Date of Award


Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Sheryl M. Strasser, PhD, MPH, MSW, MCHES

Second Advisor

Todd M. Raziano, MPH


INTRODUCTION: Immunization is an intervention proven to reduce morbidity and mortality for several infectious diseases, yet coverage remains less than optimal, especially among minorities and the poor. Challenges to adequate coverage are associated with access and consolidated immunization documentation to support clinical immunization decision making. Efforts to improve access and service delivery include Community Guide recommended interventions, the Vaccines for Children (VFC) Program, and electronic data exchange between provider electronic health records (EHR) and state and city immunization information systems (IIS).

AIM: The purpose of this study is to 1) determine if EHR-IIS interoperability improves immunization outcomes and 2) identify how EHR-IIS interoperability may improve the capacity to support activities to increase appropriate immunization.

METHODS: Data reported by state IIS for immunization provider sites both prior to and after the establishment of or the improvement of an existing EHR-IIS interface were analyzed to examine changes in 1) the mean difference in the proportion of 19 to 35 month old children at these sites who were up-to-date for age-appropriate immunizations, and 2) the mean difference in completion of key demographic and vaccine-related fields for 4m to 6 year-old children associated with enhanced sites in the IIS.

RESULTS: Statistical analysis yielded evidence of a positive change in the mean difference in the proportion of children aged 4m to 6 years with key demographic and vaccine data in IIS. A statistically significant change in the mean difference of up-to-date status in 19 to 35 month olds was not detected.

DISCUSSION: Evidence suggests that EHR-IIS interoperability can improve the capacity of IIS in targeting of immunization services to underserved populations and support accountability for the VFC program. Implementation of EHR-IIS interfaces must be performed thoughtfully and support accountability and with an understanding of the impact of the interface on IIS data used to support immunization program activities. Immunization outcomes for children at provider sites engaging in electronic data exchange with IIS should continue to be monitored. Additional analysis must be done to identify the interoperability factors that are positively and negatively associated with improved immunization outcomes.