Capsule Commentary on Patel el al., Using Active Choice Within the Electronic Health Record to Increase Influenza Vaccination Rates

Abstract Background The aim of the present study was to determine whether using a mandatory data field in an electronic health record would increase compliance with the recommendation to vaccinate pregnant women against influenza. Methods Two cohorts of women who delivered at the Centenary Hospital for Women and Children between 1–31 July 2015 and 1–31 July 2017 were compared for compliance with the national public health recommendation to vaccinate all pregnant women against influenza. The single change between audit periods was programming the electronic health record to include a mandatory field preventing clinicians from closing patient files unless they selected an answer to the question asking whether influenza vaccination had been performed. Data were audited and compliance rates were compared. Results A total of 275 and 299 women delivered in the two audit periods. There were no significant differences in maternal or neonatal characteristics between the two cohorts except for maternal age, which was younger in the second period (33.3 versus 31.5 years; P = 0.001). Vaccination rates doubled between audit periods (35.0% versus 79.8%, P < 0.0001). Conclusion Introducing a mandatory data field into an electronic health record system may increase compliance with public health interventions, such as influenza vaccination in pregnant women.

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Using Statewide Electronic Health Record and Influenza Vaccination Data to Plan and Prioritize COVID-19 Vaccine Outreach and Communications in Wisconsin Communities

American Journal of Public Health ◽

10.2105/ajph.2021.306524 ◽

2021 ◽

Vol 111 (12) ◽

pp. 2111-2114

Author(s):

Jessica Bonham-Werling ◽

Allie J. DeLonay ◽

Kristina Stephenson ◽

Korina A. Hendricks ◽

Lauren Bednarz ◽

...

Keyword(s):

Electronic Health Record ◽

Influenza Vaccination ◽

Data Visualization ◽

Health Record ◽

Health Departments ◽

Potential Barriers ◽

University Of Wisconsin ◽

Electronic Health ◽

The University ◽

Zip Code

The University of Wisconsin Neighborhood Health Partnerships Program used electronic health record and influenza vaccination data to estimate COVID-19 relative mortality risk and potential barriers to vaccination in Wisconsin ZIP Code Tabulation Areas. Data visualization revealed four groupings to use in planning and prioritizing vaccine outreach and communication based on ZIP Code Tabulation Area characteristics. The program provided data, visualization, and guidance to health systems, health departments, nonprofits, and others to support planning targeted outreach approaches to increase COVID-19 vaccination uptake. (Am J Public Health. 2021;111(12):2111–2114. https://doi.org/10.2105/AJPH.2021.306524 )

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Association of an Active Choice Intervention in the Electronic Health Record Directed to Medical Assistants With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening Tests

JAMA Network Open ◽

10.1001/jamanetworkopen.2019.15619 ◽

2019 ◽

Vol 2 (11) ◽

pp. e1915619 ◽

Cited By ~ 5

Author(s):

Esther Y. Hsiang ◽

Shivan J. Mehta ◽

Dylan S. Small ◽

Charles A. L. Rareshide ◽

Christopher K. Snider ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Electronic Health Record ◽

Colorectal Cancer Screening ◽

Screening Tests ◽

Health Record ◽

Medical Assistants ◽

Active Choice ◽

Cancer Screening Tests ◽

Electronic Health

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Fiks AG, Hunter KF, Localio AR, et al. Impact of Electronic Health Record-Based Alerts on Influenza Vaccination for Children With Asthma. Pediatrics. 2009;124(1):159-169

PEDIATRICS ◽

10.1542/peds.2010-0981 ◽

2010 ◽

Vol 125 (6) ◽

pp. 1305-1305

Keyword(s):

Electronic Health Record ◽

Influenza Vaccination ◽

Health Record ◽

Children With Asthma ◽

Electronic Health

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Impact of Electronic Health Record-Based Alerts on Influenza Vaccination for Children With Asthma

PEDIATRICS ◽

10.1542/peds.2008-2823 ◽

2009 ◽

Vol 124 (1) ◽

pp. 159-169 ◽

Cited By ~ 71

Author(s):

A. G. Fiks ◽

K. F. Hunter ◽

A. R. Localio ◽

R. W. Grundmeier ◽

T. Bryant-Stephens ◽

...

Keyword(s):

Electronic Health Record ◽

Influenza Vaccination ◽

Health Record ◽

Children With Asthma ◽

Electronic Health

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Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial (Preprint)

10.2196/preprints.16373 ◽

2019 ◽

Author(s):

Jessica G Wijesundara ◽

Mayuko Ito Fukunaga ◽

Jessica Ogarek ◽

Bruce Barton ◽

Lloyd Fisher ◽

...

Keyword(s):

Electronic Health Record ◽

Influenza Vaccination ◽

Usual Care ◽

Interactive Voice Response ◽

Care Group ◽

Health Record ◽

Electronic Health ◽

Influenza Vaccinations ◽

To Receive ◽

Voice Response

BACKGROUND Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. OBJECTIVE The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. METHODS Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record–documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were excluded from main analyses. RESULTS Among portal users, 28.4% (5549/19,506) of those randomized to receive messages and 27.1% (5294/19,505) of the usual care group had influenza vaccinations documented by November 2015 (<i>P</i>=.004). In multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, 95% CI 1.02-1.12). Among portal nonusers, 8.4% (1262/15,000) of those randomized to receive calls and 8.2% (3586/43,596) of usual care had documented vaccinations (<i>P</i>=.47), and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9%), and over half of interactive voice response calls placed (7599/14,984; 50.7%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5% of those reached (5513/7599) responded to a similar question. CONCLUSIONS Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination (OR 1.07, 95% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. CLINICALTRIAL ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277

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Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial

Journal of Medical Internet Research ◽

10.2196/16373 ◽

2020 ◽

Vol 22 (9) ◽

pp. e16373

Author(s):

Jessica G Wijesundara ◽

Mayuko Ito Fukunaga ◽

Jessica Ogarek ◽

Bruce Barton ◽

Lloyd Fisher ◽

...

Keyword(s):

Electronic Health Record ◽

Influenza Vaccination ◽

Usual Care ◽

Interactive Voice Response ◽

Care Group ◽

Health Record ◽

Electronic Health ◽

Influenza Vaccinations ◽

To Receive ◽

Voice Response

Background Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. Objective The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. Methods Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record–documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were excluded from main analyses. Results Among portal users, 28.4% (5549/19,506) of those randomized to receive messages and 27.1% (5294/19,505) of the usual care group had influenza vaccinations documented by November 2015 (P=.004). In multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, 95% CI 1.02-1.12). Among portal nonusers, 8.4% (1262/15,000) of those randomized to receive calls and 8.2% (3586/43,596) of usual care had documented vaccinations (P=.47), and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9%), and over half of interactive voice response calls placed (7599/14,984; 50.7%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5% of those reached (5513/7599) responded to a similar question. Conclusions Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination (OR 1.07, 95% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. Trial Registration ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277

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