Throughout Denver Health's pandemic vaccination efforts, the struggle was getting people who did not already have patient records with the health system into the system efficiently without burdening the call centers.

THE PROBLEM

As the safety net health system for Denver Metro, Denver Health vaccinated many people who were not regular patients. Early on, the health system stood up a vaccine interest form created by the IT teams on a separate database that allowed anyone from the public to put their name on a waitlist for an appointment, when the health system had available vaccines.

"We then used that database to pull contact info and send scheduling tickets to people to get a vaccine appointment online, without having a Denver Health Portal account," said Dr. Ann Boyer, chief medical information officer at Denver Health.

"This was a very manual process for our IT teams using tableau over the database to pull thousands of names based on age and eligibility criteria and then enter them into a tool we built to send out an email with a scheduling code.

"For our people to schedule online, they needed to make sure we did not have duplicate accounts, typically going through a process to verify identity with known information," she continued. "In our older populations, this often was difficult for them to navigate the patient matching questions required to create an account in our patient portal."

As pediatric vaccinations were coming in the spring of 2021, staff knew getting access to scheduling for thousands of kids in Denver public schools was going to be a burden for the call centers.

"Our pediatric MyChart rates were fairly low compared with our adult populations, and we partnered with Denver Public Schools to make sure we could offer vaccines to tens of thousands of kids who were 12 or older, who may not have a Denver Health account," Boyer explained. "We tackled 16 and older with our old method, sending unique generated scheduling codes and instructions to the DPS emails of all students who were 16 years or older in April of 2021.

"However, this was a very labor-intensive process," she continued. "It also was complicated by DPS spam filters and relying on students to get the info/code to their parents and get consents signed."

PROPOSAL

EHR vendor Epic's Open Scheduling system would allow Denver Health to pivot to a less manual approach, letting people who wanted an appointment click a link on the health system's website or from a community partner website, like that of Denver Public Schools, and find the location and vaccine they wanted, without already being a patient.

"Our patients also could use those tools, or log into their MyChart patient portal account and schedule directly from there," Boyer noted. "Open scheduling for us came around the time that vaccine supply was less limited and eligibility criteria was less stringent, therefore the need for the wait list and our prior prioritization tools was no longer needed.

"It allowed our clinics to have a certain number of vaccines available for Open Scheduling while reserving some spots for our at-risk patients," she added.

MARKETPLACE

There is a wide variety of electronic health record vendors on the market today, including Allscripts, athenahealth, Cerner, eClinicalWorks, Epic, Greenway Health, Medicomp Systems, Meditech, Medsphere Systems and NextGen Healthcare.

MEETING THE CHALLENGE

The Open Scheduling system offers the ability for people who have never been seen at Denver Health to schedule an appointment. This is an important tool for vaccinations as the provider tries to reach a broader community who may not have access to vaccines elsewhere, particularly earlier in the pandemic.

"We targeted Open Scheduling once we had adequate vaccine supply in late spring of 2021, once vaccines were opened to the general public," Boyer recalled. "We leveraged the ability to create special URLs for certain clinics – just our school-based health centers and school mass vaccine sites as a way to target kids and their families.

"We sent these special URLs to Denver Public Schools to post on their website and send in school communications to families, and sent directly to kids in their DPS emails to allow them to sign up for vaccines at certain Denver Health locations that targeted Pfizer vaccines, which were approved for kids," she continued.

Community clinics were able to add Open Scheduling blocks to their schedules after offering to established Denver Health patients, as a way to offer vaccines in clinics throughout the Denver Health metro area if there was vaccine availability, but still give clinics a way to serve their patients first. Given the clinics are FQHC, Denver Health wanted to protect access to its at-risk patients.

Denver Health's public website had Open Scheduling links for each vaccine manufacturer, or for first available.

RESULTS

Without Open Scheduling and direct scheduling, the call volumes for the call center would have been difficult to absorb, particularly in April/May 2021 and Nov./Dec. 2021, when new age groups were authorized.

Around 20% of appointments for people 18 and under were scheduled via Open Scheduling, more so in the first few weeks after those age groups being approved (25-35% via Open Scheduling in May and November of 2021).

For initial vaccines in people 18 years old and under, in May 2021 25% came through Open Scheduling (884 patients), 14% through MyChart (495 patients) and 62% through the call center (2,236 pts).

In November 2021, for patients 5-11, 37% came through Open Scheduling (2,412 patients), 22% through MyChart (1,467 patients) and 40% through the call center (2,668 patients).

ADVICE FOR OTHERS

"Giving patients self-service options to schedule appointments is very important," Boyer stated. "Some people will not sit on hold for hours to get appointments scheduled. Self-service tools give the ability for patients to have more control over time and location of appointments, but also off-load the need for additional staff when surges of registrations happen.

"Think about flu shots as a great use case for this as well," she concluded. "Seasonal surges in demand. Placing scheduling capability on your public website or even links from community partners allows health systems to fill appointments in areas that have capacity with people new to your health system, while keeping other areas that have no capacity reserved for select patient populations."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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