CPHA Canvax

British Columbia Ministry of Health

Project Title:  Implementing an Electronic Immunization Reminder / Recall System in Interior Health
Funding Recipient:  Interior Health, British Columbia 
Project Contact:  Jonathan Spence, Manager – Communicable Diseases Unit (jonathan.spence@interiorhealth.ca)
Project Period:  March 1st, 2017 – March 31st, 2018
 


About the Project

Appointment reminders are effective in promoting appointment adherence and overdue recall notifications have a positive effect on immunization rates. However, manually performing these tasks is time consuming and many community health centres lack the administrative capacity to complete reminders and recalls consistently.

This project proposed to implement an electronic immunization reminder/recall system that is able to improve the efficiency of conducting appointment reminders and overdue recall notifications.  The purpose of the project was to automate reminder calls for booked appointments across the Interior Health Authority (IH), resulting in reduced administrative time that can be reinvested into recall strategies.  The pilot test for this project helped identify gaps in the current system and ensure processes are performed consistently between the health centres, as well as provided the strengths, weaknesses and growth opportunities for the chosen software. The software has been implemented in all 41 health centres within IH and will be considered for expansion throughout the remainder of the province and within Yukon.

Goal 

Implement an electronic reminder / recall system in Interior Health.

Objectives

  • Engage in planning for use of an automated reminder recall system that embraces a quality improvement approach.
  • Implement the software for reminder phone calls for booked appointments in pilot phases.
  • Evaluate pilot phases of the project to inform expansion of the system to reminder recall audits.
  • Implement the software for reminder recall audits for clients who have missed an immunization.
  • Implement the software to use the clients preferred method of contact (including email and text).
  • Share findings and recommendations with other health authorities.    

Outcomes 

Short Term

  • Increase awareness of routine vaccine schedule timing 
  • Increase motivation to attend appointments
  • Increase access to immunization clinics

Intermediate

  • Decrease overdue rates
  • Decrease missed appointments
  • Increase immunization rates

Long Term

  • Decrease incidence of vaccine preventable diseases
  • Decrease morbidity and mortality from VPDs
  • Decrease outbreaks

This project helped identify gaps in IH’s current system so that IH can invest in ensuring processes are performed consistently and provide capacity to invest in additional strategies that support immunization uptake. 

The challenge that the project addresses

The administrative staff who are tasked with conducting immunization appointment reminders and overdue recall notifications have many competing priorities in their support of multiple programs provided through the community health centres across IH. As a result, the completion of appointment reminders and overdue recall notifications had not been consistently completed at all health centres. 

The most commonly cited reasons for not completing these tasks are “no time”, workload, and staffing issues. This suggests the manual process employed at most of their health centers is affected by human resource availability and moving towards an automated system should result in increased efficiencies. Addressing this issue will in turn have a positive impact on vaccination rates in IH, especially in young children under 7 years of age.

Lessons learned

System Success

  • Contact Information Quality: The outcome of each reminder and notification was tracked to determine if the communication resulted in a successful contact with the client. It was determined that the success rate for appointment reminders was higher than for overdue recall notifications (94.6% vs. 87.2%). This difference was ascribed to the difference in the quality of the contact information used for each group, with appointment reminder contact information generally collected or updated more recently than that used for overdue recall notifications.
  • Use in Small Communities: A number of IH community health centres operate in very small communities where the volume of appointments and children overdue for immunizations is quite small. In these settings the use of the automated communication system did not have significant time savings and in some cases staff reported a belief that the use of the system impacted the quality of overall interaction with clients. To address these concerns the project has recommended a volume threshold for mandatory use of automated reminders. 

Appointment Adherence Impact

  • Impact on Missed Appointments: In order to assess the impact of the shift to automated appointment reminders the average missed appointment rate for immunization appointments was assessed for the period both pre and post-adoption of the automated reminders. The missed appointment rate after the adoption of the automated reminders was not significantly higher (p> 0.05) than the rate prior to use.  

Avoided Time

  • Saved Time vs. Time to Complete: Prior to the introduction of the automated reminders and notifications these tasks were being done manually, and were not completed all the time. As a result, the reduction in the time due to automation did not exclusively free up administrative time to be reallocated to other tasks, but created an opportunity to increase the completion rate of these activities. 
  • Creating Public Communication Opportunities: The system was used to provide immunization related communications to large groups (more than 700 clients) during public health actions. This type of communication with clients would not have been undertaken if it had to be done manually due to staff capacity limitations. The use of the automated communications system allows for targeted immunization messaging directly to clients that supported general public health communications.

About the Interior Health, British Columbia

Interior Health’s Population Health department enables and supports the health authority to deliver high quality population health based programs. They have 4 overarching goals such as to improve health and wellness, deliver high quality care, ensure sustainable health care, and cultivate an engaged and healthy workforce. The Population Health - Clinical Operations portfolio is responsible for the Immunization Program. The organizational structure of the Population Health – Clinical Operations portfolio has close linkages and working partnerships with the medical health officer team and Interior Health Epidemiologists. In addition, strong relationships and networks have been built and maintained with internal partners who deliver immunization services.  

 

Last Reviewed: November 13, 2018