RSV/Flu Season Readiness: EHR Registries for High-Risk Pediatric Patients

By Karem

Every fall and winter in the United States, RSV and influenza put sustained pressure on pediatric clinics and emergency departments.

Health systems that prepare early - by building a clear EHR registry of high-risk children and running targeted, multi-channel outreach - consistently do better on vaccination rates, timely follow-ups, and home-care readiness.

This article lays out a practical, data-driven approach U.S. teams can implement now, with concrete build details, timelines, and messaging that respects family preferences and health literacy.

Two preventive options now shape U.S. RSV readiness: a maternal RSV vaccine (Pfizer Abrysvo) given at 32–36 weeks’ gestation, typically September through January, and infant monoclonal antibody administration given shortly before or during the season. 

Most infants need one approach, not both. For a subset of higher-risk children 8–19 months entering a second RSV season, nirsevimab is recommended again. 

In parallel, CDC continues to recommend annual influenza vaccination for everyone aged above 6 months, with some children needing two doses four weeks apart if they’re vaccine-naive. Starting outreach and scheduling early is crucial so that one dose isn’t delayed.

Your “respiratory-season” registry should update automatically from structured fields and drive reports, dashboards, and bulk-messaging lists.

Pediatric inclusion criteria (adapt to local policy): Include infants younger than eight months at the start of the season; children aged eight to nineteen months who meet criteria for a second RSV season based on elevated risk; children with conditions that increase RSV or influenza risk such as asthma or chronic lung disease, prematurity, or neuromuscular disorders; and children who have had emergency department or inpatient visits for wheeze, bronchiolitis, or asthma within the past twelve months as a practical indicator of recent instability. Keep this definition in a single, centralized place so the same logic feeds your registry, staff work queues, and quality dashboards without drifting over time.

Structured data to capture: Record date of birth, preferred language, and patient-portal enrollment status. Maintain an accurate problem list to reflect risk conditions. Track influenza vaccination dates and whether the child requires a two-dose series. For pregnant patients, document maternal RSV vaccination status, and for infants and toddlers, capture RSV monoclonal antibody eligibility and completion. Finally, include a simple home-care readiness field indicating access to basic devices - such as a spacer, nebulizer, and saline - so outreach teams can verify equipment availability and provide technique coaching when needed.

T-8 to T-6 weeks (late summer): Reconcile state IIS data so vaccine histories are accurate in the EHR; confirm your RSV rules reflect current CDC windows (Abrysvo 32–36 weeks, seasonal timing; infant antibody timing; second-season criteria). Create a “no portal / no mobile” segment - these families will need phone calls or mailed reminders to ensure equity.

T-6 to T-4 weeks (early fall): Open evening/weekend flu-shot sessions and build one-click order sets. Draft plain-language portal and SMS copy (≤5th-grade readability) in English and your most common languages. Outreach works best as a multi-channel plan (portal + SMS + phone) with self-scheduling links.

T-4 to T-2 weeks: Launch Wave 1 outreach - portal messages and SMS to the registry with direct booking links; OB clinics promote maternal RSV vaccination; pediatrics explains infant RSV antibody eligibility and timing. Wave 2 targets non-responders with reminder messages and outbound calls, prioritizing children who need the two-dose flu series so both doses fit in-season.

Use standardized standing orders and smart sets to reduce clicks and errors. Enable a single action for the age-appropriate influenza vaccine that also records contraindications and prints the VIS. 

Add an OB smart set for maternal Abrysvo and a pediatric smart set for infant nirsevimab when indicated. During rooming, display a subtle banner such as “Eligible today: Flu/RSV prevention” to prompt action. 

For children with wheeze or asthma , include a discrete “device access” field (Yes/No/Needs teaching) so staff can address equipment readiness without slowing the visit.

Reinforce education with a brief, 30 - 60-second teach-back, then attach a short portal video in the after-visit summary. Before the family leaves, schedule the second flu dose if the child needs a two-dose series.

Track completion rates for these steps on a weekly dashboard so teams can see where the flow is working and where to adjust.

Vaccines lower the risk of severe illness, but many kids will still get sick during peak weeks. 

Families who are prepared at home are less likely to need an ED visit. Include a simple yes/no field in the registry to confirm access to basic devices - spacer, nebulizer , and saline - and add a quick coaching step to check understanding.

For bronchiolitis, U.S. guidance focuses on supportive care, so clear, consistent instructions matter. Keep device readiness as a short, scripted check in your outreach and confirm it again in next-day follow-ups.

Families without portal access shouldn’t be left behind. Auto-route these lists to phone teams with interpreter support and offer community-friendly access points. 

Use plain-language messages and pictorial AVS instructions to reduce literacy barriers. 

Monitor outreach channel performance by language and zip code so you can rebalance staff time where it matters most.

Update one shared dashboard every week. Show the percent of patients in the registry who already have a flu-shot appointment, highlight those who need a two-dose series and have received dose one, track patient-portal enrollment, and record how many have device access = Yes.

Each month (and at the end of the season), review outcomes: total flu vaccinations completed among high-risk children, maternal Abrysvo given within the recommended window, infant RSV antibodies administered (including second-season nirsevimab when eligible), and ED/hospital visits for wheeze, bronchiolitis, or asthma. 

A 15-minute weekly huddle to review this dashboard keeps the team focused and helps you spot problems early.

With a clear EHR registry and a single, shared cohort, RSV/flu prep becomes simple and repeatable. Use multi-channel outreach, streamlined clinic workflows, and quick teach-backs to close the loop on vaccines and home care. 

Make sure each child’s nebulizer is available, clean, and used correctly, then track progress on a weekly dashboard. Start in late summer, stay consistent, and you’ll see fewer surprises, smoother schedules, and better outcomes all season.

FAQs

1) When should pregnant patients get the RSV vaccine?

Pregnant patients in the U.S. should receive a single dose of the maternal RSV vaccine at 32–36 weeks’ gestation, typically during the September–January window. This timing helps pass protective antibodies to the newborn for the first six months of life when RSV risk is highest. Clinics can make this easy by using EHR banners and an OB “maternal RSV” order set so counseling and vaccination happen during the same visit.

2) Which infants get RSV monoclonal antibodies?

Infants may receive an RSV monoclonal antibody (such as nirsevimab) shortly before or during their first RSV season to reduce the risk of severe illness. A subset of children 8–19 months old who are at higher risk are also recommended to receive a dose before their second season. Exact eligibility depends on current CDC/ACIP guidance, so your EHR registry should encode those rules and surface a clear “eligible today” prompt during well-child and sick visits.

3) Which children need two flu shots?

Children aged 6 months through 8 years who have never been vaccinated for influenza - or whose vaccination history is unknown - need two doses given at least four weeks apart in their first vaccination season. To finish on time, give dose one as soon as the vaccine is available and book dose two before the family leaves. Your dashboard should track which children still need the second dose so staff can send timely reminders.

4) Where do home devices fit in bronchiolitis and wheeze care?

Home-care readiness is part of the same plan as vaccination. Clean, working devices and correct technique - whether a spacer or a nebulizer - help families manage symptoms and can reduce avoidable ED visits. U.S. bronchiolitis guidance emphasizes supportive care, so provide simple, pictorial after-visit instructions, confirm understanding with a quick teach-back, and add a follow-up message or call to reinforce key steps during peak weeks.

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