HS420 Unit 10 Informatics Recommendation Report Example

Reminders That Reach the Right Phone: A Unit 10 Informatics Recommendation Report on Recall for Overdue Childhood Vaccines

[Student Name]

Purdue University Global

HS420: Health Informatics

Unit 10 Informatics Recommendation Report

[Instructor Name]

[Date]

Hollis Park Pediatrics, its rates, costs and targets are composite; the Cochrane review, the centralized recall trial, the data quality framework and the adoption framework cited are real.

Summary for Decision Makers

Problem: [71] percent of children turning two in the past year were up to date on the recommended series, and 18.9 percent of the clinic's reminder texts did not reach a working phone. Recommendation: run reminder and recall from the clinic's health record, using registry-reconciled vaccine histories and verified parent numbers, with a weekly worklist for families texts cannot reach. Cost: about [6] staff hours a week and [$2,400] a year in texting fees. Measures: up-to-date rate at 24 months, text delivery rate, and share of overdue children contacted within fourteen days.

Current State

The clinic sends reminder texts only for scheduled appointments. Children who are overdue and have no appointment receive nothing. The texting service draws numbers from practice management, where nearly one in five fails. The health record's list of overdue children is inaccurate because many doses given elsewhere were never entered; the registry connection, live since last quarter, has fixed most of that for children seen recently, but not for children who have not visited.

Evidence

A Cochrane synthesis of trials testing reminders and recall found that they raise vaccination uptake in children and adults alike, across telephone, letter, text and combined methods (Jacobson Vann et al., 2018). A trial in Colorado compared recall run centrally through the state registry with recall run by practices, and examined both effect and cost, finding that the approach that reaches families most reliably and cheaply depends on the setting (Kempe et al., 2017). Reminders work only if the contact data are right, which the clinic's data quality review showed is not yet the case (Wang & Strong, 1996).

Options Compared

Option 1, rely on the state registry's centralized recall. The state sends postcards to families of children who are overdue. Cost to the clinic: none. Weakness: postcards go to the address in the registry, which is often older than the clinic's, and the clinic cannot add texts or follow-up calls. Reach in the clinic's own records: unknown, since the state reports only county totals.

Option 2, clinic-run reminder and recall without data cleanup. The health record generates a monthly list of overdue children and sends texts. Cost: low. Weakness: about one text in five fails, and the overdue list still includes children whose doses were given elsewhere but never entered.

Option 3, clinic-run reminder and recall with cleanup and follow-up. Before the first send, the health record queries the registry for every child on the overdue list, accepting outside doses so that only truly overdue children remain. Numbers are confirmed at check-in using the new tablet prompt. Texts that fail go to a weekly worklist for the front desk to call. Cost: highest of the three, about [6] staff hours a week.

Option 3 costs the most staff time, but it is the only option that fixes both reasons the current reminders fail: the wrong children on the list and the wrong numbers on file.

Recommendation

Adopt Option 3. Keep the state's postcards running as a backstop for families the clinic cannot reach by phone. Assign the recall worklist to one front desk staff member each week, rotating, with the practice manager as owner.

Measures and Targets

1. Up-to-date rate at 24 months: from [71] percent to [78] percent within twelve months of launch. Source: health record report, checked quarterly against the registry.

2. Text delivery rate: from [81] percent to at least [92] percent within six months. Source: texting service delivery reports.

3. Overdue children contacted within fourteen days of becoming overdue: at least [90] percent. Source: recall worklist log.

Targets were set before launch so that the result cannot be judged against a convenient figure afterward.

Implementation

The plan follows the pattern used for the registry connection: a four-week pilot with one care team's patients, a decision point, then clinic-wide launch. Staff who call families will have a short script that offers the next available vaccine-only appointment. Frameworks for technology adoption suggest that new routines last when the people doing the extra work can see their effect (Greenhalgh et al., 2017), so the worklist will show each week how many families booked after a call.

What Families Said

Before choosing, the practice manager asked [24] parents in the waiting room over two days how they preferred to hear that a vaccine was due. Nineteen chose a text, three a phone call and two a letter. Several said they ignore texts from numbers they do not recognize, so the clinic will send from its own registered number and open each message with the clinic's name and the child's first name. Two parents said a reminder that their child was overdue felt like a scolding, which led the clinic to word recall texts as an offer of a short vaccine-only visit rather than a warning. This small check does not replace the measures below, but it shaped how the messages read before any were sent.

Alternatives Considered and Set Aside

Two further ideas were raised and set aside. Walk-in vaccine hours on Saturday mornings would help working parents, but the clinic cannot staff them this year and they would not reach families who do not know their child is overdue. Paying a vendor to run outreach calls would save staff time, but the vendor would not have access to registry-reconciled histories and would repeat the original problem of calling about doses already given elsewhere. Both may be revisited once the recall system has a year of results.

Risks and Limits

Some families do not want texts and will opt out; the clinic will honor that and rely on postcards and calls. Overdue lists for children who have moved away will include false positives until the registry shows their new provider. And the up-to-date rate depends on many factors besides reminders, including vaccine hesitancy, which recall alone does not address. The measures will show whether the system reaches families, not whether it changes every parent's decision.

Cost Summary

Staff time: about [6] hours a week across front desk and the coordinator, roughly [$9,000] a year in wages. Texting fees: [$2,400] a year. Configuration: done by the existing vendor under the current contract. Total: about [$11,400] a year, compared with the cost of a single outbreak response in an under-vaccinated school, which can run far higher.

References

Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017). Beyond adoption: A new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research, 19(11), e367. https://doi.org/10.2196/jmir.8775

Jacobson Vann, J. C., Jacobson, R. M., Coyne-Beasley, T., Asafu-Adjei, J. K., & Szilagyi, P. G. (2018). Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews, 2018(1), CD003941. https://doi.org/10.1002/14651858.CD003941.pub3

Kempe, A., Saville, A. W., Beaty, B., Dickinson, L. M., Gurfinkel, D., Eisert, S., Roth, H., Herrero, D., Trefren, L., & Herlihy, R. (2017). Centralized reminder/recall to increase immunization rates in young children: How much bang for the buck? Academic Pediatrics, 17(3), 330-338. https://doi.org/10.1016/j.acap.2016.11.016

Wang, R. Y., & Strong, D. M. (1996). Beyond accuracy: What data quality means to data consumers. Journal of Management Information Systems, 12(4), 5-33. https://doi.org/10.1080/07421222.1996.11518099