Capsule Commentary on Cutrona et al., Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: a Randomized Controlled Trial

Journal of General Internal Medicine, Mar 2018

Timothy P. Hogan

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Capsule Commentary on Cutrona et al., Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: a Randomized Controlled Trial

Capsule Commentary on Cutrona et al., Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: a Randomized Controlled Trial Timothy P. Hogan 0 1 2 0 Compliance with Ethical Standards: 1 Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester , USA 2 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Veterans Health Administration , Bedford , USA - E portals can be used for effective, low-cost populationlectronic health records (EHRs) with tethered patient based outreach. Using real-time EHR data and existing communication pathways, portal-based outreach has the potential to be applied to various preventive services and care quality metrics. In their non-blinded randomized controlled trial, Cutrona and colleagues1 examined the effectiveness of outreach via EHRtethered patient portal messages and interactive voice response (IVR) calls, with the goal of promoting influenza vaccinations among a broad ambulatory population. The authors found a small but statistically significant improvement in influenza vaccine completion among portal users who received outreach (either a portal message, IVR call, or both), although IVR calls to nonportal users did not improve vaccination rates. Over half of the portal messages were opened by the patients to whom they were sent and a questionnaire prompted patients to self-report vaccine completion and related barriers. The work of Cutrona and colleagues offers further evidence to support the adoption and use of EHR-tethered patient portals. These findings are relevant to the Veterans Health Administration (VA), which has invested considerable resources in the implementation of its own EHR-tethered patient portal,2 currently used by millions of Veterans. The ability to exchange asynchronous, secure messages with VA clinical team members is reported by Veterans as a valued portal feature3; however, most of that communication remains, from the healthcare system’s perspective, reactive as opposed to proactive. Through work funded by its Office of Connected Care and Quality Enhancement Research Initiative Program, VA is actively trying to shift that paradigm. Researchers are examining ways to support clinical team initiation of portal message outreach to Veterans in an effort to engage them in their own care. In a time of limited resources, the VA and other healthcare systems must commit themselves to identifying effective strategies for conducting rapid and effective patient outreach. Leveraging patient-directed portal messages is a technologyassisted means of scaling such outreach. Further work could help us understand the potential of portal-based approaches for promoting not just vaccinations, but a range of other preventive services and healthy behaviors. Conflict of Interest: The author declares that he does not have a conflict of interest. 1. Cutrona SL , Golden JG , Goff SL , Ogarek J , Barton B , Fisher L , Preusse P , Sundaresan D , Garber L , Mazor KM . Improving Rates of Outpatient Influenza Vaccination through EHR Portal Messages and Interactive Automated Calls: A Randomized Controlled Trial. J Gen Intern Med . DOI: https://doi.org/10.1007/s11606-017-4266-9. 2. Nazi KM , Hogan TP , Wagner T , McInnes DK , Smith BM , Haggstrom D , Chumbler NR , Gifford AL , Charters KG , Saleem JJ , Weingardt KR , Fischetti LF , Weaver FM . A Research Vision for Personal Health Records: Experiences with the VA My HealtheVet System . J Gen Intern Med . 2010 ; 25 ( 1 ): 62 - 67 . 3. Haun JN , Lind JD , Shimada SL , Martin TL , Gosline RM , Antinori N , Stewart M , Simon SR . Evaluating User Experiences of the Secure Messaging Tool on the Veterans Affairs' Patient Portal System . J Med Internet Res . 2014 ; 16 ( 3 ): e75 .


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Timothy P. Hogan. Capsule Commentary on Cutrona et al., Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: a Randomized Controlled Trial, Journal of General Internal Medicine, 2018, 745-745, DOI: 10.1007/s11606-018-4384-z