Ask AI
Back Back
Vaccination in the Real World
Vaccination in the Real World: When the Biggest Barrier Is the System Around Us

Released: March 30, 2026

Laura P. Hurley
Laura P. Hurley, MD, MPH
Activity Information

Activity

Progress
1
Course Completed
Continue
Key Takeaways
  • Make vaccination the default rather than an add-on service in your workflow.
  • Focus discussion time on people who are unsure rather than opposed to vaccination, and remember that later discussions may be needed.

I think real-world barriers to vaccination are multifactorial. The largest issue is that there is not a lot of time in a 20-minute visit for vaccines when I need to address chronic health conditions. So, having a workflow in place to facilitate vaccine uptake is really important.

Designing Vaccination Into the Workflow
The electronic health record (EHR) and standing orders, when available, help to take 1 aspect of the vaccination process off the physician or advanced practice provider (APP)’s plate. It also makes vaccination part of what the clinic does and part of its workflow rather than something additional. It varies by practice, but within this workflow, a medical assistant or nurse can administer vaccines before the physician or APP comes in.

I find it is crucial to make sure that all staff are trained and in accordance with vaccine workflows. For instance, some medical assistants or nurses may want each patient to discuss vaccines with the physician or APP first, but that is inefficient and can sometimes result in missed vaccine delivery if nobody goes back in to give the vaccine. Avoid this by making sure everyone is on board with the workflow.

Practices not set up to bill Medicare Part D need a workflow to refer people out for vaccines like Tdap, RSV, and zoster. But this referral can make it less likely that patients will receive the vaccine, so it is best to refer people to pharmacies in locations that are convenient for them, like the local grocery store or an in-house pharmacy within the clinic system.

Communicating About Vaccines
The addition of vaccines to the adult immunization schedule in the past decade adds a layer of complexity to vaccine conversations. So does hesitancy around the COVID-19 vaccines. Some people have such strong feelings about COVID-19 vaccines that it can prematurely terminate the discussion of other recommended vaccines.

In some cases, I find that motivational interviewing to meet the patient where they are and identify their concerns about vaccination is helpful. If you are able to identify their concern, you may be able to address it and help convince the patient to receive the vaccine. With COVID-19, the barrier is frequently distrust in the healthcare system. With influenza, many people do not think they need the vaccine.

However, even evidence-based techniques are unhelpful when vaccines are a conversation nonstarter. So, it is important to identify people who are not likely to receive a vaccine vs those who just need a little more discussion. For those who may need more discussion, I find it is important for medical assistants and nurses to start by telling the patient, “Your provider recommends this. You should go ahead and get it.” Then, if they are still unsure, give the patient the opportunity to discuss things further with the physician or APP. This will keep the workflow running smoothly.

The key is remembering that vaccination is an ongoing discussion. I encourage staff to never record that somebody has permanently declined a vaccine in the EHR. If they do that, it is more difficult to continue the conversation, as it will not be clear that a vaccine can be offered.

To learn modern vaccination approaches in a talk-show style discussion, join me and my colleagues Sharon G. Humiston, MD, MPH, and Rupali J. Limaye, PhD, MPH, MA. You can join us virtually or in-person at our live symposium on April 15.

Your Thoughts
What barriers do you face in providing vaccinations to adults in your practice? Join the discussion by sharing your thoughts below!

Continue