“You actually do that?”

The Surprising New Reality of Immunization Data

By Dale Dauten, syndicated columnist


“Are you really a pharmacist?”

 “Do you really do all this [immunization information] stuff?”

Those were frequent questions provoked by presentation on immunization data at the annual HIMSS19 Global Conference. (That’s the Healthcare Information and Management Systems Society, over 50K members strong, meeting in Orlando earlier this year.)

Three Walmart pharmacists took turns joining in for a demonstration of how they can use immunization data, following a mythical young woman’s vaccination experience from birth till adulthood.

To answer one frequent question, yes, all three are working pharmacists.

The second question (“you really do this?”) makes sense — after all, many tech demonstrations are practically mythical, explaining some “what if?” future.   Not here – all the data use cases presented are actually happening and available – really real.

We talked with one of the three pharmacists, Ashley Luck, who’s a Walmart PCSM, a Pharmacy Clinical Services Manager. (Her job is to travel to other Walmart pharmacies and make sure they are “clinically compliant” with state law and company policies. However, as she happily pointed out, she still “works the bench” once or twice a week.)

Reflecting back on how bi-directional data from the state registry has changed her job as a vaccinating pharmacist, she said:

“Prior to the bi-directional data, our biggest struggle was trying to figure out what vaccinations the patients needed. Now we can see the answer — we look and say, ‘Hey, they got their pneumonia vax six months ago but haven’t had their flu shot.’  So now the biggest barriers are cultural. Now we can focus on educating patients.”

Asked for an example of how the data comes into play at her work, she pointed out that Orlando has many recent immigrants and added, “We have people come through the Port of Entry and they receive vaccinations but don’t remember or don’t understand them. Just last night, on the bench, I had someone who told me, ‘I went through immigration last year and I don’t know what I got.’ I was able to look and make sure she was up to date.”

She also has patients who are temporary residents and she tells them they can go to any Walmart and they can see the immunization history. She can say that because Walmart is the first national chain to have bi-directional registry data in all pharmacies where it’s available.

As for her day at HIMSS, many of the attendees were surprised by the data available. That’s when she heard those “Do you actually do all this?” we mentioned earlier. “One person asked me,” she recalled, “how long it took to get the data into the system. I told him, ‘If you get a vaccination at your doctor’s office and then come straight to the pharmacy, we’ll already see the record.’”  

There are two chances to be surprised by all that vax data can do.

Use Case Title: Immunization Evaluation & Integration

Short Description: Follow Aria from early childhood into adulthood as she moves through multiple care locations and receives immunizations over time. Immunization schedules have become more complex as more vaccines have been added to the routine schedule, especially for adolescents and adults. Clinical decision support for immunizations is becoming increasingly available both within local EHR systems and in response to queries to immunization information systems at the local and state levels.  Throughout the care process, workflows that are demonstrated reflect the clinical capabilities tested in the HIMSS Immunization Integration Program (IIP). 


Value:  Improved access to comprehensive vaccine history and vaccine forecasts can improve immunization rates and decrease the incidence of vaccine-preventable disease. Interoperable systems place EMRs on a convergent path with immunization registries, enhancing data quality by capturing accurate data at the point of care, and streamlining workflow to increase productivity and reduce re-work.

Scheduled times: This demonstration occurs 45 minutes past the hour.

Logos: Cerner, DSS, Epic, HLN, Hyland, STC, Surescripts



Step 1: Pediatrician: Aria at age 7

Aria was born in the US and at the age of four months her family moved overseas for work.


When she was 7 they moved back to the US and her parents begin to establish care in their new city.  The provider uses the DSS Juno application.


They are back in the state where she was born so when she arrives for her appointment the provider queries the application and it returns her vaccines through the age of two months.  

The mother also produces a history of the third Hepatitis B vaccine received while they were living overseas.  This historical vaccine is documented in the record. The provider queries the STC IIS registry, and reviews the child’s forecast using the  HLN ICE immunization forecasting.


Aria’s mother thinks the child has had chicken pox, so a lab order is placed for Varicella immunity.  The results will be transmitted to her pediatrician once returned.  Her provider administers vaccines according to the catch-up schedule, minimizing data entry using vial barcodes.


Step 2: Decision Support

Evaluation of the history and the forecast is performed by clinical decision support services.


Step 3: Pediatrician: Aria at age 8

Now Aria is 8 years old and going to a new provider who uses the Epic EHR. A query to the Immunization Registry returns a forecast indicating that Aria is due for Varicella, Tdap and her annual flu vaccine. Her previous pediatrician has forwarded her records containing the serology results indicating her immunity to Varicella. Her pediatrician administers TDaP and  Influenza vaccinations. An update of both the administrations and evidence of immunity to Varicella is sent to the registry.


