Electronic Immunization Alerts and Spillover Effects on Other Preventive Care

Area of Science:

• Pediatrics
• Health Informatics
• Preventive Medicine

Background:

• Electronic health record (EHR) systems are increasingly used in primary care.
• Clinical alert systems within EHRs aim to improve patient care and adherence to guidelines.
• The impact of EHR immunization alerts on the delivery of other preventive services is not well understood.

Purpose of the Study:

• To assess the spillover effects of an EHR immunization clinical alert system on the delivery of other preventive services.
• To evaluate whether alerts for immunizations influence the provision of services like anemia screening, lead screening, developmental screening, nutritional assessment, and injury prevention counseling.
• To examine changes in oral health screening rates in conjunction with EHR immunization alerts.

Main Methods:

• Secondary data analysis combined with primary data collection from a randomized, historically controlled trial.
• Study population included children aged 18 to 30 months requiring immunizations at an urban primary care clinic.
• Comparison between a group prompted by EHR immunization alerts (n=129) and a control group (n=135).

Main Results:

• No significant differences were observed in the delivery of anemia screening, lead screening, developmental screening, nutritional assessment, or injury prevention counseling between the alert group and the control group.
• A significant increase in oral health screening was noted in the group prompted by EHR immunization alerts (OR=4.8, 95% CI=1.8-13.0).
• This increase in oral health screening was attributed to concurrent practice-level changes rather than the EHR alert system itself.

Conclusions:

• An EHR clinical alert system specifically targeting immunizations did not demonstrate a significant spillover effect on the delivery of other essential preventive services.
• While oral health screening rates improved, this was likely influenced by factors independent of the immunization alert system.
• The findings suggest that EHR alerts focused on one preventive service may not broadly enhance the delivery of others without specific design considerations.