3.4: Modify Antigen Recommendations Based on Active Diagnoses


The system notifies the provider of any conflicts between the recommended vaccines in the updated forecast and the patient’s current or historical diagnoses.


Marcel Manuel Gonzales, age 2 (birth date 12/24/2012) comes to the provider’s office for a scheduled appointment. The forecast received from the health department registry indicates that Marcel is due for the influenza vaccine. The provider’s EHR system finds a diagnosis of asthma and recommends injectable attenuated influenza vaccine rather than live attenuated nasal vaccine administration.


All systems reviewed allow entry of diagnoses or conditions on the patient’s problem list. Less clear is the ability to ensure a user is aware of a potential condition-related indication or contraindication. Section 5.12.1 (requirement 3.3.) describes methods for feedback to users about potential patient risks.

Notification in this context indicates that the system provides indication so the user is aware of a potential problem. Notification should include information, if available, about prior decisions, e.g. if a provider documented a reason to override notification about allergy or diagnosis in the past. The method for fulfilling the requirement is not prescriptive. Examples of notification include visual clues.

  • Vendor Perspective. Vendors should consider usability evaluation such as User Centered Design (UCD) to evaluate how the system handles notifications and alerts.
  • Provider and Implementer Perspective. Notifications and alerts can be a significant usability issue in EHRs. Providers should consider participating in vendor activities to address timely and appropriate notification.


Click here for a test script scenario that includes the capability, Modify Antigen Recommendations Based on Active Diagnosis. The script also indicates successful performance for each of the test sections. The notification must be visible directly on the ordering and the documentation screens specific to the vaccine ordered or documented. Note that notification based on the patient’s condition may require more advanced functionality.

Data Elements

The data elements include the condition specific to the clinical scenario in the test script.