Mandatory fields in the electronic health record: Lessons learned

Background: Pneumococcus is the bacteria responsible for three major invasive diseases: pneumonia, bacteremia, and meningitis. These illnesses affect over one million annually making pneumococcal disease the most prevalent and dangerous of all vaccine preventable illnesses. Despite safety and efficacy, pneumococcal vaccine (PPSV23) uptake remains challenging in the inpatient setting resulting in missed opportunities to vaccinate at risk individuals. The purpose of this study was to examine the efficacy of mandated fields within the electronic health record (EHR) for PPSV23 screening and vaccination in the acute care setting. Methods: This study was conducted using a quantitative quasi-experimental design to compare PPSV23 screening and vaccination rates between two acute care facilities: one EHR and one with paper-based documentation. Based on findings from phase one of the study, an education intervention targeting registered nurses was conducted, then screening and vaccination rates were re-measured using pre-test/post-test methodology. Data were analyzed using t tests for independent samples. Findings: Although utilization of mandated fields within the EHR required nurses to address PPSV23 uptake; screening and vaccine rates remained poor, and were not statistically different from those in the paper facility. While reasons for poor compliance were initially unclear, a pre-test designed to measure PPSV23 knowledge revealed significant deficits among practitioners concerning indications, safety, and efficacy. After an education module designed to enhance knowledge of PPSV23 indications, safety, and efficacy, a statistically significant increase in screening and uptake were noted. Conclusion: While use of EHR driven screening fields may facilitate vaccination, the value of education based initiatives aimed at providing healthcare practitioners with the rationale for treatment must be done in tandem to achieve the highest levels of compliance.