3.7: Receive Dose Not Indicated Alert Upon Vaccine Administration


The system notifies the individual administering a vaccine that the vaccine is inconsistent with expected timing intervals as suggested by the vaccine forecast. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism should the provider order a vaccine dose that is inconsistent with appropriate timing intervals.


The minimum valid date (earliest date) for the fourth dose of DTaP vaccine is at 15 months. However, a provider ignores the EHR system-issued alert and orders a dose of DTaP for a 13-month-old patient who has received three prior doses. In this case, the EHR notifies the person administering the vaccine that the dose is not indicated and should be delayed two months.


This capability addresses the EHR’s ability to make the provider aware that a vaccine about to be administered 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 associated with capability 3.3, which 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.


Click here for a test script scenario that includes the capability, Receive Dose Not Indicated Alert Upon Vaccine Administration. 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.