Embedding Real-Time Clinical Decision Support in An Electronic Whiteboard to Reduce Missed Opportunities for Influenza Vaccination in Children

Background: Traditional electronic prompts alone have shown only modest reductions in missed opportunities for seasonal influenza vaccination in children, and missed opportunities remain a significant problem in children despite expanded influenza vaccine recommendations.  A novel electronic clinical decision support system was coupled with proven quality improvement (QI) strategies to determine their effects on seasonal influenza vaccines rates in a primary care setting.

Setting: Primary care clinics at Monroe Carrell Jr. Children's Hospital at Vanderbilt, staffed by ~65 residents and ~15 attendings, open 6 days a week with 22 exam rooms and serving as the medical home for 11,000 patients with 35,000 annual visits for both acute and well care.

Population: Pediatric patients through age 18. 80% are publicly-insured. 30% do not speak English as a primary language.

Project Description: Interventions to reduce missed opportunities for seasonal influenza vaccination included: 1) Increasing access for patients; 2) Clinical decision support/provider team education; and 3) Patient and family education/activation. A novel method of highlighting all eligible patients within the clinic workflow was to embed real-time clinical decision support into an electronic whiteboard, which was used as a process management tool to address and document the intervention on every patient arriving in clinic. The display of these whiteboards across multiple clinical workstations throughout the clinic facilitated awareness among all care-team members of each patient's status.

Results/Lessons Learned: Based on preliminary data, we document that we offer the seasonal influenza vaccine 92% of the time and administered vaccine to 71% of patients who present to clinic. Positive feedback to date concerning the process includes improved accuracy in assessing eligibility and enthusiasm towards increasing rates. Negative feedback includes frequent retraining of new residents and inability of whiteboard documentation to serve as a legal order. Additional data being collected - including rates of refusals and deferrals - will potentially lead to better provider/family education about influenza vaccine.