Surveys on immunization coverage. CDC's quarterly telephone surveys of IAP areas will provide valuable state- and community-level information on the immunization coverage of preschool children and on progress toward the 1996 goal of 90 percent coverage for 2-year-olds. Further analysis linked to NHIS results should overcome some of the limitations of telephone surveys.

Available communication and information tools. Individual providers and public health departments can make more use of available communication and information tools. Automated dialing technology, for example, is well-established and can be applied in many settings to improve patient outreach and follow-up. Some providers, especially those without computer-based tracking capabilities, may also be able to make more use of family-held records that the family brings for every visit. If accurately maintained, such a record allows any provider to assess a child's immunization status.

Registry and tracking systems. States and communities can endorse existing demonstration projects for registry and tracking systems and can encourage the initiation of new projects with currently available public and private resources. Legislation pending in Congress would provide federal grants to states to develop and operate statewide registries. These projects must be responsive to the needs of individual providers and the community. If they create demands without providing a recognizable benefit, they may be difficult to sustain.

Immunization tracking in HMOs. HMOs can implement immunization tracking in their patient record systems. Every location within an HMO system should be able to retrieve a child's complete record and enter new information about immunizations and other care that was provided. Because immunizations are almost always a covered benefit in HMOs, children are likely to receive most of their immunizations through the HMO. For these systems to be effective, however, they must include information about any immunizations received outside the HMO.

Methods to audit delivery of services. CDC, researchers, or private vendors can develop methodologies, and perhaps software, that private providers, particularly those in small office-based practices, can use to audit their delivery of immunization services. Some office-based systems can be linked to larger registries under development.