FluAlert: Influenza Vaccine Alerts for Providers in the Electronic Health Record

Influenza infection can result in substantial costs, morbidity, and mortality, all of which would be significantly reduced by increasing vaccination rates. Guidelines recommend that all children age 6 months and older receive the influenza vaccine. Despite this, vaccine delivery rates are low, and far below rates for other childhood vaccinations. Missed opportunities to vaccinate contribute to low coverage. Influenza vaccines are given yearly, but only during certain months, so providers must remember to offer vaccination at all visits during the influenza season—not just during well-child visits, as is done with other vaccines.

Clinical decision support in electronic health records (EHRs) can remind providers about adherence to practice guidelines. This project implemented and evaluated an EHR influenza vaccine alert, FluAlert, to improve pediatric providers’ decisionmaking around influenza vaccines.

The specific aims were to:

• Integrate tailored provider influenza vaccine alerts into the EHRs of urban pediatric community health centers. 
• Evaluate the impact of tailored provider influenza alerts on pediatric influenza vaccine delivery rates. 
• Evaluate the impact of tailored provider influenza alerts on pediatric influenza coverage rates. 

Input into the design of the alert was obtained from focus groups and semi-structured interviews conducted with providers and parents. For those children not up-to-date with the influenza vaccine, providers received an alert that allowed them to order a vaccine or document the reason it was not ordered. FluAlert was evaluated with a cluster crossover study. Four urban academically affiliated community clinics that serve a primarily low-income Latino population participated. Two clinics were randomly assigned to begin the study with the FluAlert activated, and two began with the alert off. At 4 weeks the activation status was reversed between the clinics. Three main types of analyses were done: 1) process measures related to provider’s actions in response to the alert; 2) impact of alert on receipt of vaccination for children who were not up-to-date for the influenza vaccine; and 3) impact of alert on documentation of why a vaccine was not given.

FluAlert had a significant impact on influenza vaccination for children who were not up-to-date on their influenza vaccine. In addition, documentation in the EHR of why the vaccine was not ordered was significantly higher. The project team found that a tailored influenza vaccine alert in the EHR decreased missed opportunities for vaccination and improved documentation.