| Barriers | Facilitators | |
|---|---|---|
| Staff | Staff perceptions about self-efficacy; liability | Practice policies and protocols |
| Inconsistent use/attitudes of providers and staff within practice (spread) | Staff education and follow-up by leaders, liaisons (eg, staff meetings) | |
| Staff feeling the need to check with providers about order (especially laboratory tests) | Collaboration and good communication regarding expectations | |
| Time management concerns of some staff regarding new responsibilities | Staff interaction frees provider to address other health priorities | |
| Staff refusal/lack of follow through to adhere to SO protocol | Recruit staff that support a team based approach to patient care | |
| Data issues within EHR | Health maintenance templates not applied to eligible patients | Technically savvy leader within practice applies set of templates |
| Inexperience with customizing/applying templates and rule files | Demonstrate application and use of templates to all clinicians | |
| Distrust in the data to guide staff in acting on SOs | Nursing note templates and direct entry on health maintenance table | |
| Technical issues sometimes require vendor support | ||
| Patients | Patient refusal/lack of insurance for some services | Consistent practice wide approach/repeated messages |
| Incomplete data on services patient received elsewhere | Patient information update forms generated from EHR data | |
| Practices | Limited or no reimbursement for some immunizations | Referrals for patient to receive immunizations elsewhere (eg, public health clinics) |
| Legal regulations in some states prohibiting SOs or immunizations by unlicensed clinical staff | Clinicians follow up after order initially discussed by clinical staff | |
| Competing priorities decrease practice focus on implementing SOs | Leaders and liaisons keep the focus clear, communication channels open |
EHR, electronic health record.