title: Getting under the hood: exploring issues that affect provider-based recall using an immunization information system.
abstract: OBJECTIVE
  To assess 1) pediatric practices' use of provider-based recall using an immunization information system 8 months after training on the recall process; 2) initiation and sustainability barriers to provider-based recall using an immunization information system; 3) strategies that facilitated recall initiation; and 4) recommendations for alternative approaches for conducting recall.
  
  
  METHODS
  In 2008, 11 practices received training on the automatic recall function in the Colorado Immunization Information System (CIIS) for both infants and adolescents. The 2-hour computer-based training provided an opportunity for attendees to run real-time recall reports with CIIS staff assistance. Eight months later, key informant interviews were conducted with 24 providers and staff from these practices.
  
  
  RESULTS
  Eight months after training, only 4 of 11 practices had implemented recall using CIIS: 3 practices recalled children ≤2 years of age, and 1 practice recalled adolescent girls for human papillomavirus vaccine. Initiation barriers included lack of awareness of baseline immunization rates, distrust in the accuracy of CIIS-generated data, and perceived difficulties recalling adolescents. Having unrealistic expectations about recall effectiveness was a barrier to sustainability. Strategies that facilitated recall included having a dedicated staff person for recall efforts and recalling children ≤2 years of age. Most key informants viewed population-based recall conducted by public health departments or schools as an acceptable alternative to provider-based recall.
  
  
  CONCLUSIONS
  Even with a promising tool to assist pediatric offices, implementing provider-based recall is challenging for pediatric practices. Given existing barriers, providers expressed support for alternative recall methods.
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Denver, CO 80045, USA. Alison.saville@ucdenver.edu
authors.forename: Alison W
authors.initials: AW
authors.lastname: Saville
authors.forename: Karen
authors.initials: K
authors.lastname: Albright
authors.forename: Carolyn
authors.initials: C
authors.lastname: Nowels
authors.forename: Juliana
authors.initials: J
authors.lastname: Barnard
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
authors.forename: Shannon
authors.initials: S
authors.lastname: Stokley
authors.forename: Kimberly
authors.initials: K
authors.lastname: Irby
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D005260:Female; D006801:Humans; D007114:Immunization; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000379:methods*; D017010:Reminder Systems / Q000706:statistics & numerical data*; D012572:School Health Services