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The use of a mandatory best practice reminder in the electronic record improves influenza vaccination rate in a pediatric rheumatology clinic

Anjali Patwardhan (Nationwide Children's Hospital, Columbus, Ohio, USA)
Kelly Kelleher (Nationwide Children's Hospital, Columbus, Ohio, USA)
Dennis Cunningham (Nationwide Children's Hospital, Columbus, Ohio, USA)
James Menke (Nationwide Children's Hospital, Columbus, Ohio, USA, and The Ohio State University College of Medicine, Columbus, Ohio, USA)
Charles Spencer (Nationwide Children's Hospital, Columbus, Ohio, USA)

Clinical Governance: An International Journal

ISSN: 1477-7274

Article publication date: 18 October 2011




Children with rheumatic disease, who are infected with influenza, have an increased rate of complications. These complications can be reduced by improving the flu vaccination rate. This paper's aim is to document the authors' purpose of increasing the influenza vaccination rate through information technology (IT) intervention in this high risk population of patients.


The authors retrospectively reviewed the electronic health records (EHR) of three yearly cohorts (2007, 2008, and 2009) of rheumatology clinic patients from a large pediatric hospital for evidence of influenza vaccination. They introduced an automatic best practice reminder intervention in patients' EHR from September 2009 to April 2010. Using Clarity Report Write for EPIC, each chart was examined for evidence of influenza vaccination to test for vaccination rate difference among the cohorts. The authors employed logistic regression equations to control for possible confounders using SAS 9.1.3.


There was a significant difference in the probability of being vaccinated before and after intervention (p value <0.0001).The vaccination rate increased from 5.9 percent in 2007, 7.8 percent in 2008 and to 25.5 percent in 2009. During all three years, individual attending's contribution and ethnicity of patients had significant effects on vaccination rate. Confounders such as age, sex, insurance status and distance travelled from clinic had no effect on the vaccination rate.


EHR‐embedded information in past studies has been only modestly effective in improving care for many chronic conditions. The automatic best practice reminder for flu‐vaccine appears to be effective for changing physician's behaviors and improving the vaccination rate in rheumatology clinics.



Patwardhan, A., Kelleher, K., Cunningham, D., Menke, J. and Spencer, C. (2011), "The use of a mandatory best practice reminder in the electronic record improves influenza vaccination rate in a pediatric rheumatology clinic", Clinical Governance: An International Journal, Vol. 16 No. 4, pp. 308-319.



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