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Efficiently identify patients’ immunization status through bulk query

March 1, 2023

Ensuring patients are up to date on immunizations is a high priority for individuals, families, communities and public health. Yet, childhood immunization rates have been declining since the start of the pandemic.  

About 93% of kindergartners were fully vaccinated during the 2021-’22 school year, down one percentage point from the year before and two points from the 2019-’20 school year, according to the Centers for Disease Control and Prevention (

While most pediatricians can check an individual patient’s vaccine status from an immunization information system (IIS) through their electronic health record (EHR), many are not aware of the ability to obtain information on a subset of a practice’s or organization’s patients using bulk query operations.

COVID-19 vaccines have raised awareness of the need for more robust vaccine data reconciliation, and traditional methods of requesting faxes or patient vaccine cards are cumbersome and inefficient. Patients also increasingly are using pharmacies and immunization delivery mechanisms outside the medical home, leading to a more fragmented immunization record.

Furthermore, requesting information only for patients who are in the office ignores patients who are not scheduled for care. Those patients may be most at risk and in need of additional efforts to close gaps in care, including immunizations.

Jeremy Michel, M.D., M.H.S., FAAP, a general pediatrician and clinical informaticist at Children’s Hospital of Philadelphia (CHOP), has been integral to CHOP’s efforts to bulk query Pennsylvania and Philadelphia immunization registries. Dr. Michel emphasized that this was a clinician-directed initiative. “Once our clinicians described their needs, then it was presented to the technical experts for prioritization.”

Initial bulk queries were driven by patient activity (scheduled appointments and check-in), but the clinicians knew from the start this would be insufficient.

“CHOP now uses the population health query function of the EHR to regularly run queries and identify patients who need immunization and then focuses outreach resources where they can have the most impact,” said Dr. Michel, a member of the AAP Council on Clinical Information Technology.

Initial efforts targeted flu and COVID vaccines for high-risk patients, but CHOP continues to expand these efforts. Its quality metrics have improved, including Healthcare Effectiveness Data and Information Set metrics for immunization status of 2-year-olds and 13-year-olds.

CHOP also is working to improve accuracy and decrease administrative burden through automated data reconciliation. There is much work yet to be done, but “patients are getting better care, and our ability to efficiently obtain accurate immunization data from other sources is improving as well,” Dr. Michel said.

Pediatric specialists also can benefit from bulk query functionality. For example, endocrinologists can learn which patients with diabetes have not received the recommended pneumococcal polysaccharide vaccine (, and nephrologists can implement vaccination programs for patients who may need alternative Haemophilus influenza type b schedules. Even if specialists do not provide immunizations routinely in their clinic, they can educate families on the importance of receiving recommended immunizations and can include this information in reports to the primary care pediatrician.

The Immunization Integration Program (IIP) released its Bulk Query Toolkit (, providing recommendations to immunization information systems and their data exchange partners. The toolkit provides strategies to maintain core IIS functionality while expanding query capability to support population health efforts.

Pediatricians are encouraged to ask their organizations to work with their vendors to institute meaningful bulk query functionality in their practice. To have success, it is best if the initial efforts are clinician-led with concrete ideas on how to prioritize adding this functionality into their workflows.

Dr. Kressly is chair of the AAP Section on Administration and Practice Management Executive Committee and the Council on Clinical Information Technology.


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