Overview

The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.

Example

The minimum valid date (earliest date) for the fourth dose of pneumococcal conjugate (PCV13) vaccine is at 9 months.  The provider orders a dose of PCV13 for a 7-month old patient who has received three prior doses. The EHR or other clinical software system notifies the provider that the dose is not indicated and should be delayed two months.

Guidance

This capability addresses the EHR’s ability to make the provider aware that a vaccine being ordered is not yet due. EHRs have various methods for encouraging the provider to take the expected path, i.e., only order or document administration vaccines currently due. One method is to organize the workflow directly from the vaccine schedule screen. However, providers may still attempt to order or document vaccine through other screen flows. The decision support logic is presented in the section that describes capability 3.3. This section describes methods for feedback to users about potential patient risks.  These methods apply to vaccines not yet due as well as known allergies, adverse reactions or specific clinical conditions.

Notification in this context indicates that the system provides indication so the user is aware the vaccine timing is inconsistent with the decision support logic. Examples of notification include visual clues. Notification should allow the provider to proceed to order or document clinically relevant vaccines even if the timing may not be considered valid according to the routine vaccination schedule. Such clinically relevant vaccines might include urgent public health recommendations due to disease outbreaks.

• 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.

Test

Click here for a test script scenario that includes the capability, Receive Dose Not Indicated Alert for Single Vaccine Order. The script also indicates successful performance for each of the test sections. The data included in the test is limited to timing, i.e., it addresses vaccines given too early.

Data Elements

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