The onset and duration of influenza circulation are unpredictable. The virus most severely affects infants and children under 2 years of age (WHO, 2014) and the very old. Children’s naïve immune systems respond less effectively, so it can be said that they are more likely than adults to become sick from influenza infection and to remain sick for longer periods. The pre-existing immunity is lower in children, hence the viral load is higher in children than adults. Moreover, the period during which children can actively transmit infections to others is longer, thus increasing the spread of disease adding to the viral load. Considering all these, it is found that children frequently introduce influenza into households and that schools, in particular, acting as conduits for disease transmission.
To effectively protect children, Pediatricians should attempt to promptly identify their little patients who are suspected of having influenza infection for timely vaccination when indicated and based on shared decision-making between each pediatrician and child caregiver to reduce morbidity and mortality.
Less than half of people in the US get the flu vaccine every year, and EHRs have become mainstream over the past decade. As more providers use EHRs, the decisions they make with their patients are mainly taken based on the patient’s electronic records. EHRs have therefore become a valuable tool in optimizing how care decisions are made.
There are several automated features added to the electronic medical record (EMR) to alert medical providers with influenza vaccination status. Simple intervention and well-planned strategies can enhance the existing tools within the electronic medical record (EMR) to increase the rate of flu vaccinations, which are estimated to prevent millions of flu cases and tens of thousands of related hospitalizations every year.
Here are some simple yet effective strategies that physicians can undertake to increase the Influenza Vaccination rates in adult as well as pediatric population.
1. Categorizing & Identifying the number of patients
It is helpful if you have an electronic health record (EHR) or use an immunization information system (IIS), as most EHRs and IISs can categorize the number of patients by date of birth, which is important when calculating who will need 2 doses of vaccine. Identifying patients with high-risk for influenza-related complications and categorizing them accordingly will help you organize your office and educate your staff before the influx of vaccine-only visits.
2. Comparison of the vaccination status from the admission note and vaccination record
Query EHR to identify eligible patients who have not received the influenza vaccine. Program an alert in patient charts to discuss and administer the vaccine at the next visit. Prior to patient visits, review the admission note and immunization record and flag charts of patients who are due or overdue for vaccination(s).
Set up regular evaluation and review sessions to compare and evaluate your practice performance. This could contain your practice’s vaccination rates and a discussion about what is working and what is not in your performance.
3. Scheduling Strategies
Annual influenza vaccination is the most effective method for preventing influenza infection. To ensure this, preparing for the added work of the flu vaccine schedule is an important first step. The next thing on the list should be to place reminder calls to scheduled patients and avoid “missed opportunities” or “no-shows” to vaccinate. This also includes sending alerts to families about vaccine availability.
4. Communication Strategies
Communication and messaging are important components of an effective response to the influenza vaccination drive. Messaging is important (what to say, how to say it, and whom to say it to), as is the means to deliver the message. Physicians can influence vaccine acceptance by explaining and communicating the importance of annual influenza vaccination, especially for children.
With the wide use of EHRs and Patient Portal, messages can be delivered through different forms (eg, e-mails, texts, letters, alerts, etc)
5. Documentation Strategies
During each patient visit, document in the patient’s chart that the vaccination status was reviewed. If a recommended vaccine was not administered, document the reason why.
Appropriate documentation of vaccination should also be provided to the patient to be shared with his or her medical home and entered into the state or regional immunization information system (I.e, registry).
6. Enhanced Clinical Decision Support Strategies
A little nudge is all that is needed to boost vaccine coverage. Automated features added to the electronic medical record (EMR) helps to alert medical providers of influenza vaccination status. Physicians have to respond to the alert before moving forward in the EHR and could order the vaccine with a single mouse click. It is known that pop-up reminders create alert fatigue. Which can be an issue. To prevent it, alerts can be made selective. YES! That’s possible. This intervention can be enabled only during a specific time the flu season, and for a specific group of patients.
7. Implementing Standing Orders
Considering how to immunize parents, adult caregivers, and siblings strategies should be made to avoid missed opportunities in vaccination by allowing non – physician providers to administer vaccines without direct physician involvement. Standing orders allow appropriate professional staff to independently screen patients and administer recommended vaccines.
Looking for clear-cut ways to improve your practice’s efficiency in administering vaccines and increase your immunization rates? Here’s a handy check-list to help you implement or reinforce these suggestions.