An Electronic Health Record Alert for Inpatient Coronavirus Disease 2019 Vaccinations Increases Vaccination Ordering and Uncovers Workflow Inefficiencies

Kameron Collin Black; Nicole Ashley Snyder; Mengyu Zhou; Zhen Zhu; Colby Uptegraft; Ani Chintalapani; Benjamin Orwoll

doi:10.1055/a-2250-6305

Applied Clinical Informatics, Inhaltsverzeichnis

Appl Clin Inform 2024; 15(01): 192-198
DOI: 10.1055/a-2250-6305

Case Report

An Electronic Health Record Alert for Inpatient Coronavirus Disease 2019 Vaccinations Increases Vaccination Ordering and Uncovers Workflow Inefficiencies

Kameron Collin Black

¹Department of Medicine, Oregon Health and Science University, Portland, Oregon

,

Nicole Ashley Snyder

²Rocky Vista University, Parker, Colorado

,

Mengyu Zhou

¹Department of Medicine, Oregon Health and Science University, Portland, Oregon

,

Zhen Zhu

¹Department of Medicine, Oregon Health and Science University, Portland, Oregon

,

Colby Uptegraft

³Health Informatics Directorate, Defense Health Agency, Falls Church, Virginia

,

Ani Chintalapani

¹Department of Medicine, Oregon Health and Science University, Portland, Oregon

⁴Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon

,

Benjamin Orwoll

⁴Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon

⁵Department of Pediatrics, Oregon Health and Science University, Portland, Oregon

› Institutsangaben

Abstract

Background Despite mortality benefits, only 19.9% of U.S. adults are fully vaccinated against the coronavirus disease 2019 (COVID-19). The inpatient setting is an opportune environment to update vaccinations, and inpatient electronic health record (EHR) alerts have been shown to increase vaccination rates.

Objective Our objective was to evaluate whether an EHR alert could increase COVID-19 vaccinations in eligible hospitalized adults by prompting providers to order the vaccine.

Methods This was a quasiexperimental pre–post-interventional design study at an academic and community hospital in the western United States between 1 January, 2021 and 31 October, 2021. Inclusion criteria were unvaccinated hospitalized adults. A soft-stop, interruptive EHR alert prompted providers to order COVID-19 vaccines for those with an expected discharge date within 48 hours and interest in vaccination. The outcome measured was the proportion of all eligible patients for whom vaccines were ordered and administered before and after alert implementation.

Results Vaccine ordering rates increased from 4.0 to 13.0% at the academic hospital (odds ratio [OR]: 4.01, 95% confidence interval [CI]: 3.39–4.74, p < 0.001) and from 7.4 to 11.6% at the community hospital (OR: 1.62, 95% CI: 1.23–2.13, p < 0.001) after alert implementation. Administration increased postalert from 3.6 to 12.7% at the academic hospital (OR: 3.21, 95% CI: 2.70–3.82, p < 0.001) but was unchanged at the community hospital, 6.7 to 6.7% (OR: 0.99, 95% CI: 0.73–1.37, p = 0.994). Further analysis revealed infrequent vaccine availability at the community hospital.

Conclusion Vaccine ordering rates improved at both sites after alert implementation. Vaccine administration rates, however, only improved at the academic hospital, likely due in part to vaccine dispensation inefficiency at the community hospital. This study demonstrates the potential impact of complex workflow patterns on new EHR alert success and provides a rationale for subsequent qualitative workflow analysis with alert implementation.

Keywords

computerized soft-stop - clinical decision support - electronic health records - decision support systems - vaccination - COVID-19 - academic hospital

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