Leverage Electronic Systems to Improve Immunization Practice

Immunization Information Systems and Electronic Health Records functionality
For Health Care Providers

What to know

Providers can use their immunization information system (IIS) or electronic health record (EHR) to maintain patient immunization information and assess patient immunization status. Reminder and recall lists, vaccine forecasts, and coverage assessments can identify missed opportunities, improve immunization and monitor overall performance.

Immunization Quality Improvement for Providers (IQIP) logo.

Evidence base

Provider office setting

  • Reminder/Recall is supported by a Cochrane review of 75 studies1 and a 2021 review2 as an established best practice across age groups for improving immunization delivery.
  • Practice-based email reminders are feasible and can increase influenza immunization coverage rates among adolescents.3
  • Text message reminders improved compliance with routine childhood immunizations among children aged 0–2 years who were due for vaccination.4
  • EHR-based provider reminders (also called Best Practice Alerts or BPAs) enhanced with IIS-based clinical decision support resulted in a significant increase in completion of the primary immunization series in both well-child and acute care visits among most age groups and several different vaccine types.5

Birthing hospital setting

  • Using an EHR-embedded BPA improved compliance with the CDC guidelines for the administration of the birth dose of the HepB vaccine within 24 hours of birth.6
  • A birthing hospital created an individualized immunization order set and updated administration instructions to reflect new perinatal HepB administration guidelines. This strategy was part of a multidisciplinary approach which led to an increase from a baseline of 45% to 80% of infants receiving HepB vaccine before discharge.7

Evidence-based best practices

Provider office setting

  • Use reminder and recall systems to communicate with patients' caregivers/guardians about appointments (e.g., future well-child, immunization-only, and follow-up acute appointments).
  • If automated reminder and recall systems are not available, generate patient line lists routinely to identify patients who are not up-to-date and schedule appointments.
  • Use best practice alerts to assess immunization status and prompt providers and staff to offer all immunizations that a patient needs at every patient encounter.

Birthing hospital setting

  • Include alerts on electronic medical records to improve immunization workflows and support patient care by providing timely reminders and warnings to healthcare providers.
  • Incorporate immunizations into an immunization order set to facilitate administration.
  • Standardize documentation processes to accurately track the birth dose of perinatal HepB and RSV immunization and identify gaps in vaccination rates. Standardized documentation should include documenting immunization doses in the immunization information system (IIS), also referred to as the immunization registry.

Strategy resources

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Content Source
National Center for Immunization and Respiratory Diseases (NCIRD)
About This Page
Published: July 16, 2024
Updated: September 23, 2026

This page was last updated on this date. Updates may include minor edits, image changes, or other modifications to page content.

Reviewed: September 23, 2026

The information on this page was last reviewed by subject matter experts to ensure accuracy.

  1. Jacobson Vann, J. C., Jacobson, R. M., Coyne-Beasley, T., Asafu-Adjei, J. K., & Szilagyi, P. G. (2018). Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews, 2018(1), Article CD003941. https://doi.org/10.1002/14651858.CD003941.pub3
  2. Kempe, A., Stockwell, M. S., & Szilagyi, P. (2021). The contribution of reminder-recall to vaccine delivery efforts: A narrative review. Academic Pediatrics, 21(4S), S17–S23. https://doi.org/10.1016/j.acap.2021.02.016
  3. Dombkowski, K. J., Cowan, A. E., Reeves, S. L., Foley, M. R., & Dempsey, A. F. (2017). The impacts of email reminder/recall on adolescent influenza vaccination. Vaccine, 35(23), 3089–3095. https://doi.org/10.1016/j.vaccine.2017.04.033
  4. Rosen, K., Krelle, H., King, W. C., Klapheke, N., Pina, P., Anderman, J., Chung, A., Mendoza, F., Bagheri, A., Stadelman, J., Tsuruo, S., & Horwitz, L. I. (2025). Effect of text message reminders to improve paediatric immunisation rates: A randomised controlled quality improvement project. BMJ Quality & Safety, 34(5), e017893. https://doi.org/10.1136/bmjqs-2024-017893
  5. Stephens, A. B., Wynn, C. S., Hofstetter, A. M., Kolff, C., Pena, O., Kahn, E., Dasgupta, B., Natarajan, K., Vawdrey, D. K., Lane, M. M., & Stockwell, M. S. (2021). Effect of electronic health record reminders for routine immunizations and immunizations needed for chronic medical conditions. Applied Clinical Informatics, 12(5), 1101–1109. https://doi.org/10.1055/s-0041-1739516
  6. Kirchhoffer, N. (2021). Improving newborn hepatitis B vaccination compliance with the use of an EMR best practice alert: A quality improvement initiative. University of Pennsylvania. https://repository.upenn.edu/handle/20.500.14332/27529
  7. Hayashi, M., Grover, T. R., Small, S., Staples, T., & Roosevelt, G. (2021). Improving timeliness of hepatitis B vaccine administration in an urban safety net level III NICU. BMJ Quality & Safety, 30(11), 911–919. https://doi.org/10.1136/bmjqs-2020-012869