Building clinical alerts and recommendations into electronic health records significantly improved immunization rates for inner-city children in a primary care network affiliated with the Children's Hospital of Philadelphia.
During the first year the system was in place, adjusted immunization rates rose from 82% to 90% at 2 years of age, according to a study of the intervention. When children arrived due for a vaccination at a well visit, the proportion vaccinated rose from 78% to 90%. At sick visits, the impact tripled from 11% to 32%, said Dr. Alexander G. Fiks, of the University of Pennsylvania and the Children's Hospital of Philadelphia (CHOP) and his colleagues (Pediatrics 2007;120:707–14).
“No one has published or developed a system that we are aware of that works quite [the same],” Dr. Fiks, a codeveloper of the system, said in an interview.
The system, used at four urban practices in the CHOP network, alerts physicians when they open a patient chart with an incomplete immunization record. It makes recommendations based on a process that:
▸ Excludes invalid vaccine doses and vaccinations given at too young an age or too close together.
▸ Considers the child's age, timing of past doses, and interval since the last dose to determine which vaccinations are due.
▸ Checks for combination vaccine products to minimize the number of shots required.
The study began Sept. 1, 2004, and covered 1,669 children who reached age 24 months in the next year. They were compared with 1,548 ccontrols who reached 24 months in the previous year. There were 15,928 immunization alerts recorded during the intervention year. More than 80% of the children in both groups were black.
One of the authors received a grant from the Ambulatory Podiatric Association.