Health system leaders and public health officials across the country have been grappling with the roll-out of vaccination programs, and the largest health systems have had to scale up rapidly.
Altamonte Springs, Fla.-based AdventHealth includes 50 hospital campuses and hundreds of care sites across almost a dozen states. In an e-mail Q&A exchange with Healthcare Innovation, executives from AdventHealth discussed the challenges they have worked through in getting vaccines rolled out across their health system.
Weighing in were Brent Box, M.D., Senior Vice President and Chief Medical Officer; David Oakley, Vice President of Digital Health; Pam Guler, Vice President and Chief Experience Officer; and Jessica Baird-Wertman, Vice President of Operations for Physician Enterprise. They took advantage of communication software from a company called Phreesia to manage the waitlist, automate patient intake, and deliver personalized messaging for education, reminders and recalls—all integrated into the patient’s record.
HCI: Could you give us the basic timeline of when AdventHealth started administering vaccines to its patient population? What were some considerations that went into the setup?
Box: We began administering vaccines in mid-December to our workforce. We began administering vaccines to our patient population later in the new year. We had to develop vaccination procedures, protocols and tools that would follow vaccine manufacturers, and federal and state regulatory guidelines. Logistically, we had to develop scheduling, reporting, and tracking mechanisms.
HCI: Could you talk about the biggest challenges of managing the vaccine distribution process from a health system standpoint? Is it communicating about availability and whether patients are eligible? How do you manage that?
Box: The biggest challenge was developing then refining the playbook and tools to manage distribution of the vaccine across our health system. We developed a task force that looked at:
• Logistics and supply
• Regulatory and legal issues
• Administration/tracking and reporting
• Communication/marketing and consumer issues
Oakley: From a technology perspective, some of the biggest challenges we faced were the build and configuration of scheduling tools and documentation systems to enable scalable and repeatable events.
We have been running more than 50 concurrent vaccination events for employees and community members ranging between 50 and 5,000 attendees, and ensuring we have direct line of sight into the technical, pharmacological, and logistical details of these events has been challenging. As an example, manufacturers of the COVID-19 vaccines have different intervals between first and second doses, and it’s important that we are able to create the mechanisms to easily book the first appointment, create streamlined registration and clinical documentation processes to enable large-scale vaccination events, ensure we have the mechanisms in place to book the second dose at the time of the first dose administration, and enable submission of vaccination data to the state.
HCI: Do you find the process differs from state to state? Are there challenges with reporting vaccination information to state or local public health, including race/ethnicity/language data?
Box: The process differs significantly from state to state based on each state’s rules for prioritization, vaccine distribution and reporting. Each state’s reporting requirements had to be managed separately and by the teams that reside in those states.
HCI: Does some of this data entry involve the patient portal and EHR? Any challenges there? Are there quite a few people who need vaccines but don’t yet have a portal account set up?
Box: We have evolved how the EHR and data reporting/data entry are related with the goal that data is entered into the EHR and simultaneously gets uploaded for the purpose of regulatory reporting.
Oakley: We do not require patients to create a portal account in order to book their vaccine, although through Phreesia there is integration for vaccination records.
HCI: Has AdventHealth worked with Phreesia on other patient engagement efforts? How are you using its tools in this effort and what do you like about it?
Oakley: Yes, we use Phreesia to streamline the registration process in order to make the check-in processes simple on the day of events. Their contactless mobile check-in reduces the registration time at our events significantly.
Baird-Wertman: We have worked with Phreesia for our regular appointments and for COVID screening questions since early in the pandemic.
HCI: Is there an educational element – and trying to work with people who may have vaccine hesitancy?
Box: We have been committed to being diligent and transparent with all the information that is available through the EUA [emergency use authorization] process, from federal and state guidelines and communicating that information to our team members in a way that they can make the best-informed decision about taking a vaccine.
Guler: Since October 2020, AdventHealth has been conducting an ongoing research study asking our consumers about vaccine hesitancy and the likelihood that they will get an available vaccine. By January of 2021, we have heard from well over 115,000 consumers helping us better understand who is hesitant, and how this has changed over time. Our study has indicated that women are more hesitant than men to get the vaccine, and diverse Black/African American and Hispanic consumers have even higher hesitancy. For this reason, AdventHealth has chartered an intentional focus on access and outreach for vulnerable diverse communities, and women in general. To be the most impactful, we are targeting ways to go to vulnerable diverse communities in person in a grassroots effort to talk with individuals and help address their concerns, as well as administer vaccines, provided we have the doses available from government entities. We are also leveraging digital communication channels such as social media and other outlets to reach vulnerable consumers who may have this type of virtual connectivity, with thought leaders to answer questions identified as prominent concerns in our research study.
HCI: Anything else you would want to mention about this effort?
Box: The vaccine effort has been a significant challenge but an effort well worth the endeavor for our health system and a great opportunity to work with local, state and federal partners to bring vaccine to our work force and to our communities.