Non-intrusive EHR alert increases flu vaccination rates

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Using a “gentle” electronic health record flu prompt not only increased the number of flu vaccinations children received, but also improved the documentation explaining why the vaccine was not administered, according to a study reported in Family Practice News.

The study, funded by the Agency for Healthcare Research and Quality, was conducted at four urban community clinics affiliated with New York-Presbyterian Hospital Ambulatory Care Network and Columbia University that serve a low-income Latino population. It stems from an earlier related study that analyzed providers’ challenges with flu alerts and highlighted the need for “well integrated” alerts that didn’t impede clinicians’ work flow.

For this study, the researchers created a customized flu alert that activated early in the patient visit, accurately determined the child’s vaccination status by merging multiple resources, facilitated ordering and encouraged documentation.


When the alert was on, patients were 9 percent more likely to get fully vaccinated. Providers acted on the alert 82 percent of the time, and 53 percent ordered a flu shot. When a flu shot was not ordered, providers documented why 68 percent of the time. In contrast, when the alert was off, clinicians documented why they didn’t order a shot only 41 percent of the time.

The alert was embraced in large part because it was not intrusive, according to the study’s authors.

“[Having [the alert] sit there as a gentle reminder is more appealing than something that’s always flashing and telling providers what to do,” Melissa Stockwell, principal investigator, told Family Practice News.

Other studies have also shown that well designed alerts can improve patient care. However, too frequent or intrusive clinical decision support alerts can adversely affect patient safety.

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