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Appl Clin Inform 2021; 12(05): 1101-1109
DOI: 10.1055/s-0041-1739516
Research Article

Effect of Electronic Health Record Reminders for Routine Immunizations and Immunizations Needed for Chronic Medical Conditions

Ashley B. Stephens
1   Department of Pediatrics and NewYork-Presbyterian Hospital, Columbia University Irving Medical Center New York, New York, United States
,
Chelsea S. Wynn
2   Department of Pediatrics, Columbia University Irving Medical Center New York, New York, United States
,
Annika M. Hofstetter
3   Department of Pediatrics, University of Washington, Seattle, Washington, United States
4   Seattle Children's Research Institute, University of Washington, Seattle, Washington, United States
,
Chelsea Kolff
2   Department of Pediatrics, Columbia University Irving Medical Center New York, New York, United States
,
Oscar Pena
5   NewYork-Presbyterian Hospital New York, New York, United States
,
Eric Kahn
5   NewYork-Presbyterian Hospital New York, New York, United States
,
Balendu Dasgupta
6   Department of Biomedical Informatics, Columbia University Irving Medical Center New York, New York, United States
,
Karthik Natarajan
6   Department of Biomedical Informatics, Columbia University Irving Medical Center New York, New York, United States
,
David K. Vawdrey
6   Department of Biomedical Informatics, Columbia University Irving Medical Center New York, New York, United States
7   Steele Institute for Health Innovation, Geisinger, Danville, Pennsylvania, United States
,
Mariellen M. Lane
1   Department of Pediatrics and NewYork-Presbyterian Hospital, Columbia University Irving Medical Center New York, New York, United States
,
Laura Robbins-Milne
1   Department of Pediatrics and NewYork-Presbyterian Hospital, Columbia University Irving Medical Center New York, New York, United States
,
Rajasekhar Ramakrishnan
2   Department of Pediatrics, Columbia University Irving Medical Center New York, New York, United States
,
Stephen Holleran
2   Department of Pediatrics, Columbia University Irving Medical Center New York, New York, United States
,
Melissa S. Stockwell
8   Departments of Pediatrics and Population and Family Health, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital New York, New York, United States
› Author Affiliations Funding This study was funded by Agency for Healthcare Research and Quality (AHRQ), grant number R01HS023582 (PI: Stockwell).
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Abstract

Background Immunization reminders in electronic health records (EHR) provide clinical decision support (CDS) that can reduce missed immunization opportunities. Little is known about using CDS rules from a regional immunization information system (IIS) to power local EHR immunization reminders.

Objective This study aimed to assess the impact of EHR reminders using regional IIS CDS-provided rules on receipt of immunizations in a low-income, urban population for both routine immunizations and those recommended for patients with chronic medical conditions (CMCs).

Methods We built an EHR-based immunization reminder using the open-source resource used by the New York City IIS in which we overlaid logic regarding immunizations needed for CMCs. Using a randomized cluster-cross-over pragmatic clinical trial in four academic-affiliated clinics, we compared captured immunization opportunities during patient visits when the reminder was “on” versus “off” for the primary immunization series, school-age boosters, and adolescents. We also assessed coverage of CMC-specific immunizations. Up-to-date immunization was measured by end of quarter. Rates were compared using chi square tests.

Results Overall, 15,343 unique patients were seen for 26,647 visits. The alert significantly impacted captured opportunities to complete the primary series in both well-child and acute care visits (57.6% on vs. 54.3% off, p = 0.001, and 15.3% on vs. 10.1% off, p = 0.02, respectively), among most age groups, and several immunization types. Captured opportunities for CMC-specific immunizations remained low regardless of alert status. The alert did not have an effect on up-to-date immunization overall (89.1 vs. 88.3%).

Conclusion CDS in this population improved captured immunization opportunities. Baseline high rates may have blunted an up-to-date population effect. Converting Centers for Disease Control and Prevention (CDC) rules to generate sufficiently sensitive and specific alerts for CMC-specific immunizations proved challenging, and the alert did not have an impact on CMC-specific immunizations, potentially highlighting need for more work in this area.

Keywords

clinical decision support - graphical user interface - immunization information system - CMC-specific immunizations

Note

This study is registered with ClinicalTrials.gov, identifier: NCT02710318—Synchronized Immunization NotifiCations (SINC).


Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed and approved by the Columbia University Irving Medical Center Institutional Review Board.


Supplementary Material



Publication History

Received: 30 March 2021

Accepted: 05 October 2021

Article published online:
15 December 2021

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