An electronic health record alert for inpatient COVID-19 vaccinations increases vaccination ordering and uncovers workflow inefficiencies

Background: Despite mortality benefits, only 19.9% of US adults are fully vaccinated against the coronavirus disease 2019 (COVID-19). The inpatient setting is an opportune environment to update vaccinations, and inpatient electronic health record (EHR) alerts have been shown to increase vaccination rates. Objective: Evaluate if an EHR alert could increase COVID-19 vaccinations in eligible hospitalized adults by prompting providers to order the vaccine. Methods: This was a quasi-experimental pre-post interventional design study at an academic and community hospital in the western United States between 1/1/2021 and 10/31/2021. Inclusion criteria were unvaccinated hospitalized adults. A soft-stop, interruptive EHR alert prompted providers to order COVID-19 vaccines for those with an expected discharge date within 48 hours and interest in vaccination. The outcome measured was the proportion of all eligible patients for whom vaccines were ordered and administered before and after alert implementation. Results: Vaccine ordering rates increased from 4.0% to 13.0% at the academic hospital (OR 4.01, 95% CI 3.39 to 4.74, p < 0.001) and from 7.4% to 11.6% at the community hospital (OR 1.62, 95% CI 1.23 to 2.13, p < 0.001) after alert implementation. Administration increased post-alert from 3.6% to 12.7% at the academic hospital (OR 3.21, 95% CI 2.70 to 3.82, p < 0.001), but was unchanged at the community hospital, 6.7% to 6.7% (OR 0.99, 95% CI 0.73 to 1.37, p = 0.994). Further analysis revealed infrequent vaccine availability at the community hospital. Conclusion: Vaccine ordering rates improved at both sites after alert implementation. Vaccine administration rates, however, only improved at the academic hospital, likely due in part to vaccine dispensation inefficiency at the community hospital. This study demonstrates the potential impact of complex workflow patterns on new EHR alert success and provides rationale for subsequent qualitative workflow analysis with alert implementation.