as of april 25 , 2015 searching the android store with the words  immunize app and  immunization app in canada yielded 225 unique apps . on the apple app store a similar search produced 98 results ( table  1 ) .
the majority of these apps are designed to provide immunization information to individuals or health care providers such as recommended vaccination schedules , relevant news , frequently asked questions , immunization statistics ( e.g. coverage rates ) , safety and storage tips and relevant immunization events and conferences .
some examples of these apps include  immunization summary  ,  cdc  and  vaccines on the go  .
other immunization apps offer functionality which help individuals track their own vaccinations and create personalized vaccination schedules ( e.g. , canadian vacapp ) .
ivaccinate is a tool developed specifically for health care providers , allowing them to create patient vaccination schedules , maintain vaccination records , send upcoming appointment reminders to their patients , and plan and place vaccine purchases .
some apps are designed with a patient portal and a physician portal allowing physicians to create specialized immunization schedules ( e.g. vaccination reminder ) .
there are even apps for tracking animal vaccinations for both pet owners and veterinarians ( e.g , pet health record ) .
some apps permit gaming and others are developed as education tools ( e.g. , doctor kids , virtual medical center , vaccine epi - karen ) . in our search
, 2 apps were identified that permit adverse event following immunization reporting ( aefi ) and evaluation ( e.g. immunization toolkit , idsurv ) .
other app functions included tracking health information , locating health care services , accessing health records and accessing information about a specific clinic or hospital . 

table 1.immunization related apps  google playapp storegeneraln%n%total225  98  free183816263paid42193637users  parents33153233  public33151515  health care providers27121717  public & health care providers5299  pet owners9400  women3111  veterinarians2100  conference attendees2133  patients231011 
travelers0055  other4255  unspecified85381010functions  information69316061  recommended schedule41182121  personalized schedule2091818  tracking34153233  reminders26121818  medical record37161212other  game16711  animal / pet health12522  education / tool20977  baby / child raising32141111  clinic locator / clinic information8411  travel3166  miscellaneous3155 
 table 2.advantages and disadvantages of mobile apps for immunizationadvantagesdisadvantagesrecord keeping based on core minimum data elementsaccess to smartphonesbar code scanning allows for data upload directly into the devicerequires maintenance and updates with advancing operating systems and hardware devicesability to set data standards and link to other systemsadoption of technology and variation in population technology readinessautomated recall / remindersprivacy and security of informationprovision of informationoutbreak alertslocation of vaccine clinicsimmunization fact sheetsauthenticity of information enteredvaccine status and aefi reportingrelies on individuals to enter and manage datatargeted messaging by public health officials based on user location 
  immunization related apps advantages and disadvantages of mobile apps for immunization we developed immunizeca which combines functionality with a pan - canadian app which combines information delivery with functionality for creating personalized vaccination schedules , permitting tracking of individual and family members immunization records as well as appointment reminders and alerts for vaccine preventable disease outbreaks in their area .
while there is variety in the functionalities offered by immunization apps , perhaps the most valuable is the ability to serve as a mechanism for individuals to conveniently access and interact with their vaccination information ( table 2 ) .
this portability provides significant advantages over traditional paper records or patient portals only accessible through desktop computers by allowing individuals to check and change their health information data in real time , at the place of immunization . in many jurisdictions ,
mobile apps can facilitate the recording of immunization information through manual entry , drop down menus or potentially mobile scanning of 2d vaccine barcodes .
the latter can also permit the inclusion of the global trade item number ( gtin ) and lot number of the vaccine administered , substantially improving the value and quality of the information contained within the vaccination record .
apps can also assist individuals with the logistics of vaccination including scheduling appointments in their calendar , reminding them of boosters and overdue vaccinations and helping them locate immunization clinics . by improving ease of reporting immunization status for individuals , apps
fragmentation of vaccine provision has made it challenging for a single health care provider to have complete and accurate records for an individual .
enabling mobile reporting of immunization status could facilitate the transmission of this information , potentially captured at multiple settings , directly to public health authorities .
this can occur through a web service and api or as a direct upload into an immunization repository . by allowing individuals to record and report immunization information on their mobile devices , apps can also facilitate and complement immunization surveillance activities .
apps and mobile devices could permit individuals to immediately report suspected aefis to their public health unit or healthcare provider .
removing barriers to the passive reporting of aefis may allow early signal generation of possible adverse events that can be later examined through active surveillance systems and epidemiological analyses .
while mobile devices can allow individuals to send immunization information to public health officials they also open up new mechanisms for the converse ; for public health to communicate directly with individuals .
apps can permit targeted messaging to geographic specific areas using devices global positioning systems ( gps ) or the creation of region specific profiles .
public health officials can , for example , notify individuals of vaccination clinics or outbreaks of vaccine preventable diseases within their region .
apps could also permit public health officials to send lot specific notifications to individuals in case of a lot failure or lot related adverse event .
another potential benefit of apps is the opportunity they provide to improve vaccination confidence and rates .
three major reasons for not vaccinating include logistics , concerns about vaccine safety and concerns about whether vaccines are necessary   in the app we created , immunizeca , we have included measures to address each of these logistical challenges are partially addressed through scheduling and automated reminder / recall features . reminding individuals of the importance of vaccination is enabled through the inclusion of notifications of vaccine - preventable disease using an api provided by healthmap .
