Original article Use of Electronic Health Records to Improve Maternal Vaccination Sarah E. Brewer, MPA a,b, * , Juliana Barnard, MA a,c , Jennifer Pyrzanowski, MSPH a , Sean T. O’Leary, MD, MPH a,c , Amanda F. Dempsey, MD, PhD, MPH a,c a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado b Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado c Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado Article history: Received 25 July 2018; Received in revised form 17 April 2019; Accepted 30 April 2019 abstract Introduction: 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 vaccinesdincluding administration, history, and refusalsdand sought to understand clinical staff’s experience of the barriers and solutions to documentation in the EHR. Methods: In 2012 and 2014, random samples of obstetric patient charts (N ¼ 275) were reviewed 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 ¼ 34 interviews). Analyses were conducted in 2015 and 2016. Results: 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. Conclusions: 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. Ó 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc. Maternal vaccination is one strategy for decreasing maternal and infant infectious disease morbidity and mortality (Benowitz, Esposito, Gracey, Shapiro, & V azquez, 2010; Centers for Disease Control and Prevention, 2013; Eick et al., 2011; Fiore et al., 2008; Kretsinger et al., 2006; Omer et al., 2011; American Academy of Pediatrics, 2009; Richards et al., 2013; Steinhoff & Omer, 2012; Steinhoff et al., 2010; Steinhoff et al., 2012; Zaman et al., 2008). The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends maternal tetanus-diphtheria-acellular-pertussis (Tdap) vaccina- tion during every pregnancy to prevent infant pertussis (Centers for Disease Control and Prevention, 2013). Maternal vaccination against influenza is also recommended to protect both mothers and their babies from influenza infection and its complications (Fiore et al., 2008). Healthy People 2020 set goals of 80% coverage Conflicts of Interest: Amanda Dempsey serves on advisory boards for Merck and Pfizer. She does not receive research funding from either company, nor did either company play any role in this research. Funding: This work was funded by the Centers for Disease Control and Prevention, United States (IP000501-03). The opinions expressed in this manuscript do not necessarily represent those of the funding agency. * Correspondence to: Sarah E. Brewer, MPA,13199 East Montview Blvd, Suite 300, Aurora, CO 80045. Phone: (303) 724-6927; fax: (303) 724-1839. E-mail address: sarah.brewer@ucdenver.edu (S.E. Brewer). www.whijournal.com 1049-3867/$ - see front matter Ó 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc. https://doi.org/10.1016/j.whi.2019.04.017 Women's Health Issues xxx-xx (2019) 1–8