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A Little Nagging from Your EHR Can Improve Patient Flu Vaccination Rates

PHILADELPHIA — A simple electronic prompt could substantially increase the percentage of patients in your practice who receive influenza vaccines, according to a new report.

The study, published in the Journal of General Internal Medicine, looks at what happened when electronic health records were programmed to compel healthcare providers to choose an answer about whether to issue a flu vaccination order.

The “active choice,” option, adapted from behavioral economics, prompted EHRs to opt for either “accept” or “decline,” according to the study team led by University of Pennsylvania researchers.

The result? A 37% increase in vaccination rate over the prior year and a 6% increase over clinics not employing an EHR prompt.

"Our results indicate that this simple intervention could be an effective and scalable approach to use the design of electronic health records 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," pointed out lead author Mitesh S. Patel, MD, MBA, MS, an assistant professor of Medicine and Health Care Management in Penn's Perelman School of Medicine and The Wharton School, and director of the Penn Medicine Nudge Unit. "Nudges are changes to the way choices are framed or presented and can be very effective for changing physician and patient behavior. These findings build on our previous research demonstrating that active choice increased orders for high-value screening tests including colonoscopies and mammographies."

For the study beginning in 2012, vaccination rates were evaluated at three clinics; one used the alert, while the other two were controls. In the clinic with the intervention, either the physician or medical assistant would access a patient’s records and receive the prompt about flu vaccine eligibility. If “accept,” was selected, the vaccine was administered immediately.

In the past, staff had to first determine manually if the patient needed a vaccine and put in an order for it to be done, the report states.

Last fall, the program was implemented at all Penn Medicine outpatient clinics.

"Much of the decisions that physicians and patients make has shifted from pen and paper to digital environments such as the electronic health record and patient portals," Patel added. "This presents a significant opportunity to test ways to design choice architecture within these environments to improve healthcare value and outcomes."