the app also contains accurate information about vaccinations to counter misinformation that is prevalent on the internet and social media .
for example , mobile apps can permit targeted messaging . through digital detection , such as what is being accomplished in the  vaccine confidence project ,  the possibility exists for public health officials to identify , in real time , regions where vaccine hesitancy conversations are occurring .
a mobile app could then be used by officials to deliver tailored messages to individuals in a certain region to specifically address these concerns .
while apps offer potential to improve immunization practice they also have some limitations . perhaps foremost are barriers to use .
the use of smartphones is increasingly widespread , however , the willingness to use mobile applications for managing health information remains uncertain . while a younger generation of digital natives may be more willing to embrace mobile technology , older users may not be as comfortable using mobile applications to manage health information .
barriers include simple physical barriers , for example difficulties reading small screens and manually entering information . however , there are also barriers related to technology readiness reflecting a general discomfort with the use of new technology to accomplish goals in work or home life .
developing the best technology is not of value if individuals are not prepared to download and use it .
strategies to overcome  vaccine technology hesitancy  should focus on providing real value to the user , such as allowing reporting of immunization status directly to public health .
data security is a concern related to both storage of information on a device and transmission of information .
password protection of the device can be associated with encryption of the device itself such as is done by apple iphones .
mobile devices also permit remote wiping if the device should be lost removing any personal health information that may be stored .
utilizing these options would result in the security of the information on the digital record exceeding that of a paper record .
data access could be viewed as the flipside of security . changing devices , the need to share information with other family members and the ability to access data from several platforms may be important functionality that individuals expect .
cloud based storage could permit this allowing individuals to securely back up data , sync data with family members and access data across both mobile devices and desktop / laptop computers .
concerns also could arise about the quality and veracity of the data on a mobile device .
manual entry and self - report may not be considered valid , particularly in jurisdictions who primarily rely on provider entered data .
mechanisms to overcome this include having a health care provider validate the information being entered by the individual on the app .
this could be enabled through a signature function , allowing the vaccine provider to sign next to the entered data directly on the device with a stylus .
if the data is entered using the phones camera to scan the barcode , it could also serve as a method of verifying that the immunization was received .
if individuals are contributing data to a larger repository , it is important that data is standardized in a fashion that renders it useful for calculations of vaccine safety , coverage and effectiveness .
if an immunization information system has multiple data sources , an app being one , it is crucial that all contributors are using the same standards .
one such standard being used in canada for immunization data is the systematized nomenclature of medicine clinical terms ( snomed ct ) , a product of the international health terminology standards development organization .
these standards are traditionally used for electronic health records and should be an important consideration in the development of a mobile immunization app .
mobile applications will almost certainly represent the future of immunization records and trigger the advent of the next generation of immunization information systems . increasing fragmentation of immunization delivery
mobile applications will facilitate this and by permitting a mechanism for sharing of information between an individual , their healthcare provider and central immunization information repositories enable all 3 to have the same immunization data in real time . quality and granularity of immunization data will improve with mobile applications , something that will be facilitated by barcode scanning .
mobile adverse event reporting and public health officials addressing vaccine hesitancy through geofenced targeted communication will be possible . digital immunization passports that are recognized by country border officials as proof of immunization are likely to soon be developed and could address international health regulation requirements for proof of vaccination at borders , as is required for the yellow fever vaccine in some instances .
we envision a future where mobile applications will allow patients , providers and public health all to have access to real time information about an individual s immunization status .
the individual is aware whether they are fully up to date , have upcoming vaccinations or are overdue and may be vulnerable to vaccine preventable diseases .
providers are also aware of this status and can provide recommendations and counsel their patients appropriately .
these calculations form policy , resource allocation decisions and ensure program success . as mobile technology continues to change and evolve the potential of mobile applications to continue to enhance immunization practice
the authors were responsible for the development of immunizeca , a pan - canadian immunization app .
 mobile technology and applications ( apps ) have disrupted several industries including healthcare . 
 the advantage of apps , being personally focused and permitting bidirectional communication , make them well suited to address many immunization challenges . as of april 25 , 2015 searching the android app store with the words  immunize app and  immunization app in canada yielded 225 apps . on the apple app store a similar search produced 98 results . 
 these include apps that provide immunization related information , permit vaccine tracking both for individuals and for animals , assist with the creation of customized schedules and identification of vaccine clinics and serve as sources of education . 
 the diverse functionality of mobile apps creates the potential for transformation of immunization practice both at a personal level and a system level . for individuals , mobile apps 
 offer the opportunity for better record keeping , assistance with the logistics of vaccination , and novel ways of communicating with and receiving information from public health officials . for the system , 
 mobile apps offer the potential to improve the quality of information residing in immunization information systems and program evaluation , facilitate harmonization of immunization information between individuals , health care providers and public health as well as reduce vaccine hesitancy . as mobile technology continues to rapidly evolve there 
 will emerge new ways in which apps can enhance immunization practice . 
Immunization Applications (APPS)
Benefits of Mobile APPS for Vaccination Tracking
Communicating with Individuals and Opportunities to Improve Vaccine Hesitancy
Disadvantages of APPS
The Future
Disclosure of Potential Conflicts of Interest