Improving Rates of Influenza Vaccination Through Electronic Health Record Portal Messages, Interactive Voice Recognition Calls and Patient-Enabled Electronic Health Record Updates: Protocol for a Randomized Controlled Trial

Abstract

BackgroundClinical decision support (CDS), including computerized reminders for providers and patients, can improve health outcomes. CDS promoting influenza vaccination, delivered directly to patients via an electronic health record (EHR) patient portal and interactive voice recognition (IVR) calls, offers an innovative approach to improving patient care.ObjectiveTo test the effectiveness of an EHR patient portal and IVR outreach to improve rates of influenza vaccination in a large multispecialty group practice in central Massachusetts.MethodsWe describe a nonblinded, randomized controlled trial of EHR patient portal messages and IVR calls designed to promote influenza vaccination. In our preparatory phase, we conducted qualitative interviews with patients, providers, and staff to inform development of EHR portal messages with embedded questionnaires and IVR call scripts. We also provided practice-wide education on influenza vaccines to all physicians and staff members, including information on existing vaccine-specific EHR CDS. Outreach will target adult patients who remain unvaccinated for more than 2 months after the start of the influenza season. Using computer-generated randomization and a factorial design, we will assign 20,000 patients who are active users of electronic patient portals to one of the 4 study arms: (1) receipt of a portal message promoting influenza vaccines and offering online appointment scheduling; (2) receipt of an IVR call with similar content but without appointment facilitation; (3) both (1) and (2); or (4) neither (1) nor (2) (usual care). We will randomize patients without electronic portals (10,000 patients) to (1) receipt of IVR call or (2) usual care. Both portal messages and IVR calls promote influenza vaccine completion. Our primary outcome is percentage of eligible patients with influenza vaccines administered at our group practice during the 2014-15 influenza season. Both outreach methods also solicit patient self-report on influenza vaccinations completed outside the clinic or on barriers to influenza vaccination. Self-reported data from both outreach modes will be uploaded into the EHR to increase accuracy of existing provider-directed EHR CDS (vaccine alerts).ResultsWith our proposed sample size and using a factorial design, power calculations using baseline vaccination rate estimates indicated that 4286 participants per arm would give 80% power to detect a 3% improvement in influenza vaccination rates between groups (α=.05; 2-sided). Intention-to-treat unadjusted chi-square analyses will be performed to assess the impact of portal messages, either alone or in combination with the IVR call, on influenza vaccination rates. The project was funded in January 2014. Patient enrollment for the project described here completed in December 2014. Data analysis is currently under way and first results are expected to be submitted for publication in 2016.ConclusionsIf successful, this study’s intervention may be adapted by other large health care organizations to increase vaccination...

Surveillance of Vaccination Coverage among Adult Populations — United States, 2015

“…For example, to improve influenza vaccination among eligible adult patients, a protocol is being evaluated in a large multispecialty group practice. The protocol uses patient-directed clinical decision support involving EHR patient portal messages and interactive voice recognition calls to promote influenza vaccination and obtain patient self-report of vaccines received outside the practice as well as information on barriers to vaccination ( 97 ). To improve administration and documentation of receipt of Tdap, consensus-based teams of clinicians, nurses, medical assistants, and other support staff have used an automated clinical reminder system to provide patient-specific vaccination recommendations to clinicians at the point of care ( 98 ).…”

Primary Care Providers’ Opening of Time-Sensitive Alerts Sent to Commercial Electronic Health Record InBaskets

“…22,28 Previous studies have used audit logs to describe physician and care team behaviors including medical information queries, [29][30][31] team communication, 32 viewing of EHR notes, 23 response to *A total of 630 alerts were delivered to the InBaskets of PCPs who were logged into the EHR at the time of alert delivery or within 24 h of delivery; of these, 375 were opened within 24 h of delivery † Adjusted odds ratios account for clustering by PCP using a GEE model and control for PCP characteristics, patient characteristics and contextual factors clinical decision support tools, 33 and patient interactions through tethered portals. 34 This study has several limitations. The extent to which our results are generalizable to other health systems is hard to estimate.…”

Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: A Randomized Controlled Trial

“…Study design information has been published previously. 31 Using a factorial design, we assigned 20,000 patients who were active portal users to one of four study arms (5000/arm): (a) receipt of a portal message promoting influenza vaccines, (b) receipt of IVR call with similar content, (c) both a and b, or (d) neither (usual care). We assigned 10,000 patients (5000/arm) who were not active portal users to (e) receipt of IVR call or (f) no call (usual care).…”

“…Qualitative interviews with patients, physicians, nurses, and staff informed the development of outreach material. 31 Electronic Patient Portal Intervention. A secure portal message was sent via tethered patient portal to patients randomized to portal arms (Appendix A online).…”

“…The usual care group lacked this opportunity for self-report; thus, excluding these self-reported vaccines was intended to avoid introducing bias through differential capture of outcomes. 31 Additional Outcomes of Interest. We tracked self-report (via portal or IVR) of influenza vaccines administered outside the medical group, reported on or before April 1, 2015.…”