Problem: Childhood influenza coverage rates are far below rates for the other childhood vaccinations. Increasing influenza vaccine coverage rates is important not only for the health of the child, but for that of the child's household and community. Vaccinating children 6 months to 18 years of age would significantly reduce the total number of influenza cases in the US. Therefore, the Advisory Committee on Immunization Practices'current recommendation is that all children 6 months through 18 years old receive the influenza vaccine. Yet, influenza vaccine delivery rates at pediatric clinics are low, even when the vaccine is available. Influenza coverage is complicated;the vaccine is seasonal and needs to be given every year. Providers need to remember to offer it at every opportunity during the influenza season, not just during well child checks. Even when the provider remembers to offer the influenza vaccine, providers may not know how to best communicate with families about the vaccine, particularly for families reluctant to vaccinate due to fears and misinformation. Methods: The proposed project will take advantage of existing health information technology to tailor, implement and evaluate influenza vaccine alerts in the electronic health record (EHR) for pediatric providers to help improve health care decision making. The implementation of this intervention is through a network of community health centers serving primarily low-income, minority families, where children often see multiple providers and the EHR is used to facilitate high quality care despite the lack of continuity. Qualitative and quantitative methods including focus groups, in-depth interviews, and surveys of nursing and medical providers and parents, will be used in order to develop provider alerts tailored to their specifications. These alerts will be different from standard alerts in that they will include patient specific co-morbid conditions, allergies, prior influenza vaccine history, visit history and talking points to help providers better communicate with parents about influenza vaccination. The content of these alerts will conform to the health IT clinical decision support best-practices, and implementation will be coordinated with clinical sites to avoid workflow issues. Expected Outcomes: We hypothesize that these provider alerts will increase influenza vaccine delivery rates for the thousands of children seen at the intervention sites during influenza season, leading to an increase in influenza coverage rates for the whole population of children affiliated with those sites. This intervention will be created within our commercial EHR Eclipsys Ambulatory Care Manager, which is among the most common EHR applications. Therefore, knowledge discovered as a result of this study will be directly transferable to many other real-world settings. We anticipate that successful implementation and dissemination of tailored, influenza vaccine alerts could lead to the development of a new """"""""best practice"""""""" for clinical alerts. Successful results in the field of immunizations may also pave the way for researching and deploying these types of tailored alerts for other pediatric and adult health issues.

Public Health Relevance

Tailored provider influenza alerts in the electronic health record have the potential to not only increase influenza vaccine delivery and coverage rates, but could lead to the development of a new best practice for clinical alerts. Successful results in the field of immunizations may also pave the way for researching and deploying these types of tailored alerts for other pediatric and adult health issues.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Health Care Technology and Decision Science (HTDS)
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Rosenthal, Vera
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Columbia University (N.Y.)
Schools of Medicine
New York
United States
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Stockwell, Melissa S; Catallozzi, Marina; Camargo, Stewin et al. (2015) Registry-linked electronic influenza vaccine provider reminders: a cluster-crossover trial. Pediatrics 135:e75-82
Vawdrey, David K; Natarajan, Karthik; Kanter, Andrew S et al. (2013) Informatics lessons from using a novel immunization information system. Stud Health Technol Inform 192:589-93
Birmingham, Eileen; Catallozzi, Marina; Findley, Sally E et al. (2011) FluAlert: a qualitative evaluation of providers' desired characteristics and concerns regarding computerized influenza vaccination alerts. Prev Med 52:274-7