Assessment of Select Electronic Health Information Systems that Support Immunization Data Capture - Kenya, 2017

An electronic immunisation information system (IIS) might provide an efficient way to collect, access, and retrieve immunisation data, as well as analyse, report, and facilitate use of immunisation data for public health decision-making. This article reports on the findings of a rapid assessment of select electronic health information systems (EHIS) with immunisation components in Kenya. It provides lessons learned to guide future efforts on the design, development and implementation of EHIS to support the needs of the National Vaccine and Immunization Program (NVIP) in Kenya.

Conducted from January to May 2017, the assessment covered 6 EHIS that were established within the past decade; the oldest was developed in 2008, and the most recent in 2015. The EHIS reviewed varied in purpose, content, and population covered. Substantial differences in system functionality and immunisation-related data elements included in the EHIS were identified. ("The lack of immunization-specific standards and data elements limited the usefulness of these systems, especially concerning the ability to share data with national-level health information systems.") Five of the EHIS operated within Ministry of Health (MOH)-run health facilities, while one EHIS operated only in private health facilities. Although all 6 EHIS captured immunisation data, only one of the EHIS focused solely on immunisations (5 collected broader data, primarily on HIV/AIDS or maternal and child health).

The facilitators and barriers on the use of the EHIS are reported in Table 3 in the paper. None of the facilitators was specific to the immunisation components of the EHIS. Factors that facilitated use of EHIS were related to users (e.g., presence of an EHIS champion - an individual to promote the use of EHIS - and available technical support for the system) and to system functionality (e.g., ability to access and retrieve patient data easily). Only 2 barriers reported related to immunisation-specific issues of an EHIS: inability of the EHIS to update/include previously given vaccines and inability of the EHIS to generate reports required by NVIP.

The researchers found that none of the EHIS had all the data elements necessary to fully replace or operate independently from the standardised paper-based system - the Maternal and Child Health Booklet - for recording immunisation data in Kenya. They suggest that perhaps the use of a hybrid model of both paper and electronic IIS may be the next step in the future of data collection and reporting in Kenya. As countries transition from standardised paper-based systems to electronic IIS, there is a desire for the data collected in the former to also be collected in the latter. Given the challenges of staffing capacity and workload in the implementation of EHIS, consideration should be given to what data needs to be collected in both paper and electronic IIS. In this assessment, for all but one system, health facility staff were in charge of data entry, adding to staff work burden that could impact data completeness and quality from the EHIS. Although the assessment did not look at data quality, the findings suggest a need for periodic assessments of the quality of immunisation data captured by EHIS.

Overall, the findings of this assessment highlighted substantial variation in the EHIS with immunisation components. "Development of immunization specific standards and minimum data elements consistent with the goals of NVIP, and aligned with other national health information systems, would greatly facilitate collection and reporting of immunization data in Kenya....The immunization specific standards will allow for sharing of data across systems if one system is not an option for Kenya."