Impact of Clinical Alerts Within an Electronic Health Record on Routine Childhood Immunization in an Urban Pediatric Population

Fiks, Alexander G.; Grundmeier, Robert W.; Biggs, Lisa; Localio, A. Russell; Alessandrini, Evaline A.

doi:10.1542/peds.2007-0257

Cited by 142 publications

(121 citation statements)

References 37 publications

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“…17 More importantly, the use of shot reminders at sick visits through electronic health record systems has already been demonstrated to substantially improve sick-visit shot rates. 18 Previous work has also shown that most parents are agreeable to sick-visit shots if their providers recommend them. 19 In the United States, many providers who support immunization are also reluctant to adopt practices of giving or checking for immunizations at sick visits.…”

Section: Discussionmentioning

confidence: 99%

Sick-Visit Immunizations and Delayed Well-Baby Visits

Robison

2013

PEDIATRICS

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Section: Discussionmentioning

confidence: 99%

Sick-Visit Immunizations and Delayed Well-Baby Visits

Robison

2013

PEDIATRICS

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“…The clinician-focused intervention consisted of 3 components: (1) EHRbased alerts for all routine adolescent vaccinations programmed to appear prominently whenever any patient encounter at an intervention practice was opened within the EHR ( Supplemental Fig 3), 24,25 (2) a 1-hour presentation delivered in person or online to introduce the intervention, provide site-specific data on HPV vaccination rates derived from the EHR, and present evidenced-based information on adolescent vaccine safety, efficacy, and strategies for overcoming barriers to vaccine receipt, 31 and (3) 3 quarterly performance feedback reports generated from EHR data and delivered by a research assistant including individual, practice, and network rates of captured immunization opportunities for adolescent office visits (Supplemental Fig 4). The EHR-based alerts offered suggestions but required no action or documentation on the part of the clinician.…”

Section: Clinician-focused Interventionmentioning

confidence: 99%

“…21,22 Recognition of these obstacles triggered calls to develop innovative systems to foster adolescent vaccine delivery. 5,23 Research in this area is warranted since interventions using electronic health record (EHR)-based, clinician-focused decision support (CDS) to support early childhood and influenza vaccination have had mixed results, 24,25 and no published studies of EHR-based alerts have addressed adolescent vaccination. In addition, although basic reminder calls to families have proven effective in fostering vaccination, 26 only 2 studies of reminder calls for adolescent vaccination have been published, revealing mixed results.…”

mentioning

confidence: 99%

Effectiveness of Decision Support for Families, Clinicians, or Both on HPV Vaccine Receipt

Fiks

Grundmeier

Mayne³

et al. 2013

Pediatrics

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189

190

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WHAT'S KNOWN ON THIS SUBJECT: Despite proven health benefits, human papillomavirus (HPV) vaccination rates are among the lowest of all routine immunizations. No previous largescale trial has compared the benefit of automated decision support directed at clinicians, families, or both in any context. WHAT THIS STUDY ADDS:We found that a clinician-focused intervention was most effective for initiating the HPV vaccine series, whereas a family-focused intervention supported completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt. abstract OBJECTIVE: To improve human papillomavirus (HPV) vaccination rates, we studied the effectiveness of targeting automated decision support to families, clinicians, or both.METHODS: Twenty-two primary care practices were cluster-randomized to receive a 3-part clinician-focused intervention (education, electronic health record-based alerts, and audit and feedback) or none. Overall, 22 486 girls aged 11 to 17 years due for HPV vaccine dose 1, 2, or 3 were randomly assigned within each practice to receive family-focused decision support with educational telephone calls. Randomization established 4 groups: family-focused, clinician-focused, combined, and no intervention. We measured decision support effectiveness by final vaccination rates and time to vaccine receipt, standardized for covariates and limited to those having received the previous dose for HPV #2 and 3. The 1-year study began in May 2010. RESULTS:Final vaccination rates for HPV #1, 2, and 3 were 16%, 65%, and 63% among controls. The combined intervention increased vaccination rates by 9, 8, and 13 percentage points, respectively. The control group achieved 15% vaccination for HPV #1 and 50% vaccination for HPV #2 and 3 after 318, 178, and 215 days. The combined intervention significantly accelerated vaccination by 151, 68, and 93 days. The clinician-focused intervention was more effective than the familyfocused intervention for HPV #1, but less effective for HPV #2 and 3.CONCLUSIONS: A clinician-focused intervention was most effective for initiating the HPV vaccination series, whereas a family-focused intervention promoted completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt.

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“…Research has shown that EHRs, properly deployed for immunization decision support, demonstrate the clearest benefit to the quality of child health care. [43][44][45] The rules for what immunizations should be delivered when and under what clinical circumstances can be embedded in an EHR, but most pediatricians report that their EHR system lacks this function. 46 …”

Section: Immunization Decision Supportmentioning

confidence: 99%

Data Standards and Improvement of Quality and Safety in Child Health Care

Spooner

Classen

2009

Pediatrics

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Progress in using information technology to achieve the goal of high-quality health care is hindered by the lack of coordinated data standards. To accelerate quality improvement in pediatrics, child health providers must participate actively in the creation of health care data standards. To do so will require far greater understanding on the part of pediatricians and other pediatric providers regarding the scope and role of data standards in advancing health information systems for children, as well as how data standards could improve quality in child health, what kinds of data standards hold the most promise for quality improvement in child health, and how child health professionals can engage in the work of creating data standards. Child health professionals in organized and academic medicine should participate in standards development organizations, to present the pediatric point of view as data standards emerge. They also should support efforts to certify electronic health record systems that include pediatric functionality. A major challenge to academic pediatrics is to prove that data standards can lead to improved health outcomes for children; this is only a compelling conjecture as of this writing. Pediatrics 2009;123:S74-S79 T HE INSTITUTE OF Medicine specifies 6 attributes of quality in health care, namely, safety, effectiveness, patient-centeredness, timeliness, efficiency, and equitability. 1 The medical community broadly accepts that information technology (IT) and health care information systems will play an important role in implementing and measuring these quality attributes. 2,3 Progress in using IT to achieve these ends is hindered, however, by the lack of coordinated data standards. 4 To accelerate quality improvement in pediatrics, child health providers must participate actively in the creation of health care data standards. In this report, we describe how data standards could improve quality in child health, what kinds of data standards hold the most promise for quality improvement in child health, and how child health professionals can engage in the work of creating data standards. TYPES OF HEALTH CARE DATA STANDARDSStandards exist to allow people in different roles or in different institutions to cooperate efficiently and effectively. For example, because electrical outlets in a given country are standardized, different manufacturers can produce appliances that work in every home. In health care, a standard definition of acute lymphoblastic leukemia assists practitioners in providing similar care to patients in different health care facilities. Time and energy do not need to be expended in converting electrical plugs or redefining acute lymphoblastic leukemia staging, because these standards have been accepted by a wide range of individuals.There are 3 types of data standards that influence health care IT, that is, terminology standards, messaging standards, and functional standards. Terminology standards specify which terms are to be used in a particular clinical domain and how e...

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Impact of Clinical Alerts Within an Electronic Health Record on Routine Childhood Immunization in an Urban Pediatric Population

Cited by 142 publications

References 37 publications

Sick-Visit Immunizations and Delayed Well-Baby Visits

Sick-Visit Immunizations and Delayed Well-Baby Visits

Effectiveness of Decision Support for Families, Clinicians, or Both on HPV Vaccine Receipt

Data Standards and Improvement of Quality and Safety in Child Health Care

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