The cost of doing business: cost structure of electronic immunization registries.

OBJECTIVE: To predict the true cost of developing and maintaining an electronic immunization registry- and to set the framework for developing future cost-effective and cost-benefit analysis. DATA SOURCES SETTING: Primary data collected at three immunization registries located in California- accounting for 90 percent of all immunization records in registries in the state during the study period. STUDY DESIGN: A parametric cost analysis compared registry development and maintenance expenditures to registry performance requirements. DATA COLLECTION/EXTRACTION METHODS: Data were collected at each registry through interviews- reviews of expenditure records- technical accomplishments development schedules- and immunization coverage rates. PRINCIPAL FINDINGS: The cost of building immunization registries is predictable and independent of the hardware/software combination employed. The effort requires four man-years of technical effort or approximately \$250-000 in 1998 dollars. Costs for maintaining a registry were approximately \$5-100 per end user per three-year period. CONCLUSIONS: There is a predictable cost structure for both developing and maintaining immunization registries. The cost structure can be used as a framework for examining the cost-effectiveness and cost-benefits of registries. The greatest factor effecting improvement in coverage rates was ongoing- user-based administrative investment.