Even before the first COVID-19 vaccines became available in late 2020, health systems around the United States faced difficult questions about how they should be distributed:
Penn Medicine took all of these questions into consideration as it came up with a plan to vaccinate as many people as possible, efficiently and equitably across all demographic groups. It became clear that a complex, multi-pronged applied informatics approach would be essential to a successful and equitable vaccination program.
As with other Penn Medicine efforts during the COVID-19 pandemic, multiple groups across the health system brought their expertise and hard work to vaccination deployment. Nearly 50 team members from Clinical and Operational leadership across all entities, Information Services (IS), Electronic Health Record (EHR) Transformation, Office of the Chief Medical Information Officer (CMIO), Clinical Effectiveness and Quality Improvement (CEQI), the Center for Health Care Innovation (CHCI), Marketing, Data Analytics, and several other groups came together daily starting in December of 2020 to collaborate on vaccination deployment efforts. Teams met daily to discuss outreach to patients, scheduling, technology, and other elements of the program.
Starting Dec. 8, the team had just one week to set up a system for vaccination deployment. Frontline health care workers received vaccinations first, followed closely by other patients in the 1A priority group, including those over age 65 or with health conditions such as diabetes, cancer, and a weakened immune system.
The first outreach strategy to reach 42,300 of these patients was to identify them through their information in the PennChart system, and send them a message through their patient portal, myPennMedicine. Of these patients, 17,300 scheduled an appointment, an impressive 41% conversion rate.
As we extended our contact efforts, outreach to a single patient might include multiple steps and three technology platforms. A patient could get an introductory email inviting them to sign up for a vaccine appointment, sent through Salesforce, our customer relationship management platform. If the patient responded positively to that email, they would then get a scheduling ticket sent through the myPennMedicine portal (run by Penn Medicine’s electronic health record system, PennChart).
Next the patient would receive two appointment reminders via email sent through Salesforce, and would have the option to receive text message (SMS) alerts, managed through Penn Medicine’s evidence-based patient engagement platform, Way to Health. Some patients without access to myPennMedicine got a text message with vaccine registration information, and others were asked to sign up for a vaccine appointment while at a doctor’s visit.
All of these evidence-based ways of reaching patients were designed with the patients and providers in mind. Applied informatics allowed engineers and data scientists to make these tools more efficient and easier to use, so that the path to getting people vaccinated was as smooth as possible.
Equity in vaccine distribution remained a challenge, even with the technology tools, personnel, and infrastructure available at Penn Medicine. For one thing, not all patients had a smart phone or computer, or even an email address or access to myPennChart. In many cases, the people most at risk of serious illness or death from COVID-19 were also not well versed in technology. So the teams working on vaccination outreach came up with other low-tech ways to educate people about the opportunity to get vaccinated, and to address vaccine hesitancy, as well.
Through Way to Health, the team developed a system for sending text messages to Penn Medicine patients who did not use the myPennMedicine portal. After receiving the text message, a patient could request to talk to someone rather than texting back.
Starting March 1, 2021, a team began calling patients who could not receive texts or access the myPennMedicine portal. Though only about 100 people signed up for a vaccine appointment using this method, the combination of technology and thoughtful consideration of patient needs allowed the team to reach people who probably would not otherwise have had access to the vaccine.
With the help of $1 million in funding from the City of Philadelphia, Penn Medicine also partnered with local businesses and religious groups to operate multiple vaccine clinics in West and Southwest Philadelphia. These clinics allowed walk-in appointments for the vaccine and made it easier for the team to reach Black and Latinx communities that had less access to the vaccine, and were at higher risk of serious illness or death from the virus.
As a result of this innovative, multi-faceted approach, the vaccination deployment team got shots in the arms of more than 140,000 people over the course of just three months.
Many more people have been vaccinated since then, and lessons from Penn Medicine’s vaccination deployment efforts and informatics-driven solutions will continue to inform the health system’s approach to patient outreach in other areas as well.