40% More Vaccinations. Bang.

How Using Bi-Directional State Registry Data Changes Immunization Rates

By Dale Dauten, Syndicated Columnist

“Data! Data! Data! I can’t make bricks without clay!”

Sherlock Holmes (Arthur Conan Doyle)

We all know that bit about information being power, and we now know the horsepower of the information available in a state immunization registry: a 40% increase in additional vaccinations given at the time of flu shots.

That 40% represented so profound a multiple over traditional expectations, so far beyond mere triple or quadruple, that I had to go to five sources to even find the proper word: it’s a viguple increase:

The lead author of the new study, Ben Bluml, said of the results, “The current industry data says that an additional 1-2% of vaccinations occur at the point of a flu shot. So think about that – if you doubled that level and went from 2-4%, you’d have accomplished something. You’d be delighted. But we went from 2% to 40% — a 20-fold increase!”

And that’s what sent me searching for the right uple for a twenty-fold increase, a viguple.


Ben Bluml, APhA foundation, American Pharmacy Association, Pharmacy Research, Community Pharmacy

Ben Bluml, Senior VP, American Pharmacists Association Foundation


The research in question was undertaken by the American Pharmacists Association Foundation and the findings were published in a Population Health Management article authored by Benjamin Bluml, Kelly Brock, Scott Hamstra and Lisa Tonrey. A summary:



DESIGN. The study was conducted in eight community pharmacies in Washington state last fall and winter.


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Quality Food Centers pharmacists at one of the research locations

When customer-patients asked for a flu shot, the pharmacist checked with the state Immunization Information System (IIS), using STC’s ImmsLink data, to identify additional vaccination needs.

immslink, immunization reporting, STC, STC home, scientific technologies corporation, intelligent solutions, pharmacy solutions, pharmacy immunization reporting, pharmacy compliance


THE SAMPLE. A total of 1,080 patients were included in the study. Of those, the pharmacists found 1,334 eligible vaccinations that were due.

THE RESULTS. Of the 1,344 additional vaccinations needed, a total of 447 were given during the course of the study, nearly all (just over 95%) administered by the pharmacist at the point of that initial flu shot and conversation.

That’s a 41.4% increase in the number of vaccinations over the flu shots alone.




To help explain the findings, we went back to an earlier study conducted among pharmacists in Washington state. That study, in 2014, was undertaken by STC and Bartell Drugs.

Although the Bartell study was much smaller, with a sample size of 66 patients, the design was similar – patients were coming in for flu shots and, after a check of registry data, told of needed immunizations. In that study, 14% of the patients agreed to and received an additional vaccine, an exciting result. (Remember that 1-2% number.) Still, that 14% fell far below the big number in the new study, the 41%. However, it’s instructive to consider this prescient statement from discussions of the earlier 14% result:

Todd Watkins, President of STC says, “We believe that as we expand the pharmacists’ knowledge of the registry, the percentage of customers who will accept additional vaccinations will quickly double or triple — to 30 or 40% — and continue to climb from there.”

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Quality Food Centers pharmacists who participated in the research

It seems likely that the passage of time has allowed the expanded registry familiarity that Watkins predicted. Further, while the pharmacists in the Bartell study had no training on how to have the conversation with the patient, the pharmacists in the new study had much more involvement in the planning and execution of the conversion process. Bluml added this:


“We had detailed discussions with the pharmacists about doing the right thing for patients, but the magic is in the tech, bringing the information to the pharmacists so they can have informed conversations about unmet needs.”

(How does finding that conversation-starter information fit into workflow? The earlier study found that adding the information lookup took just 84 seconds, on average.)


Scott Hamstra, provider, indian health services, pharmacy, writer, author, study design, pharmacy research, pharmacy researcher

Dr. Scott Hamstra

Dr. Scott Hamstra, who was involved in both studies, was divided in his thinking about the results and what they mean for the future, saying, “In one sense, the people in the study are the cream of the crop. They were people already popping in for the flu shot, so they are already vax-friendly, or at least vax-open. However, given what we knew going in, we were thinking that 10 or 20% would be great and we were double that. Everyone was excited about 40%. Now though, I keep thinking it’s sad – you offer this to 100%, why wouldn’t everyone say yes?”

How do we get closer to everyone saying “yes”? It seems likely that some training beyond use of IIS data and Immslink might discover what will take the vax percentage higher – one likely possibility is experimentation with the conversation to persuade patients to accept the recommended additional vaccines, perhaps to include brochures or other support materials.


For now, Dr. Hamstra put the study in the broader context of adult vaccinations:

“We got to the point where we were doing pretty well with children’s vaccines and then we woke up to the fact that adults are at risk, too. We’re at a mind-shift, where pharmacists will be the front-line vaccinators for adults. Most people between 20 and 60 are not going to the doctor’s office. Plus, come Fall, when it’s time for flu shots, there’s no way to run all those people through the doctor’s office. Pharmacists are more accessible, more convenient and less expensive. We now know that if we deliver to them the Registry information they need, they will deliver on additional vaccinations.”



The American Pharmacists Association Foundation study report is available at:





Ben Bluml and the folks at the American Pharmacists Association Foundation shared with us their PDF showing where this recent study fits into their plans and into what they call the Innovation Arc. Notice their next step: expanding the study from 8 locations to 50.


Project IMPact Immunizations