FluAlert: A qualitative evaluation of providers' desired characteristics and concerns regarding computerized influenza vaccination alerts Eileen Birmingham a , Marina Catallozzi a,b,c , Sally E. Findley b , David K. Vawdrey c,d , Rita Kukafka d,e , Melissa S. Stockwell a,b,c, ⁎ a Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA b Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA c NewYork-Presbyterian Hospital, New York, NY, USA d Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, NY, USA e Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA abstract article info Available online 27 January 2011 Keywords: Immunization Vaccine Influenza Alert Reminder Clinical decision support Objective. To explore pediatric providers' perceived barriers to influenza vaccine delivery, and desired characteristics and potential concerns regarding an influenza vaccine alert integrated into the electronic health record (EHR). Methods. Four focus groups with providers (n = 21) and five individual interviews with practice leaders in an urban, pediatric primary care network affiliated with an academic medical center in New York City were conducted. Data were collected during the 2009–10 influenza season and analyzed using thematic analysis. Results. Participants identified several barriers to influenza vaccine delivery, including remembering to vaccinate during sick visits, need to review multiple sources of immunization information, time shortages and inadequate staffing. They felt that an alert could help many of these challenges. They desired the following alert characteristics: 1) alerting providers early in the visit, 2) accurately determining patients' vaccine status by merging multiple sources of immunization information, 3) facilitating vaccine ordering, and 4) generating appropriate documentation in the EHR when vaccines were refused or otherwise not given. Potential concerns regarding the alert included reliability and accuracy of alert, workflow interruptions and forced actions. Conclusions. This study highlights providers' interest in a well-integrated, accurate alert that streamlines assessment of vaccination eligibility, ordering and documentation without impeding work-flow. © 2011 Elsevier Inc. All rights reserved. Introduction Current guidelines of the Advisory Committee on Immunization Practices (ACIP) recommend universal influenza vaccination for children aged 6 months to 18 years (Fiore et al. 2010). Yet, influenza vaccination rates among children remain suboptimal, partially due to missed vaccination opportunities (Centers for Disease Control and Prevention, 2009; Verani et al., 2007; Daley et al., 2005). Computer decision support systems, like immunization alerts, are promising tools for improving adherence to clinical guidelines and reducing missed opportunities for influenza vaccination by helping identify, at the point of care, children in need of vaccination (Szilagyi et al., 2000; Pickering et al., 2009). While there is strong support for provider immunization alerts, pediatric influenza vaccination alerts have met only modest success (Briss et al., 2000; Fiks et al., 2009). It has been proposed that their limited effectiveness may be linked to design problems or to workflow issues unrelated to alerts (Sittig et al., 2009). Provider use of electronic health records (EHR) is growing, with 50% using at least a partial EHR and 29% evaluating options (CompTIA, 2010). Because EHRs provide a convenient platform for decision support, it is important to understand providers' desired character- istics and potential concerns about immunization alerts in the EHR. The goal of this study was to explore pediatric providers' perceived barriers to influenza vaccine delivery, and desired characteristics and potential concerns regarding an influenza vaccine alert integrated into the EHR. Methods Four focus groups were conducted in December 2009 with pediatricians and a pediatric nurse practitioner in four pediatric ambulatory care group practices affiliated with an academic medical center. The practices were located in northern Manhattan, serving a primarily Latino, publicly insured Preventive Medicine 52 (2011) 274–277 ⁎ Corresponding author at: Division of General Pediatrics-Columbia University, 622 W. 168th Street-VC 402; New York, NY 10032, USA. Fax: +1 212 305 8819. E-mail address: mstockwell@columbia.edu (M.S. Stockwell). 0091-7435/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2011.01.008 Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed