Expert Forum: Leaders share vaccine management strategies and early lessons
For good reason, COVID-19 vaccinations top the list of trending healthcare stories for 2021. But for each healthcare organization and their respective municipalities, strategies for communication, engagement, and physical setup may differ vastly.
athenahealth recently spoke with three leaders in different stages of their vaccination initiatives about what they’ve learned throughout their pandemic response and from initial immunization efforts.
Aaron Miri is the chief information officer for Dell Medical School at the University of Texas at Austin. Their first round of vaccinations for front-line healthcare workers included 300 recipients a day, who received their second “booster” shots the first week of this year.
Steven Travers is the chief information officer at USA Health, one of the largest provider groups on the Gulf Coast. The academic medical center is affiliated with the University of South Alabama College of Medicine, and has several care sites including University Hospital and Children & Women’s Hospital. Through a partnership with the city of Mobile, USA Health also developed a drive-through COVID-19 testing and vaccine administration center at a municipally owned arena. USA Health's first round of vaccinations began in mid-December with 2,600 doses total and booster shots began the first week of January.
Breanna Lathrop is the chief operating officer at Good Samaritan Health Center, a federally qualified healthcare clinic in Atlanta staffed by doctors and volunteers. She and her team started vaccinating staff and volunteers and some patients age 65 and older in the middle of January; a community helpline will continue to schedule up to 200 tests daily, and add 100 vaccinations weekly (with the possibility of increasing those numbers based on supply and demand).
What was your initial approach to managing COVID-19 and how has that set the stage for the vaccination process?
Travers said having a cloud-based EHR in place helped his team at the arena testing center use iPads connected to a 4G wireless network so they could hit the ground running, rather than configure the slower option of connecting through USA Health’s off-site intranet. As far as external communication, USA Health focuses resources on continually updating its website with COVID-19 information for patients. And an internal task force has evolved from focusing on testing to broader vaccination strategies.
Miri’s team had a similar approach. “[Cloud access] allowed our clinicians to respond quickly to COVID flare-ups in the community, be it at the Salvation Army, be it churches, be it homeless shelters. We’ve learned a whole lot” that will inform future approaches for vaccinating larger populations off-campus, he said.
Lathrop spearheads a robust blog at Good Samaritan, where she also makes it a point to liaise frequently with other non-profits. It’s where she got the idea for a new triage system for outpatient care throughout the pandemic. “We [hired] someone who sits outside...with the thermometer. They have screening questions, and then they are able to let people into the clinic for regular care, have people wait outside if they're trying to schedule testing, or route them to the alternative entrance if they're here for COVID-related service. That position has been really critical just right from the start and won’t be going away anytime soon.”
What tools or initiatives have been most valuable for your organization?
Miri and Travers made it a priority to reduce the burden of scheduling vaccinations for already overworked staff, and are using athenahealth’s Consumer Scheduling tool. The solution doesn’t require logins to reserve appointments, meaning vaccine recipients didn’t have to be existing patients or go through a long registration process.
Good Samaritan was able to set up a customized COVID-19 clinical department to create log-ins for phone line volunteers with access to select patient records. “Normally giving access to that many people would make me nervous, but they can only see and schedule in the COVID department, or escalate a case to a provider’s inbox,” Lathrop said. “Plus, it’s easy to train volunteers, they shadow for a morning and it’s like they’re pros.”
Her team also started a COVID-19 helpline for patients and the community that has responded to more than 21,000 calls since last spring. The line now also traffics requests for vaccinations. “It’s voice-reactive so they’re asked questions and it populates in a live spreadsheet so that our phone line volunteers, who are on a scripted program with support from providers, know who to prioritize and what’s going on.”
What are your approaches to communication and patient engagement?
Besides the blog, Good Samaritan is proactive about patient education. Early on in the pandemic, the team put together virus FAQ sheets that were “on every counter, in every exam room, so that as patients were waiting and they were here for a service, those big common questions were answered,” explained Lathrop. For vaccine distribution, her team is thinking bigger. “We may do a fuller high-production type of video with staff receiving it, giving their reasons to be vaccinated. We’ll compile that and use it for short media spurts out to our Facebook, Twitter, and for sharing through our community partnerships,” she said. “We have a lot of internal conversations around talking and being open to answering patient questions.”
