Sample USAPI WebIZ Immunization Data Sharing Agreement <put on PIHOA letterhead>

Background: WebIZ is a web-based immunization information system (immunization registry) administered by the immunization programs of each USAPI health department and ministry. WebIZ stores immunization records that can be retrieved, reviewed and updated for the purpose of providing immunization services and immunization-related assessment, referral and inventory management.

Before a vaccine is given to a patient, it is important to check the vaccine history of that patient. With a large number of people migrating from jurisdiction to jurisdiction throughout the USAPI, this is often difficult. Giving each other ready read-only access to vaccination records across jurisdictions can save staff time, improve the accuracy of decisions for giving vaccine doses, and increase immunization coverage and protection of USAPI populations from vaccine-preventable diseases.

Provisions:

  1. As a signatory of this agreement, each of us will designate two immunization program staff from our ministry/department, to be given read-only access to WebIZ immunization program records from other PIHOA member jurisdictions.
  2. In return, our immunization program will grant read-only access to two immunization program staff from each of our other member jurisdictions.
  3. We agree not to permit use of aggregate data from other PIHOA member jurisdictions for comparison or research purposes.
  4. By signing this agreement, we agree, on behalf of our ministry/department, to require our staff to adhere to the requirements set forth in the attached User Confidentiality Agreement. Before getting cross-jurisdiction data access, each of the immunization staff who we nominate for data sharing will be required to sign the User Confidentiality Agreement. A signed agreement form will be shared with all of the other jurisdictions in this agreement for each of our nominees.
  5. Violation of any of the terms of the User Confidentiality Agreement by any parties to this agreement shall be grounds for termination of this records sharing agreement.

As signatories of this agreement, we agree to share immunization data contained in our WebIZ database, and to uphold the provisions set forth above.

<PIHOA Board Members Names and Titles here, including directors of health from each FSM state (so that their immunization programs can also have direct access)>

USAPI Immunization Data Sharing User Confidentiality Agreement,

WebIZ is a web-based immunization information system (immunization registry) administered by the, Immunization Program of each USAPI ministry and department of health. WebIZ stores immunization records that can be retrieved, reviewed and updated for the purpose of providing immunization services and immunization-related assessment, referral and inventory management. In order to enhance efficiency of immunization programs across the USAPI, and to improve protection of our peoples from vaccine preventable diseases, the PIHOA Board, comprised of the Ministers, Secretaries and Directors of Health of the US-affiliated Pacific islands jurisdictions (USAPI), have agreed to permit read-only access to WebIZ immunization records across the USAPI.

Please read this statement carefully. All Users must read, understand and sign this Agreement before being given access to WebIZ records from other USAPI jurisdictions.

As a WebIZ Data Sharing User I agree to:

1. Use cross-jurisdiction WebIZ access only in the course of my assigned duties to provide immunization services and/or immunization-related assessment, referral and inventory management services.

2. Access cross-jurisdiction WebIZ records only from authorized computer terminals at my Agency/Employer.

3. Use cross-jurisdiction WebIZ access only for those records of clients presenting to my Agency/Employer for services.

4. Maintain a confidential user password for my personal access only. I will not share password with any other individuals, including other authorized WebIZ users at my Agency/Employer. Any written documentation of my password will be maintained in a location that cannot be accessed by other individuals (e.g., in a locked filing cabinet).

5. I will log off from the WebIZ system at the end of my shift or at any point when I must leave my workstation. In addition, I will position my computer monitor in such a manner to prevent unauthorized individuals from viewing WebIZ information on the screen.

6. I will maintain confidentiality of patient information obtained from WebIZ as required by law of all medical record information.

7. I will notify immunization program staff of USAPI members if I am no longer employed at this Agency/Employer, if my duties change such that Ino longer require access to WebIZ, or if I plan to take a leave of absence from work for more than 90 days.

As a cross-jurisdiction WebIZ User I agree not to:

1. Examine or read any document or computer record contained in WebIZ containing confidential medical information, except on a “need to know” basis; that is, if required to do so in the course of your job duties.

2. Compile any aggregate data or statistics from the USAPI jurisdictions except those from our own jurisdiction.

4. Remove from a job site or copy any document or computer record containing confidential information unless authorized to do so or if required in the course of your job duties.

I have read and understand the USAPI cross-jurisdiction WebIZ User Confidentiality Agreement. I understand that records stored in WebIZ are confidential medical information. Inappropriate use or disclosure of patient information may result in civil and criminal penalties and revocation of my access to WebIZ. I also understand that an electronic record (audit trail) will be created automatically by the home jurisdiction WebIZ system and will document which WebIZ records I have accessed. I understand and agree to abide by the WebIZ User Confidentiality Agreement.

Print Name: ______Signature: ______

Phone Number: ______Fax Number: ______Email address: ______

Director/Minister of Health (print name): ______Jurisdiction: ______

Director/Minister’s signature (required): ______

WebIZ User Type and Access Levels

The table below outlines the suggested user type and access levels for users of the Immunization Program’s Immunization Information System (IIS/WebIZ). An asterisk indicates that the user has the ability to perform the function in the particular column.

User Type / Add
Person / Update
Person / Add Immunization Encounter / Modify Immunization Encounter / View Immunization Status / View Immunization History
Providers (public and private) / * / * / * / * / * / *
Hospitals / * / * / * / * / * / *
Community Health Centers / * / * / * / * / * / *
Schools/day cares / * / *
XX Island Immunization Program / * / * / * / * / * / *
Other Pacific Island Immunization Programs / * / *
Others (CDC Assessment Staff, Local Assessment Staff, etc.) / * / *