BACKGROUND: Influenza vaccinations are a preventive health quality measure. Home telehealth nursing staff interventions can reduce influenza disease burden and complications. PURPOSE: To improve seasonal flu vaccine rates using novel home telehealth clinical and technology interventions. METHODS: A pre- and postintervention concurrent cohort study for 513 outpatients was conducted. Interventions included automated 2-way patient messaging using remote monitoring equipment, a new note template to record vaccination status in the electronic health record, and flu vaccine patient education. RESULTS: Interventions resulted in vaccination rates of 70.4% for Veterans ages 19 to 65 years, and 81.7% for Veterans 66 years and older, exceeding national, regional, and local Veterans Administration targets. CONCLUSIONS: Two-way messaging and standardized documentation increased rates. Declinations persisted despite education. Reasons included fear of side effects, and rarely leaving home due to the COVID-19 pandemic. Nursing interventions can increase influenza vaccination quality measures for primary care home telehealth patients.