title: Registry-linked electronic influenza vaccine provider reminders: a cluster-crossover trial.
abstract: OBJECTIVE
  To determine the impact of a vaccination reminder in an electronic health record supplemented with data from an immunization information system (IIS).
  
  
  METHODS
  A noninterruptive influenza vaccination reminder, based on a real-time query of hospital and city IIS, was used at 4 urban, academically affiliated clinics serving a low-income population. Using a randomized cluster-crossover design, each study site had "on" and "off" period during the fall and winter of 2011-2012. Influenza vaccination during a clinic visit was assessed for 6-month to 17-year-old patients. To assess sustainability, the reminder was active at all sites during the 2012-2013 season.
  
  
  RESULTS
  In the 2011-2012 season, 8481 unique non-up-to-date children had visits. Slightly more non-up-to-date children seen when the reminder was 'on' were vaccinated than when 'off' (76.2% vs 73.8%; P = .027). Effects were seen in the winter (67.9% vs 62.2%; P = .005), not fall (76.8% vs 76.5%). The reminder also increased documentation of the reason for vaccine non-administration (68.1% vs 41.5%; P < .0001). During the 2011-2012 season, the reminder displayed for 8630 unique visits, and clinicians interacted with it in 83.1% of cases where patients required vaccination. During the 2012-2013 season, it displayed for 22 248 unique visits; clinicians interacted with it in 84.8% of cases.
  
  
  CONCLUSIONS
  An IIS-linked influenza vaccination reminder increased vaccination later in the winter when fewer vaccine doses are usually given. Although the reminder did not require clinicians to interact with it, they frequently did; utilization did not wane over time.
authors.affiliation: Departments of Pediatrics, Population and Family Health, NewYork-Presbyterian Hospital, New York, New York mss2112@columbia.edu.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Stockwell
authors.affiliation: Departments of Pediatrics, Population and Family Health, NewYork-Presbyterian Hospital, New York, New York.
authors.forename: Marina
authors.initials: M
authors.lastname: Catallozzi
authors.affiliation: Departments of Pediatrics.
authors.forename: Stewin
authors.initials: S
authors.lastname: Camargo
authors.affiliation: Departments of Pediatrics.
authors.forename: Rajasekhar
authors.initials: R
authors.lastname: Ramakrishnan
authors.affiliation: Departments of Pediatrics.
authors.forename: Stephen
authors.initials: S
authors.lastname: Holleran
authors.affiliation: Population and Family Health.
authors.forename: Sally E
authors.initials: SE
authors.lastname: Findley
authors.affiliation: Biomedical Informatics, and Sociomedical Sciences, Columbia University, New York, New York; and.
authors.forename: Rita
authors.initials: R
authors.lastname: Kukafka
authors.affiliation: Departments of Pediatrics, NewYork-Presbyterian Hospital, New York, New York.
authors.forename: Annika M
authors.initials: AM
authors.lastname: Hofstetter
authors.affiliation: Departments of Pediatrics.
authors.forename: Nadira
authors.initials: N
authors.lastname: Fernandez
authors.affiliation: NewYork-Presbyterian Hospital, New York, New York Biomedical Informatics, and.
authors.forename: David K
authors.initials: DK
authors.lastname: Vawdrey
mesh_terms: D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D012042:Registries; D017010:Reminder Systems; D012621:Seasons; D014611:Vaccination
chemical_list: D007252:Influenza Vaccines
keywords: alert; clinical decision support; immunization; influenza; reminder; vaccine