Using patient portals to improve flu shot rates

Patient portals can be a powerful communication tool for both clinician and family, but can they also be used to improve uptake of the annual influenza vaccine?

Patient portals in electronic health records are a helpful way for patients and families to have beneficial information about diagnoses and prescriptions. The portal is also a helpful tool for clinicians and families to communicate with one another. A study in Pediatrics looked at whether using the portal to remind parents about influenza vaccines had a positive impact on vaccination rates.1

The investigators performed an intention-to-treat randomized clinical trial in children aged 6 months to <18 years who were seen in 1 of 53 primary care practices. Patients or their parent/proxy who were considered active portal users were randomly assigned to 1 of 2 groups: receive reminder messages that were framed as gains or losses or receive no messages. The participants were also separately randomized to receive a precommitment message before the start of the influenza season. The administration of ≥1 seasonal influenza vaccinations were considered primary outcomes. Among patients aged 6 months to < 3 years who needed a second influenza vaccine dose, participants were randomized to either receive a message reminding the parent about the second dose or receiving no reminder.

There were 22,046 children included in the study. In the main control group, the vaccination rate was 56.9%. Within the intervention groups, the rate was 58.0% in the loss-frame reminders group (P = .07), and 58.0% in the gain-frame group (P = .47). When looking at the precommitment messaging, the investigators found that the rate was 58.3% in the precommitment group versus 57.0% in the control group (P = .11). Furthermore, the adjusted risk ratio for precommitment messaging was 1.02 (95% CI: 1.00–1.04) versus the control and 1.01 (95% CI: 0.98–1.05) for gain-frame reminders as well as 1.02 (95% confidence interval [CI]: 1.00–1.04) for loss-frame reminders. For the subset of children who required a second dose, the second-dose vaccination rates were 55.0% in the intervention group and 44.1% in the control group and had an adjusted risk ratio of 1.25 (95% CI: 1.07–1.45).

The investigators concluded that using patient portal reminders for influenza vaccines had no impact on first-dose influenza vaccination rates. However, the use of reminders was found to be an effective way to get young children back into the office for their second dose of the influenza vaccine.


1. Lerner C, Albertin C, Casillas A, et al. Patient portal reminders for pediatric influenza vaccinations: a randomized clinical trial. Pediatrics. July 28, 2021. Epub ahead of print. doi:10.1542/peds.2020-048413