Ann Arbor physician discusses risks of not getting the flu vaccine

Dr. Jack Billi, Todd Nelson and patient Robert Donnellan

An interview with Dr. Jack Billi, an internist at the University of Michigan

How do you maintain a high rate of patients who get the influenza vaccine?

It takes a system to improve quality. Our system includes my medical assistant, our nurses, our front desk staff, and our electronic health record. We rely on our EHR to prompt us when a patient hasn’t had his or her flu vaccine, or has any other gap in care. Because the flu vaccine is recommended for almost everyone, our medical assistant offers it to every patient we see. It’s one of the most cost-effective techniques in all of health care.

A lot of credit goes to my medical assistant, Todd Nelson. He has a great approach with patients and his own technique for giving vaccines. He comes up with ideas on how to approach patients who haven’t agreed to get a flu vaccine before. I tap into his creativity when we’re coming up with ways to improve our vaccination rates.

What are the challenges to making sure everyone gets vaccinated, and how do you overcome them?

We see several reasons why our patients decline the flu vaccine. We work with them to counteract the misinformation and incorrect beliefs. Some say they never get the flu. We explain that three-quarters of all influenza cases have no symptoms, but they can infect others. Or they say they always get a mild case (that might not have been flu). Others are skeptical of vaccines in general. Some of my patients see me less than once a year. There are a small number of what I call healthy indestructible males who don’t ever come see me. We send reminders to those patients through our patient portal and try to reach healthy people we rarely see. We also make it easy. Patients can schedule their flu shot without having a physician office visit. Some want to delay until the perfect time for the vaccine, but I usually convince them it is better to get it while they can. They could be exposed early or they might get another infection, which would delay their vaccination further.

Many people who resist at first change their minds and get the flu shot. We tell them powerful stories about the risks of not vaccinating, including risks to them, to their family members, and to people who can’t be vaccinated. It helps to share a personal story. In my second year as resident, I got influenza. I was a very healthy 27-year-old and was bedridden for over a week, unable to stand. So, we continue to work on these resistant patients and their numbers grow smaller each year.

What about pharmacies? How do you record that your patients got a flu vaccine elsewhere?

I used to ask all our patients to get their flu shots from us, but I realize it’s sometimes inconvenient to come to our office. Often pharmacies have the vaccine before we do. We ask patients to let us know they were vaccinated elsewhere, or else we’d waste time tracking down people who were already vaccinated.

In the past, pharmacies were inconsistent entering the vaccine into MCIR. What’s helped us is the medication reconciliation information in our electronic health record. Our record shows meds “prescribed” outside our system, and often it’s a flu shot at a pharmacy. So we know they got the vaccine.

Is there anything you’d like to add that you feel is important?

We use the resources that come through value-based reimbursements, such as BCN incentive payments or the Blue Cross PGIP program, to support our office systems for improving quality. They help support the infrastructure and our whole team – medical assistants, call center staff, front desk staff. We use the whole team to their maximum potential to help us do the right things for our patients and create a good patient-centered medical home.