SMS direct from PMS for active adverse event surveillance

A West Australian research team has developed a tool that can seamlessly extract patient data from practice management software and send an SMS query to patients to conduct active adverse events following immunisation (AEFI) surveillance.

Designed by software developer Ian Peters of Datavation, who also developed the Canning clinical data extraction tool, SmartVax has been used in a study published today in the Medical Journal of Australia that shows simple SMS messages can allow general practices to accurately monitor vaccine safety.

The study, conducted at the Illawarra Medical Centre (IMC) in Perth and led by IMC GP Alan Leeb and Paul Effler of WA Health's Communicable Disease Control Directorate, was conducted between November 2011 and June 2013.

It involved 3281 patients who had received one or more vaccines: 1053 (32.1 per cent) were adult patients who received a flu vaccine and 2228 (67.9 per cent) were paediatric patients who received scheduled childhood vaccinations.

At IMC, all patients who receive a vaccine are recorded in its Best Practice clinical and practice management software, along with the type and number of vaccines administered, and the vaccine's brand and batch number.

All patients or their parents are also asked to provide a mobile phone number, which in this study was the vast majority. Only two paediatric patients' parents did not provide a mobile number (0.1 per cent) and only five per cent of adult patients.

In this study, an SMS was sent to patients vaccinated within the preceding seven days. Two versions of the SMS were created, one for adult patients that read “[Patient name], Tks for caring to have a flu vaccine. We would like to know if there were any reactions to the vax. Kindly reply YES or NO”.

The text to parents read “Tks for caring to immunise [Patient name]. We would like to know if there were any reactions to the vax. Kindly reply YES or NO”.

For adult patients, 69.8 per cent replied to the SMS, 92 per cent replying no and 7.6 per cent replying yes. Those who replied yes or didn't reply to the SMS were followed up by a phone call.

Similarly with paediatric patients, 73.9 per cent of parents replied to the SMS, 86.9 per cent of whom replied no. Those who replied yes or didn't reply to the SMS were also followed up by a phone call.

As the authors write, the SMS replies were automatically written back into the SmartVax tool, linked to the patients’ vaccination data and collated in real time. The study team typically waited for 24 hours to receive a response before calling those who hadn't responded or had indicated a reaction. Clinical staff were then able to administer a survey to ascertain the nature, duration and severity of any reaction reported.

The authors say there are a number of advantages to using the tool, including the probability that it can be modified to work with other practice management systems besides Best Practice. The ability to extract data directly from the PMS also reduced the amount of effort required to identify vaccinated patients.

SmartVax also provides very timely feedback, with half of all patients responding within 10 minutes of receiving the SMS, and more than 80 per cent within two hours. “Such timeliness could be valuable when an urgent investigation into potential vaccine safety issues is necessary, and it would permit ongoing safety monitoring in near real-time,” they write.

They also found that the proportion of patients who reported an adverse reaction was similar between those who replied to the SMS and those who did not but were subsequently contacted by phone. This may overcome the major limitation of the system, which requires clinic personnel to personally phone patients who didn't respond.

However, the authors write that contacting the small number of respondents with a suspected AEFI is far less onerous than trying to survey all patients who had been vaccinated. During routine monitoring of vaccine safety, they write, it may not be necessary to phone all patients who didn't respond to the text, as they are likely to report a similar proportion of adverse events to those who did.

The team is now exploring the option of developing sequential text messages to those who responded affirmatively to the initial text, or providing a link to a web-based survey.

Posted in Australian eHealth

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