Use EMR reminders to increase vaccination rates

Here’s a solution to the problem of low vaccination rates for adults: Set a reminder in the electronic medical record (EMR).

A study published in Archives of Internal Medicine reports that EMR reminders increase pneumococcal vaccination rates by 50% and raise influenza vaccination rates 20% compared with usual care.

Based on 2009 National Health Interview Survey data, 34% of adults aged more than 65 years do not receive a seasonal influenza vaccine, and 40% lacked pneumococcal vaccinations. Other indicators of care have even lower rates-just 18% to 36% of adults have a completed advance directive, and less than one-third of women at risk for osteoporosis have had bone mineral density testing.

The study had three arms: EMR reminder, EMR reminder with a panel manager, and usual care. Fifty-five primary care physicians (PCPs) affiliated with Beth Israel Deaconess Medical Center’s general medicine and primary care divisions in Boston, Massachusetts, participated in the study, which focused on preventive care for patients aged more than 65 years. Researchers focused the study on advance directives, osteoporosis screening, and influenza and pneumococcal vaccination, but they also set reminders for aspirin chemoprevention, medication alerts, and fall screening.

In the only EMR reminder arm, physicians opened a patient’s file to see a “geriatrics alerts” link, which showed them all active reminders and the last status for each. In the reminder plus panel manager arm, an administrative assistant compiled a list of patients who needed one or more of the four interventions and forwarded it to the PCP. If granted permission to follow up with the patient to complete the items, the administrative assistant would call up to three times and send a letter. If the patient was reached and agreeable, the panel manager scheduled the screening, mailed the advance directive forms, or made an appointment for immunization.

Over the 1-year study period, 19.5% of previously unvaccinated patients received pneumococcal vaccinations with the EMR reminder alone, 25.6% were vaccinated in the EMR plus panel manager group, and 13.1% of those in the control group were immunized. For influenza vaccination, 56.5% of the EMR reminder group, 59.7% of the EMR plus panel manager group, and 46.8% of patients receiving usual care received vaccinations. The authors noted that the relatively small difference in vaccination rates in the two EMR arms “might be because patients are responsive to a direct recommendation by their PCP during a face-to-face encounter and are able to immediately receive vaccinations at the point of care.”

For bone density screening and healthcare proxy designation, EMR reminders alone made little difference, but adding the panel manager component produced a marked improvement. Of patients in the panel manager group, 30.5% had bone density screening, compared with 19.7% with EMR reminders alone and 17.7% of controls. Nearly 20% of patients in the panel manager group completed healthcare proxies, whereas only 8.8% of those with just reminders and 6.5% of controls did so.

Noting that implementing all recommendations would require a PCP with an average patient panel to work 18 hours a day, the researchers concluded that EMR “reminders and panel management are effective when they assist physicians without adding significant burden to their workload” by allocating time-intensive tasks to other members of the healthcare team.

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