Use of Electronic Health Records to Improve Maternal Vaccination

Accurate electronic health record (EHR) documentation of maternal vaccination is an essential component of evidence-based strategies to increase vaccination uptake. Within a larger intervention trial, this study assessed the impact of tailored protocols and immunization champions on obstetrics-gynecology practices' EHR documentation of maternal vaccines-including administration, history, and refusals-and sought to understand clinical staff's experience of the barriers and solutions to documentation in the EHR.

In 2012 and 2014, random samples of obstetric patient charts (N = 275) were reviewed during the preintervention and postintervention periods to assess changes in vaccination documentation. In-depth interviews with clinic staff were conducted during and after the intervention to evaluate the experience of clinical providers and staff in using the EHR to document maternal vaccine activities (N = 34 interviews). Analyses were conducted in 2015 and 2016.

Documentation of any vaccination activities in the EHR for influenza vaccine improved from 27% to 60% (p < .001) and from 13% to 87% (p < .001) for tetanus-diphtheria-acellular-pertussis vaccine. Documentation improvements were largely located in unsearchable notes rather than in searchable fields (52% for influenza, 59% for tetanus-diphtheria-acellular-pertussis). Barriers to EHR documentation reported by clinic staff included perceptions that inputting vaccine information into searchable fields was time consuming and that searchable fields were difficult to use.

Existing EHR structured fields do not meet the needs of obstetric providers, posing challenges for maternal immunization. We recommend obstetrics-gynecology practices collaborate with staff to develop effective maternal vaccination documentation protocols, test usability when selecting an EHR, and customize alerts to balance effectively reminding clinical staff against alert fatigue. Further, we recommend that future work address the need for improved maternal vaccination documentation to facilitate quality improvement in obstetrics-gynecology settings.