Flu Alert: Influenza Vaccine Alerts for Providers in the Electronic Health Record

描述（由申请人提供）：问题：儿童流感覆盖率远远低于其他儿童疫苗接种率。提高流感疫苗接种率不仅对儿童的健康，而且对儿童的家庭和社区的健康都很重要。为6个月至18岁的儿童接种疫苗将大大减少美国流感病例的总数。因此，免疫实践咨询委员会目前的建议是，所有6个月至18岁的儿童都应接种流感疫苗。然而，即使在疫苗可用的情况下，儿科诊所的流感疫苗接种率也很低。流感疫苗的覆盖面很复杂;疫苗是季节性的，需要每年接种。提供者需要记住在流感季节的每一个机会提供它，而不仅仅是在儿童健康检查期间。即使提供者记得提供流感疫苗，提供者也可能不知道如何进行最佳沟通 向家庭提供疫苗信息，特别是由于恐惧和错误信息而不愿接种疫苗的家庭。研究方法：拟议的项目将利用现有的卫生信息技术，为儿科提供者定制、实施和评估电子健康记录（EHR）中的流感疫苗警报，以帮助改善医疗保健决策。这项干预措施的实施是通过社区卫生中心网络，主要为低收入的少数民族家庭服务，在这些家庭中，儿童经常看到多个提供者，尽管缺乏连续性，但电子健康记录被用于促进高质量的护理。定性和定量的方法，包括焦点小组，深入访谈，以及对护理和医疗提供者和家长的调查，将被用来制定供应商警报适合他们的规格。这些警报将与标准警报不同，因为它们将包括患者特定的合并症，过敏，既往流感疫苗接种史，访问历史和谈话要点，以帮助提供者更好地与父母沟通流感疫苗接种。这些警报的内容将符合健康IT临床决策支持最佳实践，并将与临床研究中心协调实施，以避免工作流程问题。预期结果：我们假设，这些提供者警报将增加流感季节在干预地点看到的数千名儿童的流感疫苗接种率，从而增加与这些地点有关的儿童的整个人口的流感覆盖率。这种干预将在我们的商业EHR Eclipsys门诊护理管理器中创建，这是最常见的 EHR应用。因此，作为本研究结果发现的知识将直接转移到许多其他现实世界的设置。我们预计，成功实施和传播量身定制的流感疫苗警报可能会导致临床警报的新的“最佳实践”的发展。免疫领域的成功结果也可能为研究和部署这些针对其他儿科和成人健康问题的定制警报铺平道路。

DESCRIPTION (provided by applicant): Problem: Childhood influenza coverage rates are far below rates for the other childhood vaccinations. Increasing influenza vaccine coverage rates is important not only for the health of the child, but for that of the child's household and community. Vaccinating children 6 months to 18 years of age would significantly reduce the total number of influenza cases in the US. Therefore, the Advisory Committee on Immunization Practices' current recommendation is that all children 6 months through 18 years old receive the influenza vaccine. Yet, influenza vaccine delivery rates at pediatric clinics are low, even when the vaccine is available. Influenza coverage is complicated; the vaccine is seasonal and needs to be given every year. Providers need to remember to offer it at every opportunity during the influenza season, not just during well child checks. Even when the provider remembers to offer the influenza vaccine, providers may not know how to best communicate with families about the vaccine, particularly for families reluctant to vaccinate due to fears and misinformation. Methods: The proposed project will take advantage of existing health information technology to tailor, implement and evaluate influenza vaccine alerts in the electronic health record (EHR) for pediatric providers to help improve health care decision making. The implementation of this intervention is through a network of community health centers serving primarily low-income, minority families, where children often see multiple providers and the EHR is used to facilitate high quality care despite the lack of continuity. Qualitative and quantitative methods including focus groups, in-depth interviews, and surveys of nursing and medical providers and parents, will be used in order to develop provider alerts tailored to their specifications. These alerts will be different from standard alerts in that they will include patient specific co-morbid conditions, allergies, prior influenza vaccine history, visit history and talking points to help providers better communicate with parents about influenza vaccination. The content of these alerts will conform to the health IT clinical decision support best-practices, and implementation will be coordinated with clinical sites to avoid workflow issues. Expected Outcomes: We hypothesize that these provider alerts will increase influenza vaccine delivery rates for the thousands of children seen at the intervention sites during influenza season, leading to an increase in influenza coverage rates for the whole population of children affiliated with those sites. This intervention will be created within our commercial EHR Eclipsys Ambulatory Care Manager, which is among the most common EHR applications. Therefore, knowledge discovered as a result of this study will be directly transferable to many other real-world settings. We anticipate that successful implementation and dissemination of tailored, influenza vaccine alerts could lead to the development of a new "best practice" for clinical alerts. Successful results in the field of immunizations may also pave the way for researching and deploying these types of tailored alerts for other pediatric and adult health issues.