N537 Module 8 assignment: information system evaluation paper, a full sample

Ready for a Mass Vaccination Campaign? Evaluating a County Immunization Information System With the DeLone and McLean Success Model

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Master of Science in Nursing Program, Aspen University

N537: Health Care Informatics

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Month Day, Year

Ready for a Mass Vaccination Campaign? Evaluating a County Immunization Information System With the DeLone and McLean Success Model

Public health informatics applies information systems to the health of populations. Few situations test those systems more than a mass vaccination campaign, when health departments must decide whether a campaign is needed, deliver vaccine quickly to many people, and show whether it worked. This paper evaluates a composite county immunization information system's readiness to support a mass influenza vaccination campaign, judged against the six success dimensions DeLone and McLean proposed, identifies the data that would establish need and measure success, and recommends improvements.

The System and the Scenario

Immunization information systems are confidential, population-based computerized databases that record vaccine doses administered by participating providers to people in a given area, consolidating vaccination histories for clinicians and providing aggregate data to monitor coverage and guide public health action (Groom et al., 2015). The composite Harbor County system, operated by the county health department, receives data from 140 provider sites, including clinics, pharmacies, and hospitals. Pediatric reporting is required by state law, while adult reporting is voluntary.

The scenario: early in the fall, syndromic surveillance shows a sharp rise in emergency department visits for influenza-like illness in young adults, and laboratory data identify a novel influenza strain against which a newly available vaccine offers protection. The health department must decide within days whether to launch a mass vaccination campaign across schools, workplaces, and community sites.

Data That Establish the Need

Several data sources would inform the decision. Syndromic surveillance, which analyzes near-real-time data such as chief complaints from emergency department visits, can detect unusual increases in illness before laboratory confirmation and supports all-hazards public health surveillance (Yoon et al., 2017). Laboratory surveillance confirms the strain and its spread. Hospitalization and death data show severity and which groups are most affected. The immunization information system adds baseline coverage: which age groups and neighborhoods have low influenza vaccination rates and would benefit most. The case for a campaign rests on combining these sources: surveillance shows the threat, and the registry shows where people are least protected.

Evaluating Readiness With the DeLone and McLean Model

DeLone and McLean (2003) updated their model of information systems success to include six interrelated dimensions, three about quality (of the system, of its information, and of the support service around it) and three about results (how much it is used, how satisfied its users are, and the net benefits it delivers). The model is useful for evaluation because it asks not only whether a system works technically but whether its information is trustworthy, whether users are supported, and whether it produces benefits.

System quality: The Harbor County system handles routine volume but has not been load-tested for thousands of doses per day. Real-time reporting exists through standards-based interfaces with most clinics and pharmacies, but 30 sites still submit batch files weekly, which would delay coverage data during a campaign.

Information quality: Pediatric data are nearly complete because reporting is mandatory, but adult records are incomplete because reporting is voluntary. Duplicate patient records are common when people are vaccinated at different sites. Coverage estimates for young adults, the group most affected in the scenario, are therefore unreliable.

Service quality: The health department has two informatics staff supporting 140 sites. Onboarding new mass vaccination sites quickly would exceed that capacity.

Use and user satisfaction: Clinics use the system to check children's vaccination histories, but pharmacies and adult providers use it less, and a survey found that hospital users find the interface slow.

Net benefits: For routine pediatric immunization, the system clearly contributes to coverage monitoring and reminder-recall. Research supports this: a Community Guide review of 240 articles and abstracts found that immunization information systems can support client reminder and recall, provider assessment and feedback, outbreak response, and assessment of coverage and disparities (Groom et al., 2015). For an adult mass campaign, the benefits would be limited by the gaps above.

Data That Would Measure Success

A campaign's success would be measured with data from several sources. The immunization information system would provide doses administered by day, site, age, and neighborhood, and coverage compared with baseline, if adult reporting is complete. Surveillance would show whether influenza-like illness visits, hospitalizations, and deaths decline faster in areas with higher coverage. Equity measures, such as coverage by race, ethnicity, and neighborhood income, would show whether the campaign reached those most at risk. Vaccine safety monitoring would track adverse events. Process measures, such as wait times at sites and time from dose to registry entry, would show whether the system kept pace.

The Nurse's Role in Public Health Informatics

Nurses sit at several points in this system. Public health nurses plan and staff mass vaccination sites, and their workflows determine whether doses are recorded accurately and quickly. School nurses and occupational health nurses identify groups with low coverage and bring vaccination to them. Nurse informaticists translate between epidemiologists who need data and clinicians who enter it, designing entry screens that capture required fields without slowing a line of people waiting for a shot. During the campaign, a nurse reviewing daily coverage maps can redirect mobile teams to neighborhoods falling behind, which turns registry data into an equity intervention in real time. Preparing nurses for these roles, including brief training on the registry's mobile entry tool before the campaign begins, should be part of readiness planning.

Recommendations

To make the system ready, the health department should require reporting of all doses given at campaign sites, move the 30 batch-reporting sites to real-time interfaces, load-test the system for peak volumes, deploy mobile data entry for community sites, and add temporary informatics staff to onboard new sites. Deduplication routines should run daily during the campaign. Long term, the department should advocate for mandatory adult reporting, since the gaps in adult data are the system's most significant weakness for any adult-focused campaign.

Conclusion

Harbor County's immunization information system is a proven tool for childhood vaccination but only partly ready for an adult mass influenza campaign. The DeLone and McLean model shows strengths in system use for children and weaknesses in adult information quality, real-time reporting, and support capacity. Surveillance and registry data together can establish the need for a campaign and measure its success, but only if the registry captures the doses given. Fixing those gaps before the next threat is the most important recommendation of this evaluation.

References

DeLone, W. H., & McLean, E. R. (2003). The DeLone and McLean model of information systems success: A ten-year update. Journal of Management Information Systems, 19(4), 9-30. https://doi.org/10.1080/07421222.2003.11045748

Groom, H., Hopkins, D. P., Pabst, L. J., Murphy Morgan, J., Patel, M., Calonge, N., Coyle, R., Dombkowski, K., Groom, A. V., Kurilo, M. B., Rasulnia, B., Shefer, A., Town, C., Wortley, P. M., & Zucker, J. (2015). Immunization information systems to increase vaccination rates: A community guide systematic review. Journal of Public Health Management and Practice, 21(3), 227-248. https://doi.org/10.1097/PHH.0000000000000069

Yoon, P. W., Ising, A. I., & Gunn, J. E. (2017). Using syndromic surveillance for all-hazards public health surveillance: Successes, challenges, and the future. Public Health Reports, 132(1, Suppl.), 3S-6S. https://doi.org/10.1177/0033354917708995