Supplement Article  |   February 2010
Just in time information—vaccinations
Article Information
Preventive Medicine
Supplement Article   |   February 2010
Just in time information—vaccinations
The Journal of the American Osteopathic Association, February 2010, Vol. 110, S27. doi:
The Journal of the American Osteopathic Association, February 2010, Vol. 110, S27. doi:
Learning the schedule for the more than 50 vaccines indicated for our patients is like memorizing telephone numbers; or finding a way to have that information where we needed it so we could access it when we needed it. 
With telephone numbers, storing them in our phones, speed and voice dialing and other technologies have taken away the need to memorize them. Thus, many of us have long forgotten telephone numbers, relying on systems and programs to get us to our goals and contacts. The same thing is happening with vaccination schedules. 
The concept of “teaching information at the point of care,” or “just in time education” is not new. The technology and quality of bedside informatics are new and they put a lot of valuable information at our fingertips. 
Currently, some 64% of physicians are using smart phones or portable digital assistants.1 Smart phones have a lot of advantages: They are easy to carry, easy to use, fast and are perceived by physicians as a means of improving productivity and patient care.2 These devices can also increase a physician's adherence to guidelines like vaccination schedules.3 
Many physicians do not follow guidelines for many reasons. One common reason cited is difficulty or inconvenience in using guidelines.4 Clinical decision support programs are tools to facilitate the use of guidelines and schedules and make it easier for physicians to practice evidence-based medicine.5 
While some people argue that physicians should have memorized the schedules at least once in their careers, the concept of primacy, or what we learned first, stays with us and can make unlearning difficult. 
Another argument is that programs can skew behavior in unintended or unwanted ways, and we need to know how the program is working or a concept called jailbreaking. Jailbreaking a program means that you have the ability to get to the core processing of the program. Is it necessary to understand how the recommendations came up, or is it sufficient to know which organization supplied the recommendations? 
It is clear that these programs are here to stay. Whether they become sanctioned or not is yet to be seen. The most common clinical support decision programs for vaccinations include: 
Shots 2010—A collaboration of the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP), it has easy access to the 2010 Immunization Schedule, recommended by the ACIP. Details on each vaccine are available by clicking on the vaccine names. It has internet update capability, but does not require internet access for use. For details, visit 
Up To Date—Current reference on vaccinations. No software processing of information. It is an authoritative repository of information. For details, visit 
Additional Resources
CDC—2010 child and adolescent immunization schedules. For details, visit 
Lexi-Comp—Drug and vaccine information. Includes algorithms and specific vaccine information. In addition, offers users more room for decision making. For details, visit 
Micromedex—An information-heavy program that can be downloaded from the internet. For details, visit 
Vaccines Handbook Mobile Version—A companion to Orenstein and Offit. Free download. Good program for vaccination information for travelers, as well as special situations. For details, visit 
  Tyler C. Cymet, DO, is the associate vice president for medical education at the American Association of Colleges of Osteopathic Medicine. Owen D. Vincent, OMS III, is an osteopathic medical student at the Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) in Harrogate, Tenn. Cecily E. Dupree, OMS II, is an osteopathic medical student at Rocky Vista University College of Osteopathic Medicine in Parker, Colo.
Dolan P. Can a surge in physicians' use of smart-phones ripple to health IT adoption? American Medical News May 25, 2009. Accessed January 7, 2009.
Al-Ubaydi M. Handheld Computers. BMJ.. (2004). :328:1181-1184.
Sintchenki V, Iredell JR, Gilbert GL, Coiere E. Handheld computer-based decision support reduces patient length of stay and antibiotic prescribing in critical care. J Am Med Inform Assoc. (2005). :12.398-402.
Cabana M, Rand C, Powe N, Wu A et al Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999: 282:1458-65.
S. Rothchild, JM. Handy point-of-car decision support. Annals of Internal Medicine 2009: vol151 #10, 748-9.