Six comparable general clinics (2 for pediatric care and 4 for adult primary care) from all MultiCare facilities will be selected to participate in the study. Half of the clinics will be in the Puget Sound Region and others in the Eastern Washington Areas. Allocation to the intervention will be based on randomization: one pediatric and two adult (Internal Medicine or Family Medicine) clinics will get the comprehensive intervention.

The other three facilities will stay as the control under routine care. The three control group sites will have no additional interventional activities regarding vaccination, except for MultiCare's usual vaccine promotion practices (which the interventional clinics will have also).

An enhanced electronic reminder mechanism specialized on vaccines and actively highlight vaccine standing orders in the system.

Set up a data benchmarks, so clinic managers or providers are able to aggregate immunization data, red flag missed opportunities, and facilitate modifying vaccine promotion plans.

Other components:

1. missed opportunities and doubts/hesitancy about immunization as a whole;
2. specific questions with regard to specific vaccines;
3. health conditions and socioeconomic/demographic vulnerabilities (insufficient resources in health literacy, linguistic or cultural considerations); and
4. challenges in patient-clinician interactions. These components will be addressed through team training/meetings, pamphlets, physician-led speech in online videos, and group messages via MyChart on the clinic level.

Vaccination attitude (confidence or hesitancy) measured by the following:

For caregivers of 19-35 months children: Parent Attitudes about Childhood Vaccines Survey - Short Form (PACV-SF) and Emory Vaccine Confidence Index (EVCI);

For caregivers of pediatric patients 3 years or older: Vaccination Confidence Scale (VCS) and EVCI;

For adult patients: Vaccination Attitudes Examination Scale (VAX);

For clinical workers/health professionals: VAX.

Well visit completion in the previous 12 months prior to baseline, and post-pre changes in adult patients;

Well-child visit completion rate 12 months prior to baseline, and post-pre changes in 3-18 yo for the pediatric clinics;

Total numbers of well clinic visits at baseline and changes over 6 months.