In this unprecedented healthcare era brought on by the COVID-19 pandemic, one possible silver lining is that the industry has shown the potential to innovate fast when needed. This transformation was on full display during health systems’ rapid transition to telehealth when most non-essential in-person visits were halted. Another example of quick innovation has been providers finding new ways to engage with, communicate and educate their patients during a global health crisis. The importance of these strategies will only ramp up as COVID-19 vaccines continue to be rolled out to the general population.
To get out in front of these issues and proactively connect with patients, Prisma Health, the largest system in South Carolina, serving 1.2 million patients annually across 18 hospitals, has been working with virtual care and communications provider Conversa Health on a program to tackle the challenge of communicating with patients about vaccines—specifically, what they need to know, when they can schedule their appointments for the two doses, and how to ensure they come in for both visits.
This effort begins with simply educating patients on the safety and efficacy of the vaccines. Patients want to know when they will be eligible to receive vaccines and what their experience will be like, including potential side effects. They also need an easy way to set up vaccine appointments and get reminders to follow through on their visits. Health systems additionally want to monitor such potential side effects, both to ensure patients get needed follow-up care and to report any side effects to the CDC. Put altogether, having digitized and personalized processes to meet these needs can save health systems a lot of time and resources, says Nick Patel, M.D., chief digital officer at Prisma Health.
In partnership with Conversa, Prisma Health officials have been aiming to accomplish this level of automation for the 1.2 million patients the enterprise serves each year. On the vaccination front specifically, Patel stresses that education “will be extremely important as there are different vaccines that have dissimilar protocols,” explaining that the Pfizer vaccine averages about 28 days before immunity is reached, with Moderna’s averaging 40-plus days before immunity. What’s more, there are some side effect differences between the two vaccines, he points out. “So for Prisma Health, we have to send out messaging that there is a vaccine, it is safe, and here's how it's being distributed,” says Patel.
Indeed, Prisma Health is playing a key role of vaccine distributor, using the Vaccine Administration Management System (VAMS) set up by the CDC. Patel, who got his first dose of the vaccine in late December, explains that the health system will receive a notification through VAMS when a given person has been deemed eligible for the vaccine. From there, the recipient of the vaccine will enter his or her demographic and contact information, and then schedule an appointment. A QR code is given at the end of the registration process, which gets presented to the provider on the day of the appointment.
Patel notes that it will be working with Conversa on personalized virtual messaging that provides information to the recipient for when he or she needs to get the second shot. And the system should have the ability to nudge the person a few times leading up to the second administration of the vaccine, and conversely should turn alerts off once it’s been confirmed the second dose has been given, he says. “With millions of people needing to be vaccinated, we cannot have a manual, paper process to track who received a vaccine and who experienced side effects. We have to automate this process to track information accurately and at scale,” Patel asserts.
Starting with the basics
Long before coronavirus vaccines were even a consideration, Prisma Health tapped into Conversa for the company’s COVID-19 Health Screener and Triage Program, a fully automated screener and triage tool designed to educate patients and help them understand what actions they should take if they are worried they have COVID-19. Via the personalized tool, patients can quickly and easily check their symptoms and, if necessary, get connected to the appropriate next level of care, such as a telehealth visit or additional testing. Additionally, patients may sign up for ongoing automated alerts about COVID-19.
Early on in the pandemic, Patel recalls that the health system’s practices and contact centers were getting flooded with calls from concerned patients, and at the time, there weren’t standard protocols, so the information a person received might depend on who they spoke to. So, as the organization’s chief digital officer, the first thing Patel did was reach out to Conversa to start using its COVID-19 screening chat. “We have had over 170,000 engagements on that chat alone, which is just around getting tested. The [chat] gives you education about testing, but it also helps us triage these folks to where they need to get tested based on their zip code, while also catching people who may have non-COVID symptoms, but still need to be paid attention to,” he explains.
From those engagements in the screener program, which is available on Prisma Health’s website, a person falls into a green, yellow, or red category. Green means that the user is healthy, and the tool provides that feedback, conveys that a COVID-19 test isn’t necessary, and also gives advice on how to continue to stay healthy. The yellow category means the user has some symptoms, such as a fever or cough that could be related to COVID-19, but also other symptoms that could mean the issue is a non-COVID one. Yellow category users will be set up with a subsequent virtual visit. Finally, those who fall into the red category have the primary COVID symptoms of fever, cough, and shortness of breath, as well as recent potential exposure to the virus. These patients are given information on self-isolating as well as how to get tested, explains Patel. “All of this has helped us triage these patients, and our contact centers love it because their call volume has significantly dropped. It’s also helped get people to the right place for testing, and we have seen people getting tested faster and more efficiently,” he reports.
Even before the screening and triage program, there was still a very early need to educate residents on what Patel calls the “3 Ws”: wear masks, watch your distance and wash your hands. “We put a lot of education out there around safety protocols, because early on there was so much confusion, even around issues such as how the virus spreads and how long you were supposed to keep packages out before opening them. Data was coming from all directions—social media, online, and from routine news forms that we're used to—so we wanted to standardize that, and make sure that we communicated very clearly that people should not just look at social media where there’s unverified data, but rather at verified resources like the CDC and our local governmental agencies,” he recounts.
Alleviating fears
A related challenge that health system leaders have been trying to sort through since the onset of the pandemic has been addressing an array of patient concerns and other issues, from safely seeking care to being able to get the vaccine, and to declining mental and physical health. For instance, in a November survey of physicians from the Primary Care Collaborative, over 85 percent of respondents reported that the mental health of their patients has decreased during the pandemic, with 31 percent said they have been seeing a rise in patients suffering with addiction. Over a third (37 percent) said their patients with chronic conditions are in “noticeably worse health resulting from the pandemic.” This is due, in part, to visits that are not happening: 56 percent of surveyed clinicians said they have seen an increase in negative health burdens due to delayed or inaccessible care, according to those findings.
This is where Conversa CEO Murray Brozinsky believes automated, personalized messaging can play such a key role. “There is a lot of fear being expressed by folks, [particularly] now around the possibility they won't get the vaccine. So it's all about allaying fears and addressing very specific issues through personalized and automated communication,” Brozinsky says.
Kate Perry, PsychD, director of behavioral science at Atlantis Healthcare, a global company that develops and delivers scalable patient support programs, agrees, additionally noting that the pandemic has actually created an environment in which patients are more becoming more familiar in engaging digitally with their healthcare.
Concerned about the potential impact COVID-19 could have on the day-to-day management of chronic diseases—as well as the behavioral support that’s required when people are self-isolating—Atlantis Healthcare has developed a “Corona Coach” chatbot that profiles each individual, aiming to ensure they have access to the information they most need first, while also supporting them through multiple pillars of psychosocial wellbeing.
“For the psychology team here, COVID has [enabled] us to open up into a space in which we can talk more about mood or quality of life, compared to just disease or treatment. And that has allowed us to ultimately engage with patients in ways that are much more meaningful, offering more holistic content and support,” says Perry. “Patients aren’t as frightened as before about engaging with nurses on the phone or through a chat, and we see that as a [result] of the increase in telehealth and other digital solutions during the pandemic,” she says. Adds Patel, “The value of virtual care and communication has never been greater.”
