What we learned from 40 health systems

Health systems across the country tested different approaches to integrating vaccination into specialty care. Their experiences revealed six themes that cut across specialties and settings.

doctor patient discussion

Specialty physicians face a fundamental workflow problem: vaccination doesn’t align with specialty visit priorities. Successful programs embedded vaccination into existing clinical workflows rather than treating it a s a separate task, engaged frontline staff to refine approaches based on real-world feedback, and ensured on-site vaccine access.

Four health systems each tested a different model – from stationing nurses with vaccines in waiting areas, to color-coded cards on patient charts, to EHR hard stops, to making vaccination as routine as taking vital signs. All four emphasized learning from frontline staff and adjusting based on what actually worked.

Health System Results

Organization Result
Kaiser Permanente Roseville Stationed nurses with vaccines in infusion and clinic waiting areas, bypassing the clinical visit entirely Influenza vaccination rates rose from 48.9% t o 54.0%.
Cleveland Clinic Medical assistants reviewed charts and reconciled immunization records, then placed color-coded laminated cards on patient charts during rooming (green = fully vaccinated, red/orange = needs discussion). Influenza vaccination rates increased from 44% to 65%.
UCLA Modified EHR notes with “hard stops” so providers could not complete documentation without addressing vaccination status. Prover vaccine reviews increased from 5% to 67%.
Swedish Cancer Institute Trained medical assistants and RNs to make vaccination status checks as routine as taking vital signs The location where providers initially said “this is not our job” now reports the highest vaccination documentation rates system-wide.

Vaccination gaps often stem not from lack of commitment, but from unclear roles and untapped team potential. Health systems that surveyed their teams uncovered striking disconnects — medical assistants felt confident recommending vaccines but didn’t think it was their job, while clinicians believed they alone were responsible.

Success depended on engaging the full care team: nurses, medical assistants, pharmacists, care coordinators, and clinicians. Projects that empowered non-physician team members to initiate vaccination discussions, assess status, and administer vaccines achieved greater reach and sustainability.

Health system results:

Organization Result
University of Utah Empowered medical assistants to reconcile immunization records, identify gaps, and administer vaccines — often before clinicians entered the room. Shingles vaccine completion rates increased from 57% to 65%.
Emory Healthcare Bi-weekly reports showed providers how their vaccination rates compared to colleagues, and a rotating “Most Vaccinated Practice” trophy sparked friendly competition. Influenza vaccination rates improved by 10 to 30 percentage points across three clinics.
Grady Hospital Fellows trained in motivational interviewing techniques after patient interviews revealed that vaccine-hesitant patients wanted providers to explore their concerns. Vaccination conversations sustained through the entire flu season, breaking the typical post-December plateau.
Harbor-UCLA Nurse-driven vaccination assessment processes achieved 100% adherence to the assessment workflow and sustained over time, while physician-driven interventions remained inconsistent despite reminders and training.

Health systems increasingly leveraged EHR tools — SmartPhrases, dot phrases, Best Practice Advisories, and health maintenance modules — to centralize immunization data and prompt clinical action. The most effective systems treated documentation not as a static record but as a dynamic trigger for proactive intervention.

Three health systems demonstrated how to make practical use of connections between EHRs and state Immunization Information Systems (IIS) through targeted workflow interventions — revealing that the real challenge isn’t whether systems can connect to state registries, but whether clinicians can actually use the data they gain.

Health system results:

Organization Result
WVU Medicine Developed a pulmonary vaccine “dot phrase” in Epic and iterated through four design cycles based on clinician feedback. Provider utilization of the tool reached approximately 70%, with a direct correlation to increased vaccine orders.
UT Health Houston Texas’s opt-in Immunization Information System required patient consent that the geriatrics clinic lacked for 90% of patients. By redesigning the consent workflow, same-day consent rates enabling IIS queries rose from 0.52% to 6.13%.
HealthPartners Working across dual EHR systems with limited integration with the state Immunization Information System, the team created paper-based reports from Minnesota’s state immunization registry, achieving 50% screening rates and demonstrating that registry data can drive clinical action even without sophisticated EHR integration.
University of Colorado Built a custom clinical decision support tool displaying specialty-specific vaccine status directly in clinician notes. Patients who received vaccine counseling were 2.7 times more likely to receive a vaccination.

