A patient walks in for a routine visit and can’t say for certain whether they’re due for a shingles vaccine or whether they already got one at the pharmacy down the street last spring. It’s an increasingly common moment, and it’s less a failure of memory than a reflection of how vaccination itself has changed. Patients no longer receive their immunizations in one place, and the record often doesn’t follow them when they move on.
Vaccination Has Left the Building
For decades, vaccination occurred mostly in one place: the doctor’s office. That’s no longer accurate. A CDC analysis of adult vaccine recipients found that pharmacies and drugstores were the single most common site for flu shots (48%), updated COVID-19 vaccines (71.5%), and RSV vaccines (81.7%) during the 2023–24 season. Doctor’s offices came in a distant second for flu and weren’t close for the other two.
Workplace clinics and urgent care visits add more access points, as do specialty offices. None of these settings are doing anything wrong; however, even within a single health system, documentation of a vaccine administered by a specialist doesn’t always flow back automatically to the primary record. Each new site is one more place a record can originate—and one more place it can remain once the patient has moved on.
Even with more places to get a shot, the practice visit still carries its own weight. It is where a provider can catch a gap in person and correct it on spot.
Why the Paper Trail Breaks
The systems behind these sites vary in sophistication. A large academic health system may run predictive alerts across a fully integrated electronic health record (EHR), while a rural clinic two counties over may still keep paper charts. Between those extremes sit thousands of practices and pharmacies running platforms that were never designed to exchange information with one another, so a record created in one place has no reliable way of reaching the next.
Patients add another layer simply by moving through life. Whether that’s relocating for a new job, switching insurance, aging into Medicare, or finding a new primary care provider after the previous one retires, none of that reflects carelessness. It means that recent vaccination history often remains with a provider the patient no longer sees, while the new provider begins with only a partial picture.
The Cost of a Broken Record
Missing records create two opposite problems: a needed dose that’s never given and a dose that’s given twice unnecessarily. The latter is more common than it may seem. One national analysis of pediatric vaccination records found that 10% to 21% of young children received an unnecessary repeat dose after completing a series, at a projected cost of $10 million to $18 million for administration alone. Adult records, scattered across even more disconnected systems, are no better positioned.
For practices, the gap often appears as time rather than statistics. Piecing together a complete history may require contacting a previous provider or restarting the conversation with the patient, and that time adds up quickly—especially for practices already managing full patient panels. Atlantic Health Partners works to keep the ordering and pricing side of vaccines straightforward, so it doesn’t add to an already full day.
Closing the Loop
Immunization information systems—state-run registries that aggregate data from multiple providers—help fill in much of that picture. Participation among adolescents nationally reached 88.6% in 2024, though adult participation still lags.
Within a practice, an EHR alert that flags an incomplete history before a visit begins, paired with a routine check of the registry rather than reliance on memory, closes a meaningful share of the remaining gaps.
Closing the rest depends partly on patients. Maintaining even a basic personal record—whether that’s a paper card, a personal log kept on a phone or PC, or a dedicated app such as OneRecord—provides a fallback when the official record doesn’t transfer. For patients who cannot keep that record themselves, such as young children, older adults, or anyone managing a cognitive or physical limitation, having a designated caregiver or family member take on that role matters just as much as the record itself. A provider who asks about it directly, rather than assuming the chart is complete, often uncovers information the registry missed.
More Access, Not Less
None of this argues for reducing convenience. A patient who can receive a flu shot at a pharmacy during a lunch break, rather than waiting weeks for an appointment, is more likely to be vaccinated in the first place. Every site of care should support that accessibility without losing track of the record. A quick registry check and a direct question during the visit go a long way toward keeping that record complete, regardless of where the next dose is administered. A seasonal flu shot given at the practice tends to do double duty, since it’s often the moment a provider notices what else might be due, from a shingles vaccine to a booster the patient forgot about.
Atlantic Health Partners supports practices navigating the realities of modern vaccine delivery, offering access to preferred pricing, procurement guidance, and resources across the full recommended schedule. That support is built on direct relationships with major manufacturers and a dedicated service team, helping the practice remain a natural place for patients to get their seasonal shot. Reach out to learn more.