A thematic overview and proposed model for defining, identifying and using best practices in public health informatics for immunization registries

Population-based immunization registries are a relatively new and distinct type of confidential information system that protects individuals and the community from deadly infectious diseases. Immunization registries are costly and complex to integrate into public health programs and clinical practices. Effective use of best practices in public health informatics is essential for successful immunization registries. Needed is an improved definition of best practices, an enhanced conceptual understanding of successful use, and a process for adapting those practices to each agency's unique context.;The purposes of this study are: (1) to improve the definition and conceptual understanding of best practices and (2) to explore the proposition that a successful, population-based, immunization registry is dependent upon adapting those best practices to the particular organizational context and information system architecture.;Published literature and reports were reviewed and used to synthesize a definition and conceptual model for best practices. Registry practice themes and a list of national consensus based practices are identified. The model is illustrated using a local community registry representing 22 mostly rural Minnesota counties and a statewide registry in Minnesota. Findings include: (1) A synthesized definition of best practices as "methods and techniques that, when adapted to a specific organizational context and information system architecture, increase the chances of successfully achieving the system objectives." (2) A model for best practices that has two concurrent, distinct, yet related processes of development and use of best practices. (3) Creation of a multi-dimensional framework for adapting best practices that extends the classic organizational learning theory of "exploit and explore" to include external public health partners as critical factors in the successful system implementation. (4) A list of 22 consensus developed best practices and gaps related to interoperability, system integration, and funding and mapping standards for the national public health information network (PHIN) standards, and emerging vocabularies. (5) A proposal that there is an informatics threshold and that agencies need to achieve a state of "informatics preparedness" to move forward. (6) A suggestion that registry implementation is most likely when organizational learning occurs through adaptive paths and incremental changes, rather than through large leaps forward.