Her pediatrician refers Aria’s parents to participate in the Immunization Registry’s patient-portal to subscribe to reminders for future vaccines due.  Through this portal, her parents can access her immunization records for school and camps.


Step 4: Immunization Registry Patient Portal

At age 10, Aria is off to camp and is already signed up for the MyIR portal. Aria’s mom is able to access the immunization record online. She is able to print the ‘yellow card’ certificate to provide the camp and her new school as proof that she is up-to-date on her vaccinations, which is required for registration.


Step 4: Primary Care

Aria is now 11 years old and has an annual care visit where she is due to her flu vaccine and her TDaP vaccine.  Her primary care provider uses the LIT on FHIR app which is seamlessly integrated with the EHR and displays data based on data from the EHR, data from other health care channels, and calculations from ICE.  


Step 5: Primary Care

Aria, now age 13, has moved across the state and her new provider uses Cerner PowerChart.

Checking with the Immunization Registry, and internal forecasting engine, Aria’s provider determines she is due to begin HPV and MCV4, and for catch-up with TDaP. She is vaccinated, and her provider is able to scan the vaccines given to minimize data entry.


Step 6: Pharmacy

Aria is now an 18-year-old college freshman. She enters a pharmacy to pick up her birth control prescription and while there, the pharmacy tech reviews her immunization status, and notices she needs her 2nd doses of the Meningococcal vaccine and the HPV vaccine.  The Meningococcal vaccine is administered while Aria refuses the 2nd dose of HPV.


PDF Version of Article>>


Herd Immunization:

The Challenge of Achieving 95% Coverage

By Bill Davenhall, Geomedicine Analyst

Examining the five-year forward (2023) projections of population growth of children under 9 years of age revels a startling trend – 95% of all children under nine years of age will reside in approximately 56% (or 520) of the Census Bureau’s defined metropolitan areas (MSA’s), while the remaining 5% of children under nine will be widely distributed across the remaining 413 MSA’s.

Estimating the need for immunization will likely become the analytical responsibility of “regional” health department collaboration and not solely the responsibility of any single public health jurisdiction. Traditionally, states and counties have assumed this responsibility with support  from the US Centers for Disease Control and Prevention (CDC).

The map below reveals just where child immunization will become an imperative – if herd immunization remains the de facto strategy to reduce the incidence of infectious disease (e.g. measles, polio, rubella, etc.). The MSAs colored RED must strive to meet the 95% coverage rate in order for the nation to achieve a 95% coverage rate in 2023.  More specifically, the thirty-three (33) metropolitan areas listed below will need to administer about 50% of the all the vaccines intended for children under 9 years of age, nationwide. Notice that there are eleven (11) MSAs (hi-lighted) that will be required to address meeting 95% coverage goals across several state and local public health jurisdictions. Looking at the recent measles vaccine coverage challenges by MSAs may help us see the organizational challenges that immunizers might face, today and in the future.


New York-Newark-Jersey City, NY-NJ-PA

Los Angeles-Long Beach-Anaheim, CA

Chicago-Naperville-Elgin, IL-IN-WI

Dallas-Fort Worth-Arlington, TX

Houston-The Woodlands-Sugar Land, TX

Washington-Arlington-Alexandria, DC-VA-MD-WV

Atlanta-Sandy Springs-Roswell, GA

Miami-Fort Lauderdale-West Palm Beach, FL

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD

Phoenix-Mesa-Scottsdale, AZ

Riverside-San Bernardino-Ontario, CA

Boston-Cambridge-Newton, MA-NH

San Francisco-Oakland-Hayward, CA

Detroit-Warren-Dearborn, MI

Seattle-Tacoma-Bellevue, WA

Minneapolis-St. Paul-Bloomington, MN-WI

San Diego-Carlsbad, CA

San Antonio-New Braunfels, TX

Denver-Aurora-Lakewood, CO

Tampa-St. Petersburg-Clearwater, FL

Charlotte-Concord-Gastonia, NC-SC

Baltimore-Columbia-Towson, MD

Orlando-Kissimmee-Sanford, FL

St. Louis, MO-IL

Austin-Round Rock, TX

Las Vegas-Henderson-Paradise, NV

Portland-Vancouver-Hillsboro, OR-WA

Sacramento–Roseville–Arden-Arcade, CA

Columbus, OH

Kansas City, MO-KS

Indianapolis-Carmel-Anderson, IN

Cincinnati, OH-KY-IN

Nashville-Davidson–Murfreesboro–Franklin, TN


It is likely that health service arrangements that desire to achieve the widest “local” geographical coverage of immunizations for children, will require multi-jurisdictional (state and county) demographic analysis and a more efficient way to monitor, in a timely manner, changes across a broad geographical region. Setting priorities about which “herds” will likely present serious challenges in achieving desirable coverage rates across a large metropolitan area will become a critical analytical and operational endeavor.