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EHR Clinical Decision Support Alerts Increase HPV Vaccination

EHR-based clinical decision support alerts led to an increase in administered HPV vaccinations.

EHR clinical decision support alerts lead to HPV vaccinations

Source: Thinkstock

By Kate Monica

- Physicians using EHR systems with clinical decision support are more likely to lead to the ordering human papillomavirus (HPV) vaccines when alerts are included, according to a recent study in the American Journal of Managed Care (AJMC).

Bae et al. assessed the association between using an EHR system’s clinical reminder functionality with increased HPV vaccine administration among office-based physicians.

Researchers used data from the National Ambulatory Medical Care Survey from 2007–2012 to determine whether EHR systems with alerts built into clinical decision support tools contributed to increased rates of immunization in different patient populations.

Specifically, researchers analyzed visits by adolescents recommended to receive HPV vaccines to all office-based physicians including primary care physicians, pediatricians, internists, obstetricians and gynecologists, and other specialists.

Researchers studied visit samples for 3,388 patients aged 11 to 12 years; 14,354 patients 11 to 18 years; and 25,573 female and male patients aged 11 to 26 years and 11 to 21 years, respectively.

Ultimately, study findings indicated physicians using clinical decision support with alert functions were more likely to order HPV vaccines.

“Clinical reminder functions were particularly effective at increasing HPV vaccine use among adolescent males,” noted researchers.

The association between clinical alerts and HPV immunizations was not significant in the younger adolescent population. Still, researchers maintained that because incidence of HPV decreases substantially with any increase in vaccination rate, increasing HPV immunizations in the male population aged 11 to 21 years will likely have a positive impact on overall health outcomes.

Males also have a higher prevalence of HPV infections and may warrant additional attention.

“Therefore, targeting males to receive HPV vaccination immunizations through clinical reminders provides a positively disproportionate return on vaccination rates and disease burden,” stated researchers.

Furthermore, researchers determined EHR-driven clinical reminders could increase preventive care among at-risk — but frequently neglected — patient populations.

“As expected, preventive care visits were associated with significantly higher rates of HPV vaccination, along with visits to patients’ own primary care physicians,” they wrote.

Researchers concluded these findings could have significant implications for public health officials and policymakers in charge of developing meaningful use requirements.

“For public health advocates, any tool that increases effective immunization adherence in support of disease prevention is an important contribution to the well-being of communities,” stated researchers. “Additionally, policy makers responsible for the Meaningful Use program need meaningful measurements to assess whether increased EHR adoption leads to better treatment modalities.”

Researchers also stressed that clinicians should use EHR systems to assist in more accurate care delivery, as well as for the purposes of more effectively assessing the return on investment associated with owning and operating EHR technology.

This most recent study confirming the advantages of using EHR-based alerts compounds previous evidence supporting the potential for alerts to improve patient safety.

This summer, physicians at Nanaimo Regional General Hospital and Oceanside Health Centre in Vancouver cited EHR-based alerts as being useful for notifying physicians of the potential for adverse drug interactions when administering medications. In an op-ed, physicians Drew Digney, MD, and Ben Williams, MD, credited alerts built into a Cerner EHR with significantly improving care delivery.

After implementing a new Cerner EHR system with built-in alerts, Nanaimo staff have been notified of more than 2,000 medication errors in which a medication may have been issued to the wrong patient.

Furthermore, more than 3,600 alerts have signaled physicians of potential adverse drug interactions, and more than 6,000 alerts have warned of potential allergies.

These and other alerts built into clinical decision support in EHR systems can improve patient safety and lead to optimal patient health outcomes. 

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