4.2: Update Vaccine Inventory from Patient Dosage Administration


The system updates the vaccine inventory to assure the correct count of remaining available vaccine inventory.


The EHR or other clinical software system maintains the number of doses of inactivated polio vaccine (IPV) available from the Vaccine for Children (VFC) program at a specific site.  The system then decreases that number when one of the IPV doses is administered to a patient. The updated list can be displayed to Dr. Smith, so that she can write orders for vaccines available for administration.


The intent of this capability is to allow providers to order or document vaccines administered by selecting vaccines from the appropriate inventory. The inventory chosen (i.e., government guarantee program such as Vaccines for Children (VFC) or private stock) should be consistent with the patient’s eligibility for the related guarantee program.

Most providers interviewed for this project stated that specific personnel in their offices manage their vaccine inventory using paper logs or electronic spreadsheets. In most practices, an individual staff member then enters the inventory into the practice’s EHR manually, including the vaccine lot number and expiration date. Some, but not all software provides fields that providers can use to document the source of the vaccine products (e.g., VFC or private), list the number of available doses, and decrement that number each time a clinician documents administering a dose from the respective vaccine lot. Some products allow use of bar code technology to load vaccine stock into the EHR instead of manual entry. Other products allow use of bar code readers to document administration of vaccine doses instead of requiring manual entry. Most vendors indicate their customers differentiate private vaccine stock from that provided by guarantee programs such as VFC using mechanisms other than the EHR.

Some public health registries provide inventory management software that help providers manage guarantee program inventory, as well as private stock. Providers manually enter inventory information and orders and into these External Information Systems (ExIS), reporting all vaccine doses the guarantee programs that are used, wasted, expired and returned. The ExIS software updates the amount of available stock. The registry coordinates inventory data with CDC’s Vaccine Tracking System (VTrckS) to place orders for additional stock and VFC vaccine is shipped to the provider.[i],[ii] Some registries allow providers to document their private vaccine inventory in the ExIS software as well, but the provider is responsible to order private stock through other mechanisms. The American Immunization Registry Association published guidance for inventory management to support the ExIS systems.[iii]

There is currently no interface between ExIS programs and EHRs providing inventory capabilities. Some hospital software vendors produce inventory applications that allow customers to order all materials the office needs, including examination gloves, syringes, alcohol wipes, medications, and vaccinations. These inventory software products use an existing American National Standards Institute (ANSI) standard, Advanced Ship Notification (EDI 856[iv]), to transmit data from the warehouse to the inventory software. However, there is no known connection of such applications to clinical software used to order and administer vaccines.

Feedback from EHRs vendors and providers suggests that providers who only treat adults see limited value in EHR inventory capabilities. However, vaccine inventory capabilities generate greater interest to pediatricians and family physicians who manage a complex series of childhood immunizations as a core practice competency.

Collaboration among providers, EHR vendors and public health immunization registries will more clearly define the requirements and allow the workflow to be streamlined.

  • Vendor Perspective. A decision to provide inventory functionality depends on the product’s intended market. Collaboration with public health registries and providers should help to further define capabilities and develop capabilities. Vendors should consider usability evaluation such as User Centered Design (UCD) to evaluate how the system manages inventory.
  • Provider and Implementer Perspective. Providers should understand vendor processes and timeliness for managing inventory. Participation in discussions with public health registries and software vendors should help to further define capabilities that meet the needs of providers and public health.


There are no tests for this capability.

Data Elements

There are no data elements for this capability.

[i] Centers for Disease Control and Prevention.VTrckS. 2013. Available at: http://www.cdc.gov/vaccines/programs/vtrcks/topics/ExIS.html. Accessed 23 June 2015.

[ii] American Immunization Registry Association. VTrcks_ExIS Presentation (Janet Fath). Available at: (http://www.immregistries.org/resources/iis-meetings/5D_VTrckS_ExIS_Janet_Fath.pdf. April 22 2015. Accessed 23 June 2015.

[iii]American Immunization Registry Association. Immunization Information System Inventory Management Operations: Recommendations of the AIRA Modeling of Immunization Registry Operations Workgroup (MIROW). June 14, 2012. Web. 20 March 2014. Available at: http://www.immregistries.org/AIRA-MIROW-Inventory-Management-best-practice-guide-06-14-2012.pdf. Accessed 9 December 2014.

[iv] Cardinal Health. 856 Advance Ship Notice: Supplier Implementation Guide. 2007. Web. 4 March 2014. http://www.cardinal.com/mps/wcm/connect/e68a4e804b878ab6b7d6bfb8790f6c17/856+Advance+Ship+Notice+Implementation+Guide%5B1%5D.pdf?MOD=AJPERES&lmod=-956895819&CACHEID=e68a4e804b878ab6b7d6bfb8790f6c17&lmod=-956895819&CACHEID=e68a4e804b878ab6b7d6bfb8790f6c17.  Accessed 9 December 2014.