Strengthening Immunization Data: Protocol for the Evaluation of an Electronic Immunization Register.

Background: Electronic immunization registers (EIRs) can strengthen immunization systems and, if used effectively, can lead to greater efficiency and improvements in vaccination coverage. Several low- and middle-income countries introduced EIRs for COVID-19 vaccination and are now integrating them for routine immunization.

Objective: This study aims to describe the protocol used to evaluate the implementation of an EIR in the Lao People's Democratic Republic in 2022. In addition, it seeks to identify opportunities to improve implementation, scale-up, and sustainability in the country.

Methods: To evaluate the implementation of the EIR in the Lao People's Democratic Republic, we will (1) map the EIR workflow process, (2) examine EIR user and stakeholder perspectives, and (3) assess the EIR data quality. Data will be collected and analyzed through a mixed methods approach. This evaluation will involve a document review, observation of workflows in health facilities, health facility user surveys, key informant interviews with decision makers, and an assessment of immunization data quality. This protocol details the methods for each of these components. The evidence generated will be triangulated to identify the strengths and weaknesses of the early implementation phase of the EIR, facilitators of and barriers to the implementation, and whether the introduction of the EIR has improved immunization data processes and quality compared with paper-based processes.

Results: Data collection took place between April 2024 and August 2024. Data analysis is currently ongoing, with results expected to be shared with study stakeholders in October 2024.

Conclusions: This early evaluation will contribute to developing a road map for the nationwide strengthening and sustainability of the EIR based on challenges and lessons learned, potentially streamlining further implementation efforts and enabling more effective use of the EIR. This paper presents a methodology for evaluating EIR implementation that can be replicated in other low- and middle-income countries implementing EIRs.

International Registered Report Identifier (irrid): DERR1-10.2196/65663.