Hepatitis B shots; and four HIB shots. Most immunizations are done in a series of two to four injections, which must be spaced out in specific intervals for them to be effective, Vivier explained.

After a number of measles outbreaks in the late 1980s, health officials nationwide began paying more attention to immunization issues, he added. More recently doctors have seen an increase in pertussis, which is also known as whooping cough.

Though young patients may appear in the Hasbro Children’s Hospital emergency room for stitches or seek treatment for the flu at one of Lifespan’s pediatric clinics, doctors cannot order any vaccinations without checking the child’s medical records first. So if the child appears in the emergency room after normal business hours or in a clinic without an appointment, it is most likely their records won’t be retrieved from the medical records department during the appointment.

“It’s not enough to know that they’re two,” Vivier said. “You need a complete medical record available. You need to know how many previous shots they’ve had.”

The intranet site, once it is fully operational, will allow authorized doctors and nurses throughout the Lifespan system, which includes Rhode Island Hospital and Newport Hospital, to instantly check the patient’s record. This will be done by accessing a database through a Web-based browser. Then they can either administer the needed vaccination on the spot, or can remind the parent that a shot will soon be needed.

The idea for the intranet site has its roots in talks Vivier and Steven Reinert, a physician liaison with Lifespan’s Medical Computing department, had some three years ago when they began collaborating on a database to track immunization records. Once that was up and running, the next step was to make this information available to the medical staff.

But the problem was that the database was only accessible by Vivier and his staff.

The Medical Computing department was establish shortly after Lifespan’s creation and is headed up by a physician. The staff’s goals are to help find ways to use computers to practice medicine, Reinert said.

The easiest and least expensive way to make the database information more widely available was to use existing Internet technology to create a private intranet, he added.

They could have opted to create a new program for the hospital’s private network – which involves roughly 4,000 computers throughout Rhode Island – to provide access to immunization data. But, Reinert said, that approach would be more costly.

”You’d have to make sure everyone had the hardware to support this and the software,” he explained.

The database and intranet project are funded through a grant from the Hallet Prevention Initiative, which was initially set up to fund polio research, according to Dr. Vivier.

The immunization records, which are considered part of a patient’s private medical records, will be protected by various security measures on the intranet. Only authorized medical staff will be allowed to use the database, and they will require passwords and other identification, according to Reinert.

”Outside the network, nobody can see this,” said Don DeMaio, who is Lifespan’s Webmaster and has also been working on the project.

The program is also designed to shut down automatically if it is left open and unused for a certain period of time.

DeMaio said similar technology is being used to collect data for several other Lifespan projects. One such project is a weight loss study using only Lifespan staff members, who have access to the existing network. It allows the participants to communicate with the researchers and other participants, including sharing details of lapses in their diet. In addition, he said, Lifespan researchers who’ve been collecting data on child abuse using a database will soon be putting out a study.

”You have a built-in world wide network that’s all set up. As long as you understand the protocols it’s there for the using,” DeMaio said. “It’s easier to go through the Web than through a regular network.”

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