Three diverse healthcare settings confronted the same insight: the barrier to vaccination often wasn’t hesitancy — it was accessibility, trust, and meaningful engagement. Vaccination needed to shift from a transactional checklist item to a relationship-based conversation that honored patient autonomy.

Specialists are uniquely positioned to influence vaccination decisions. When a trusted oncologist or cardiologist recommends a vaccine, patients listen. And vaccine-hesitant patients often don’t want the conversation to end at “no” — they want providers to explore their concerns.

Health system results:

Organization Result
UCSF / San Francisco Health Network Trained 1,800+ staff in the HEAR technique — a framework for respectful patient conversations — and launched drop-in clinics staffed by nurses who share patients’ cultural and linguistic backgrounds. Influenza vaccination at trained sites increased from 40.4% to 55.2%, and vaccine refusals declined significantly.
Penn Medicine Discovered that 78% of elderly patients (average age 82) were unaware of current vaccine recommendations. Sent EHR reminders and hosted monthly onsite vaccine clinics. Shingles vaccination increased from less than 1% to 11%.
3M (via ACOEM) Reached 70,000 employees across multiple manufacturing and office settings with online education modules, lunch-and-learns, and one-on-one nurse consultations. Employees showed statistically significant increases in vaccine knowledge and trust in CDC recommendations.
ACC Partnered with retail kiosk companies to deliver vaccine messages while customers had their blood pressure checked. Over 1 billion message plays, generating an estimated 50,000 to 100,000 additional influenza vaccinations annually.

When specialty clinics struggle with vaccination rates, the solution may lie beyond their own walls. Strategic collaborations — with state health departments, retail pharmacies, community organizations, and technology companies — can solve problems that individual health systems cannot address alone.

These partnerships took many forms: working with state health departments and immunization registries to improve third-party reporting, sending vaccine prescriptions to retail pharmacies, negotiating collaborative drug therapy agreements with on-site pharmacies, and deploying vaccine messaging through retail health screening kiosks.

Health system results:

Organization Result
Prisma Health Partnered with South Carolina’s Department of Health and Environmental Control and retail pharmacies (Walgreens, CVS, Publix) to improve vaccination data reporting into the state immunization registry. Influenza vaccination documentation increased from 71% to 80%.
Houston Methodist Built an EHR SmartSet order panel to send vaccine prescriptions directly to retail pharmacies, making vaccination an actionable task extending beyond the clinic visit. Prescriptions showed 50.8% fill rates, and overall influenza vaccination increased from 56% to 67%.
OHSU Established a Collaborative Drug Therapy Management agreement with an onsite pharmacy to deliver vaccines to the practice and handle billing through the patient’s pharmacy benefit. The protocol now runs seamlessly across three clinics and sustained after the departure of the dedicated vaccine medical assistant.
University of Colorado Stocked COVID-19 vaccines on-site in the pulmonary clinic. In-clinic COVID-19 vaccine administration improved from 4% to 25%, and patients receiving both influenza and COVID-19 vaccines in a single visit increased from 1% to 7%.

Without intentional action, most quality improvement efforts fade after six months. Three health systems proved that sustainability requires fundamentally changing how vaccination integrates into specialty care — aligning with existing accountability metrics, empowering organic champions, investing in infrastructure, and demonstrating financial viability.

The most successful programs built a pro-vaccine culture where vaccination was recognized as a marker of quality healthcare. When vaccination became embedded in organizational identity and expectations, sustainability followed naturally — surviving staff turnover, leadership changes, and the end of grant funding.

Health system results:

Organization Result
CARTI Cancer Network Aligned vaccination with existing MIPS quality measure requirements and demonstrated financial break-even to secure administrative support. Vaccination assessment rate reached 99.9%. Pneumococcal vaccination increased from 63% to 76%, COVID-19 from 18% to 40%, and influenza from 40% to 57%.
Brown University Health Developed the “Rhode Island Two-Step” — a simple scripted approach that reduced staff anxiety about initiating vaccine conversations. COVID-19 vaccination increased from 27% to 34% in eight months.
UNLV Health Medical assistant-led vaccination protocol, designed with an Epic specialist, spread organically system-wide to all clinics including internal medicine, obstetrics, pediatrics, family medicine, surgery, and ENT. Influenza vaccination increased from 12% to 49%.
OHSU Program sustained even after the departure of the dedicated vaccine medical assistant. The culture change was deep enough that when new medical assistants join, they adopt the vaccination workflow as standard practice.

Search CMSS SSAI