The Warren Clinic in Tulsa, Oklahoma, is a 450-provider employed medical group that's part of the Saint Francis Health System. Three million people need the COVID-19 vaccine in Oklahoma and Warren is the hub for Tulsa as well as seven surrounding counties.

THE PROBLEM

The clinic started planning early for how it would handle the influx of appointments once the COVID-19 vaccine became available.

"We established a COVID-19 department to spearhead the entire initiative and set up vaccine clinics to focus solely on the distribution of the COVID-19 vaccine," said Warren Clinic vice president Collin Henry. 

"One of our first priorities was to develop an effective way to communicate with the public very quickly and keep the entire process organized. Making sure vaccine doses didn't get wasted was also of the utmost importance to us."

In conjunction with the Saint Francis technology team, the Warren Clinic's COVID-19 department developed a plan to execute a vaccination program that was organized and efficient, and that could seamlessly be integrated into its current processes.

"The first vaccine manufacturer to get approved was Pfizer, and that vaccine's short shelf life made the scheduling and appointment-reminder process critical to reduce no-shows to ensure there was no extra vaccine at the end of the day that could possibly go to waste," Henry explained.

PROPOSAL

The Warren Clinic has been working with health IT vendor Relatient for a long time, specifically with their bi-directional appointment-reminder solution. The clinic had created some new workflows in its Epic EHR and then turned to Relatient to help with direct-to-patient reminders. 

The vendor's technology was easily integrated with Epic, and allowed staff to automate text, email and phone reminders, Henry said.

"We are proud to be able to share the Warren Clinic Epic appointment system with the local health department to support their efforts. This also means that they have access to Relatient's reminders and proven algorithm."

Collin Henry, the Warren Clinic

"Relatient proposed a fast turnaround of custom reminders that were connected to the department we built in Epic," he explained. "The reminder would be triggered by the vaccine appointments scheduled in Epic's department appointments report. 

"When patients make an appointment, they would receive reminders, and their responses were later available in the department appointments report, so our team would see where new vacancies opened up from cancelations and who had confirmed," he added.

Warren Clinic is aiming for zero wasted vaccine doses, and this strategy would mean that it would minimize both no-shows and waste. The multi-location management feature of the technology would also allow staff to efficiently manage all locations so staff would have the ability to be heavily focused on the distribution of COVID-19 vaccines as the clinic looks forward to expanding vaccine sites from three drive-through locations to its 46 primary care locations.

MEETING THE CHALLENGE

The technology's patient appointment reminder solution offered the Warren Clinic a level of responsive support and integration with Epic that made them stand out from other vendors the clinic had used before, Henry said.

"The organization and efficiency of COVID-19 vaccine appointments hinged on a new build in Epic that would then feed appointment reminders with Relatient," he explained. "The new Epic build is automatically triggered by a patient's first vaccine dose to create a second appointment 21 days later at the same time as the first."

Warren Clinic also added its new COVID-19 vaccine department to its existing Relatient appointment reminder template so patients are not only delivered a reminder to their appointment, but also a link to directions and a map to the drive-through vaccine clinic.

"Because Warren Clinic is vaccinating communities in and around the Tulsa area, many of the patients we are able to serve are new to the system," Henry noted. "We are proud to be able to share the Warren Clinic Epic appointment system with the local health department to support their efforts. This also means that they have access to Relatient's reminders and proven algorithm.

"We've been using the established algorithm and it has become extremely helpful for the 21-day follow-up appointment for patients to get their second vaccine dose," he continued. "We are also heavily relying on the vendor's appointment reminder system to ensure patients remember when their appointment is coming up and which location to go to."

RESULTS

The Warren Clinic has been working with Relatient for five years, and it initially piloted the vendor's technology across six provider locations with the highest no-show rates, and saw an immediate drop in no-shows by 52%.

"We believe this is due to patients receiving the appointment information directly to their phones, where patients are more easily accessible," Henry observed. "Based on this success, we subsequently rolled this technology out through the rest of the health system."

The other key to the clinic's success is the integration between Epic and Relatient, which is what makes patient responses accessible in Epic's department appointments report.

"This aids in backfilling vaccine appointments and optimizing providers and vaccine schedules," Henry said. "To date we have been able to distribute more than 21,000 COVID-19 vaccines."

ADVICE FOR OTHERS

"I would first recommend having a myriad of vendors who offer great service, are responsive and act more like partners than vendors," Henry advised. 

"Then, leverage those relationships so you can respond quickly and get a plan in place. Having a plan is so important to the COVID-19 vaccination process, because you really need the technology infrastructure to not only document it in the EHR but to also feed that information back to the state so the federal government can also have their daily reporting."

Additionally, having established vendors who one knows and trusts – and most important, who understand the values and expectations of one's organization – makes the rollout of any new project or technology easier, he said.

"My other advice would be to ask for the things you need, maybe it's ensuring the integration is there," he concluded. "Maybe for the sake of speed, you want to ask for something unintegrated that can be connected at a later point in time.

"Epic and Relatient were key to our success, because we needed those two systems to talk to each other and we weren't afraid to ask Relatient to move really fast to help us get our strategy in place on time and on brand."

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