At USA Health, one of Travers’ top priorities is enhancing means of enabling patient communication this year. “I’m looking for more, beyond a standard portal, which was what USA Health did previously to be in line with government mandates. I’m looking for a communication system so patients can get text messages, we can do video visits. They can get information that we push out based on which diagnosis they might have. So we’re trying to look at an encompassing consumer-based portal that, if I was the other person on the other end, I’d find it useful,” he said. “As we move away from [vaccinating] employees, we’re going to have to be much more diligent about ways to manage follow-up appointments.”
What are some of your biggest challenges and how are you rising to meet them?
Travers said he can anticipate some potential challenges when it comes to educating patients down the road, because only 55 percent of eligible employees expressed interest in the first round of vaccinations in an initial survey. That number has since “spiked” but some staff — including security guards and cafeteria workers — didn’t know they qualified as front-line workers, he said. USA Health also made a concerted on-the-ground effort to address healthcare disparities with minority groups who indicated less interest in being vaccinated. “We really focused on the hospital administrators, and leaders just walking around and saying, “Are you getting vaccinated? Let me talk to you about signing up,’” said Travers. “I think a lot of that helped out quite a bit.”
Lathrop is strategizing about storage, as Good Samaritan doesn’t know whether they will receive doses from both Pfizer and Moderna (the former must be stored at -112 to -76 Fahrenheit, the latter -13 to -5F).
“A lot of the question is also, do we have the opportunity to open it up more widely and vaccinate anyone who wants to come by or is our site just going to be vaccinating our established patients. I’m open to either,” she said. “But we do flu shots for every single one of our patients that will take it every year. So the idea of suddenly vaccinating all of my patients is something we have a process for,” she said, while “running a community vaccine program would be different” in terms of staffing and budget.
What advice would you offer other organizations that are or will be vaccinating?
Besides configuring patient schedules, having a plan in place to protect staff exposure has been vital throughout the pandemic, say Miri and Lathrop. Dell adopted a seven-days-on/seven-off approach for determining who was on-site, and Good Samaritan started a “clinical task force” where only select providers would be exposed to infected patients. “I've got providers that have never been in our COVID room and have never answered a single COVID call,” said Lathrop. “We can then move our prenatal patients and our highest risk patients to these providers.”
Miri’s team, and Lathrop, advise that there’s no such thing as reiterating too much. At Good Samaritan, medical assistants ask the same questions as the person assigned to entrance triage. “Just in case some folks got confused or intimidated,” Lathrop explained. “We do catch a few who just hearing it from a different person will need to be routed otherwise.”
Dell Medical School provided guidance for patients when booking their initial vaccination appointments that included arriving early and bringing identification; and then repeated those messages by using functionality to attach instructions once patients are scheduled.
All three organizations extolled the virtues of working with others locally. Lathrop frequently talks to leaders at other FQHCs, while Travers participates in a consortium for CIOs of Alabama universities. Currently, that group’s primary focus is COVID-19. “Learn from others is what I say,” advised Miri. “Reach out to other institutions who were earlier on the list [of those vaccinating] to talk about what was learned and what we haven't learned. Work with your state agencies. Make sure you build those relationships ahead of time.”
What have you learned throughout the pandemic that will affect your future approach to healthcare?
Miri and Lathrop see more partnerships on the horizon. “A lot of the reason we had testing that was as good as we did is because of partnerships with pharmacies. For example, we're testing 200 people a day because CVS has come in and taken over what was a gym in a health pavilion,” said Lathrop. “I've already been putting bugs out, like, I heard CVS is going to be involved in vaccination, remember us — you'll always have the health pavilion at your disposal!”
In Austin, Miri calls partnerships with local grocery stores and pharmacies “tremendous.” “I foresee much more interesting private/public partnerships, really good partnerships that can service the community in a truly encompassing manner.”