WASHINGTON – A pop-up on children’s electronic medical records was enough of a reminder to significantly increase influenza vaccine coverage in four large urban clinics, according to Dr. Melissa S. Stockwell.
"FluAlert" was built into the electronic medical record system and synchronized with the New York City vaccine registry. When it was activated during the winter flu season, children were 9% more likely to be fully vaccinated for influenza than when the reminder system wasn’t engaged, she said at the annual meeting of the Pediatric Academic Societies.
Dr. Melissa Stockwell
In addition to prompting physicians to vaccinate, the program allowed them to document reasons that the vaccine wasn’t given – a particularly valuable feature, said Dr. Stockwell, a pediatrician who is medical director of the New York–Presbyterian Hospital immunization registry.
"In this world of core measures, documentation of why a child is not vaccinated is becoming increasingly important," she said.
FluAlert was designed based on provider and parent focus groups, and implemented at four urban, community clinics that serve a primarily low-income Hispanic population. When the child’s electronic medical record opens, a FluAlert box appears at the upper-right-hand corner of the screen. The program searches both the provider registry and the larger vaccination registry and displays the vaccination status as having received no vaccine, having received one vaccine, or up to date. It asks, "Do you want to order the flu vaccine today?"
"Our providers wanted the alert to show up early in the visit, when the child’s record is opened, in order to integrate it into conversation with the parent," Dr. Stockwell said. "Doctors can ignore the message, order the vaccine, or document any reason why it wasn’t given. It’s not a forced action."
The alert also offers a look at the child’s overall immunization status, with the opportunity to order those vaccines. A "more info" button offers talking points that can be incorporated into a discussion about the importance of vaccinations.
The program was tested in a randomized study, with each clinic having an on and off period in two flu season phases (October through December and January through February).
When FluAlert was on, it fired for 8,630 visits, identifying the 62% of children who were not up to date on the vaccine. Most of those alerts (77%) came up during well-child and adolescent visits; 16% were acute care visits, 7% were visits specifically for vaccination, and the remaining visits were for Women, Infants, and Children program assessments. Providers acted on the alert 82% of the time: 53% ordered the vaccine. When they did not order the vaccine, providers noted the reason 98% of the time.
Overall, non–up-to-date children who were seen when FluAlert was on were 9% more likely to receive vaccine than children seen during an "off" period.
The program was also associated with significantly more documentation about why a child who needed the flu shot didn’t get it. In total, 625 children left the visit unvaccinated. When FluAlert was on, the reason for not vaccinating was noted for 68%; when it was off, documentation was present for only 41%.
The alert’s relative unobtrusiveness is probably one reason it was embraced as well as it was, Dr. Stockwell added. "What really annoys people is if something pops up and you can’t do anything else until you go through the entire process. So having it sit there as a gentle reminder is more appealing than something that’s always flashing and telling providers what to do."
Dr. Stockwell said she had no relevant financial disclosures