Skip to main content
Improving Rates of Influenza Vaccination Through Electronic Health Record Portal Messages, Interactive Voice Recognition Calls and Patient-Enabled Electronic Health Record Updates: Protocol for a Randomized Controlled Trial
University of Massachusetts Medical School Faculty Publications
  • Sarah L. Cutrona, University of Massachusetts Medical School
  • Meera Sreedhara, University of Massachusetts Medical School
  • Sarah L. Goff, Baystate Medical Center
  • Lloyd D. Fisher, University of Massachusetts Medical School
  • Peggy Preusse, Reliant Medical Group
  • Madeline Jackson, University of Massachusetts Medical School
  • Devi Sundaresan, Reliant Medical Group
  • Lawrence D. Garber, University of Massachusetts Medical School
  • Kathleen M. Mazor, University of Massachusetts Medical School
UMMS Affiliation
Meyers Primary Care Institute; Department of Medicine, Division of General Medicine/Primary Care; Department of Pediatrics, Division of Community Pediatrics; Graduate School of Biomedical Sciences, Clinical and Population Health Research Program
Publication Date
Document Type
BACKGROUND: Clinical decision support (CDS), including computerized reminders for providers and patients, can improve health outcomes. CDS promoting influenza vaccination, delivered directly to patients via an electronic health record (EHR) patient portal and interactive voice recognition (IVR) calls, offers an innovative approach to improving patient care. OBJECTIVE: To test the effectiveness of an EHR patient portal and IVR outreach to improve rates of influenza vaccination in a large multispecialty group practice in central Massachusetts. METHODS: We describe a nonblinded, randomized controlled trial of EHR patient portal messages and IVR calls designed to promote influenza vaccination. In our preparatory phase, we conducted qualitative interviews with patients, providers, and staff to inform development of EHR portal messages with embedded questionnaires and IVR call scripts. We also provided practice-wide education on influenza vaccines to all physicians and staff members, including information on existing vaccine-specific EHR CDS. Outreach will target adult patients who remain unvaccinated for more than 2 months after the start of the influenza season. Using computer-generated randomization and a factorial design, we will assign 20,000 patients who are active users of electronic patient portals to one of the 4 study arms: (1) receipt of a portal message promoting influenza vaccines and offering online appointment scheduling; (2) receipt of an IVR call with similar content but without appointment facilitation; (3) both (1) and (2); or (4) neither (1) nor (2) (usual care). We will randomize patients without electronic portals (10,000 patients) to (1) receipt of IVR call or (2) usual care. Both portal messages and IVR calls promote influenza vaccine completion. Our primary outcome is percentage of eligible patients with influenza vaccines administered at our group practice during the 2014-15 influenza season. Both outreach methods also solicit patient self-report on influenza vaccinations completed outside the clinic or on barriers to influenza vaccination. Self-reported data from both outreach modes will be uploaded into the EHR to increase accuracy of existing provider-directed EHR CDS (vaccine alerts). RESULTS: With our proposed sample size and using a factorial design, power calculations using baseline vaccination rate estimates indicated that 4286 participants per arm would give 80% power to detect a 3% improvement in influenza vaccination rates between groups (alpha=.05; 2-sided). Intention-to-treat unadjusted chi-square analyses will be performed to assess the impact of portal messages, either alone or in combination with the IVR call, on influenza vaccination rates. The project was funded in January 2014. Patient enrollment for the project described here completed in December 2014. Data analysis is currently under way and first results are expected to be submitted for publication in 2016. CONCLUSIONS: If successful, this study's intervention may be adapted by other large health care organizations to increase vaccination rates among their eligible patients. CLINICALTRIAL: NCT02266277; (Archived by WebCite at
  • Electronic Mail,
  • Health Records,
  • Personal,
  • Internet,
  • Medical Informatics Applications,
  • Telephone,
  • clinical decision support,
  • electronic health records,
  • influenza vaccines
Rights and Permissions
This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
DOI of Published Version
JMIR Res Protoc. 2016 May 6;5(2):e56. doi: 10.2196/resprot.5478. Link to article on publisher's site.
Related Resources
Link to Article in PubMed
PubMed ID
Citation Information
Sarah L. Cutrona, Meera Sreedhara, Sarah L. Goff, Lloyd D. Fisher, et al.. "Improving Rates of Influenza Vaccination Through Electronic Health Record Portal Messages, Interactive Voice Recognition Calls and Patient-Enabled Electronic Health Record Updates: Protocol for a Randomized Controlled Trial" Vol. 5 Iss. 2 (2016) ISSN: 1929-0748 (Linking)
Available at: