Because of COVID-19, many primary care physicians have seen declines in well-child visits and vaccinations. The trend has put children at risk for developmental delays, and children and adults at risk for infectious diseases. The declines have significantly impacted operations.

In the summer of 2020, healthcare data and software company Arcadia started offering provider-organization clients analytics to create educational outreach campaigns designed to cut through conflicting information and encourage parents to bring their children and themselves in for well visits and routine vaccinations.

The vendor's provider-organization clients found the most successful medium to be text messaging, compared with the more common email approach.

Dr. Rich Parker, chief medical officer at Arcadia, has learned how to overcome data quality issues, how to value analytics for monitoring care gaps, and how to build patient and provider trust when implementing strategic patient outreach and engagement. Healthcare IT News sat down with him to bring some of his expertise to readers.

Q. Where are patient-engagement efforts that use text messaging falling short?

A. There are two main ways patient engagement efforts via text messaging can fall short. First, there can be technical problems, such as incorrect data capture or incorrect teeing up of the messages prior to outbound sending.

One challenge is that healthcare organizations may not have the technical abilities to adequately prepare the messages, and they must rely on vendors to do the preparatory work before a text campaign can be launched. This can take days or even weeks, which then can frustrate the healthcare organization on a tight timeline.

Additionally, at times, phone number data is incomplete, especially when targeting older adults who have a higher likelihood of using a land line that cannot accept a text.

The second way text-messaging efforts can fall short rests fully with the healthcare organization. The healthcare organization may not be adequately organized with the details of its outbound text campaign.

For example, if it is focusing on COVID vaccines, it might not have adequately culled its vaccine registry to make it completely up to date, resulting in errors. Another pitfall is incorrect data, such as advising a mammogram to a woman who just had one a month ago. Errors erode trust by patients in their providers and wear down trust of the providers in their institution.

Q. How can data and analytics improve text outreach programs to patients?

A. Data and analytics are foundational to the success of a text outreach program. First, the healthcare organization needs a clear goal for each text-outreach program. Goals may include the number or percentage of patients reached, the percentage who open the text, and the percentage who act on the text.

For example, a healthcare organization might wish to improve its mammogram screening rate by 15%. Such a goal requires data and analytics to understand the baseline, and then the ability to measure results going forward.

Further, analytics and data can inform healthcare providers and payers about where patients' most significant gaps in care lie, both at the ZIP code level and within discrete age ranges. For example, a health system might wish to target women between ages 50 and 60 for a mammogram campaign in a particular set of ZIP codes.

Data and analytics also can inform financial information. For example, an accountable care organization might wish to understand how a 15% increase in mammogram rates would translate into a financial pay-for-performance payout under multiple contracts.

Q. Please describe your customers' patient-engagement efforts to boost well-child visits and childhood vaccinations during the pandemic, and why these efforts were needed.

A. We learned during the pandemic that many people were foregoing needed routine care due to the understandable fear about contracting COVID-19 during an office visit. As a result, we have seen a significant decline in well-child visits and childhood vaccination rates around the country.

However, the focused use of data and analytics allows healthcare organizations to identify gaps in well-child visits and childhood vaccinations. Based on these gaps, the healthcare organization can create a registry for a targeted text outreach campaign that reminds parents to schedule well-child visits and vaccinations for their children.

Our experience suggests these projects require collaboration between the CMIO and population health leadership to bring data, analytics and clinical operations together. Though these projects are not costly, they do require adequate support from leadership and buy-in from community practices, especially for pediatric initiatives.

There often is a place for a centralized entity to push out high volumes of messages while the practices do the boots-on-the-ground work. Depending on the patient population, text messages can be sent out in multiple languages with very high uptake.

Healthcare organizations with large pediatric populations have told us they see the combination of influenza, respiratory syncytial virus (RSV) and COVID-19 causing a large spike in childhood respiratory illnesses. This spike in cases has further impelled healthcare organizations to accelerate text outreach programs for pediatric patients.

Q. How does a provider organization build patient and provider trust when conducting patient outreach and engagement?

A. Start small and get it right. As is true with many new projects, there will be providers who can't wait to start a text outreach program, and there will be others who are in the "over my dead body" crowd.

Most providers will fall somewhere in between on the spectrum in their willingness to try something new. We suggest asking the clinical lead to choose a practice that tends to like-new projects and is not averse to technology. Starting small allows the healthcare organization to iron out the bugs, as well as starting to build confidence among the provider community.

Bring in key opinion leaders from community practices to gain provider insight. The focused use of data and analytics also allows healthcare organizations to send texts that reference the name of the practice/provider and use the same area code as the practice phone number to build trust in the engagement.

Frequent refreshes of data and scheduling data availability allows healthcare organizations to track patients who scheduled an appointment or received a vaccine.

Another lesson learned in building trust is the importance of sending out text messages in batches, rather than all at once. For example, if an accountable care organization with one million members sent out texts all at the same time to every family with well-child or vaccination gaps in care, the incoming requests to a practice could swamp their ability to both respond and provide timely appointments.

Therefore, we suggest sending out weekly aliquots of messages over a four- to twelve-week time frame in order to smooth out the demand for new appointments. Ultimately, patient trust is engendered by sending out accurate information that can result in timely appointments.

Make sure to use simple language and have the message address come from the patient's personal physician, rather than the larger healthcare entity.

Ultimately, provider trust is engendered by seeing the successful results of an outbound text campaign result in a large number of children coming in for well-child and vaccination visits without a large expenditure of staff time or resources.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.