Li’s app removes vaccine barriers for TN families

Vaccines help the immune system to recognize and fight many types of diseases, from viral illnesses like COVID-19 to bacterial infections like tetanus. In 2024, the United States Centers for Disease Control and Prevention (CDC) estimated that routine childhood immunizations had prevented more than 1.1 million child deaths over the past 30 years.

Yet in 2021, one of four children in Tennessee under two years old had not received all their CDC-recommended vaccines.

“Compared to other states, we’re not doing a good job with childhood vaccinations,” said Xueping Li, a professor and Dan Doulet Faculty Fellow in the Department of Industrial and Systems Engineering (ISE) at the University of Tennessee, Knoxville.

Li is an expert in complex system modeling and optimization. For the last 20 years, he has been applying his expertise to healthcare as co-director of the Health Innovations Technology and Simulation (HITS) Lab housed within the UT College of Nursing.

“As an industrial engineer, I have always had a passion for solving problems, and the healthcare system is very complicated,” Li said. “There are dozens of pieces that all have to work together. If there’s a problem, you cannot look at only one piece. You need to look at the system holistically to come up with a solution that works.”

When the TN Department of Health (TDH) put out a call for solutions to improve childhood immunization rates, Li and his colleagues at HITS knew they needed a way to efficiently tackle multiple barriers. Their answer is SmartSHOTS, a vaccine tracking and information smartphone application based on the specific needs of Tennessee families.

SmartSHOTS combines systems-level thinking with expertise in coding, health science, public science communication, and user-friendly design to create a convenient app with big potential to improve health outcomes for Tennessee children.

In addition to Li, the SmartSHOTS leadership team includes UT College of Nursing Dean Victoria Niederhauser and Associate Dean of Research Tami Wyatt; School of Design Director Sarah Lowe, a user interface expert in the College of Architecture and Design; and linguistics experts from the College of Media and Communication.

“We have a very diverse team, so each of us brings a different angle to look at this problem,” Li said. “I think that will contribute to a more effective solution.”

With funding from the TDH, the SmartSHOTS team conducted statewide surveys to identify the biggest barriers faced by caregivers who want to vaccinate their young children, then constructed their app to address each one.

Results from the app’s beta test—including enthusiastic feedback from caregivers—were published in the international Health Informatics Journal this January.

“The beta tester feedback was incredibly rewarding,” Li said. “SmartSHOTS was built through close collaboration with nurses, engineers, public health experts, designers, and community partners, so seeing such strong validation from users affirmed both our approach and the real need for this solution.”

Identifying Barriers to Vaccination

To identify important barriers to childhood vaccinations, the SmartSHOTS team partnered with County Health Councils (CHCs)—TDH-supported teams of teachers, doctors, parents, and other volunteers from each county across the state.

“It doesn’t matter how capable you are if you don’t understand the problem,” Li explained. “These representatives understand the people from their community, so we started by first asking what their needs are.”

The CHCs revealed that locating and reaching vaccine clinics is a major barrier, especially to families that move a lot, so SmartSHOTS includes a GPS-enabled tool to help caregivers locate nearby vaccine clinics and public transportation options.

Caregivers’ safety concerns and misinformation, like believing that homeschooled children do not need vaccinations, were another major factor identified by CHCs. The SmartSHOTS team responded by creating evidence-based animations about each CDC-recommended vaccine and the disease it protects against in both English and Spanish, the two most-spoken languages in Tennessee. 

The app’s centerpiece is a tool where caregivers can create unique profiles for each of their children and log the date of each vaccination. This feature tackles the single biggest hurdle to child immunizations in Tennessee: human memory.

“Our analysis indicated that understanding immunization schedules and keeping up with those deadlines is a challenge,” Wyatt said. “Our app helps parents know when immunizations are due and sends them reminders.”

An Award-Winning, Life-Saving App

Li and three of his ISE students, Aliza Sharmin, Jose Tupayachi, and Xudong Wang, were responsible for coding the back end of SmartSHOTS and the database containing all its reference information.

“Not many people think it, but as industrial engineers, we’re capable of coding as well,” said Li, who holds a master’s degree in computer science. “These are very good students and they’re working very hard. We’re all very happy that they are on this project, because it’s a very good, real-world problem to work on.”

That app’s potential was recognized in 2024, when SmartSHOTS won the Mobile/Web App Competition at the Institute of Industrial and Systems Engineers (ISSE) Annual Conference and Expo. With the beta test complete, the team is now seeking funding to roll out a public release on major smartphone app stores.

Until then, Li—an unofficial alpha and beta tester—is continuing to monitor his own children’s vaccines with the app.

“I’m hoping that with this app helping parents keep track of their kids’ personal health records, we’ll see a reduction in the number of kids without immunizations,” he said. “I think SmartSHOTS will be good for the health of Tennesseans.”