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Patient prompts can increase flu shot rates nearly 40%


A simple prompt reminding patients of their flu shot was found to be highly effective in a trial run at the University of Pennsylvania.

The flu vaccine has been shown to prevent, or at least lessen symptoms, of influenza, yet less than half of American adults receive the vaccine annually, according to the Centers for Disease Control and Prevention (CDC). 

The key to improved vaccination rates can be as simple as a programming change that reminds physicians to have the conversation about the flu vaccine with their patients.

In a new study, titled "Using Active Choice Within the Electronic Health Record to Increase Influenza Vaccination Rates," conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania and published in the Journal of Internal Medicine, researchers found that a simple prompt programmed into an electronic health record (EHR) at an internal medicine outpatient office resulted in a nearly 40% relative increase in flu vaccinations among adult patients over the prior year and a 6% increase in comparison to two other internal medicine clinics in the same health system used as controls.

Mitesh S. Patel, MD, MBA, MS, an assistant professor of medicine and healthcare management in Penn’s Perelman School of Medicine and the Wharton School and lead author of the report told Medical Economics well-designed "nudges" can be helpful across many areas of practice, especially when used to increase uptake of evidence-based practices like influenza vaccination.

"Medical decision-making is often sub-optimal," Patel says. "Active choice is a method used to prompt one's attention, provide information on the risks and benefits of options, and make it easy to submit a decision."

Next: Prompots not a panacea


Prompts not a panacea

Previous support has supported the benefits of active choice, particularly in increasing the use of certain diagnostic tests. In this case, Patel and his team took that a step further, programming a "best practices alert" into the clinic's EHR that would display any time an adult patient was eligible to receive the flu vaccine. To move on within the EHR, providers would have to select "accept" or "cancel" on the prompt, cashing in on what may previously have been a missed opportunity for the physician to offer to and discuss a flu vaccine with the patient. The prompt also resulted in the generation of an order, allowing the vaccine to be administered quickly at the time of the visit, removing steps that previously required providers to manually search a patient's eligibility and then place an order.

The intervention was programmed into the EHR system in February 2012, and by the end of the 2012-2013 flu season, orders for flu vaccines in that clinic rose by 37% in comparison to the prior flu season. As a result of the success of the intervention, the prompt was programmed into the EHRs of all of the internal medicine outpatient clinics across Penn Medicine.

While prompts like this can be beneficial to both practice operations and patient outcomes, Patel warned that there can also be too much of a good thing.

"Alerts in the electronic health record should be balanced to prevent overload and alert fatigue," he said. "The way choices are offered and information is framed in the electronic health record can have significant impact on how clinicians behave. Our study indicates that better testing can help to optimize the design of choices to improve the delivery of high-value healthcare."


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