Use of Clinical Decision Support to Increase Influenza Vaccination: Multi-year Evolution of the System

Abstract

Despite recognition that clinical decision support (CDS) can improve patient care, there has been poor penetration of this technology into healthcare settings. We used CDS to increase inpatient influenza vaccination during implementation of an electronic medical record, in which pharmacy and nursing transactions increasingly became electronic. Over three influenza seasons we evaluated standing orders, provider reminders, and pre-selected physician orders. A pre-intervention cross-sectional survey showed that most patients (95%) met criteria for vaccination. During our intervention, physicians were increasingly likely to accept pre-selected vaccination orders, Year 1 (47%), Year 2 (77%), Year 3 (83%); however vaccine administration by nurses was suboptimal. As electronic medical record functionality improved, patient receipt of vaccine increased dramatically, Year 1 [0/36; 0%], Year 2 [8/66; 12%], Year 3 [286/805; 36%]. Successful use of clinical decision support to increase inpatient influenza vaccination only occurred after initiation of CPOE for all medications and integration of an electronic medication administration record. Also, since most patients met criteria for influenza vaccination, complicated logic to identify high-risk patients was unnecessary.

Influenza vaccination rates for hospitalised patients: a multiyear quality improvement effort

“…Unlike other studies reported in the literature,16 the foundation for this improvement work was an already fully functional EMR. From 2008 to 2013, the percentage of US hospitals using EMRs increased from 9% to 80% 17.…”

Clinical Trial of Standing-Orders Strategies to Increase the Inpatient Influenza Vaccination Rate

“…During the 2006-2007 influenza season, after we activated an electronic medication administration record but when there were no additional interventions, the rate of influenza vaccination for all patients increased to 36%. 8 Because, for both of our evaluations, prehospitalization vaccination status was unknown, our denominators included previously vaccinated (ie, ineligible) patients; therefore, our reported vaccination rates are artificially low.…”

Registry-Linked Electronic Influenza Vaccine Provider Reminders: A Cluster-Crossover Trial

“…[7][8][9][10] Computerized clinical decision support tools, such as reminders in electronic health records (EHR), may improve adherence to clinical guidelines. [11][12][13][14][15][16] Several studies have reported beneficial results from electronic vaccination reminders in both adults and children [17][18][19][20][21] ; however, electronic reminders may also adversely affect clinician workflow (eg, contributing to "alert fatigue"). [22][23][24][25] Reminders are dependent on accurate, timely data.…”