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Nudge, nudge! Get your flu shot

April 19, 2017
by Nicole Stempak, Senior Editor
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Electronic health records (EHRs) are helping more people get flu shots.

Researchers programmed EHRs to alert providers when a patient was eligible for the vaccination. The prompt, or nudge, is a behavioral economics technique known as “active choice.”

Researchers at the University of Pennsylvania’s Perelman School of Medicine began using the intervention in mid-February 2012. By the end of the 2012-13 flu season, orders for flu vaccines rose about 37 percent from the prior two flu season compared to the control group.

“Our results indicate that this simple intervention could be an effective and scalable approach to use the design of electronic health records to increase the rate of flu vaccinations,” said lead study author Mitesh S. Patel, MD, MBA, MS, assistant professor at the University of Pennsylvania, staff physician at the Crescenz VA Medical Center and director of the Penn Medicine Nudge Unit, in a news release. “Nudges are changes to the way choices are framed or presented and can be very effective for changing physician and patient behavior. These findings build on our previous research demonstrating that active choice increased orders for high-value screening tests including colonoscopies and mammographies.”

The research team examined vaccination rates across three clinics, one that used the intervention and two controls. Providers in the intervention who accessed a patient’s EHR during the visit would see if the patient was due for the flu shot, followed by an alert requesting they “accept” or “decline” a vaccine order. The vaccine would be administered during the visit if the order was accepted. Providers in the control group had to manually check to see if a patient needed the shot and place an order for it.

As a result of the findings, published in the Journal of General Internal Medicine, the intervention was amended as a “best practices alert” in the EHR software and expanded in September 2016 to all internal all internal medicine outpatient clinics across Penn Medicine.

Behavioral economic techniques are being studied for their potential to improve public health. In another study, a virtual glucose management service helped improve glycemic control among hospitalized adults with diabetes who develop hyperglycemia. A feature was built into the patient EHR to automatically detect and report uncontrolled blood glucose levels that were read remotely by a diabetes specialist, who makes recommendations for insulin dosing using an electronic note in the patients’ charts. 

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