Jefferson Health, a multistate health system serving the greater Philadelphia region and southern New Jersey, has been recognized as a 2022 HIMSS Davies Award winner.

The provider organization leveraged analytics capabilities and a variety of technologies to address several clinical challenges through the peak of the COVID-19 pandemic, notably closing equity gaps with the administration of COVID-19 vaccinations and mitigating infection risk for acute care patients.

THE PROBLEM

The COVID-19 pandemic has had a disproportionate impact on vulnerable communities and has highlighted health disparities. By May 2020, Jefferson Health recognized that in Philadelphia, Black patients were experiencing higher death rates from COVID-19 than white patients, and Black and Hispanic women in Philadelphia were infected at rates five times higher than white women.

"Despite the clear, disproportionate impact of COVID-19 on vulnerable communities early in the pandemic, when COVID-19 vaccination became available, Black, Latinx, Asian and American Indian people were being vaccinated at lower rates nationally despite poorer outcomes with infection," said Dr. Patricia C. Henwo​od, executive vice president, chief clinical officer and chief quality officer at Jefferson Health.

"Jefferson Health is centered in Philadelphia, which faces challenges as the poorest of America's largest cities," she continued. "We recognized persons of color were being vaccinated at disproportionately low rates locally, presenting an equity gap that needed to be addressed."

"From May 2021 to December 2021, our mobile clinics administered 7,481 vaccine doses. Our mobile clinics vaccinated 82.7% people of color patients compared to 35.8% at traditional clinics."

Dr. Patricia C. Henwo​od, Jefferson Health

Jefferson set out to create a more equitable invitation process for vaccines, then followed suit by bringing mobile vaccination units to underserved populations. Without the use of data analytics, the health system could not have targeted the correct populations and locations, she added.

PROPOSAL

Before COVID-19, Jefferson Health already had a strong data analytics program. It was leveraging data to make operational decisions to increase efficiency and make improvements to processes across the enterprise, with the ability to drill down to the unit level.

"Having this strong foundational basis made it possible to turn to data analytics to address these gaps in care," said Nassar Nizami, executive vice president and chief information and digital officer at Jefferson Health and Thomas Jefferson University. 

"We continued to look to the data to make decisions and bring the vaccine to high-risk and vulnerable communities. Due to our existing program, we were able to make necessary quick decisions.

"Using data available to us, we planned to address the equity gaps that the pandemic highlighted and identify where we needed to distribute vaccines," he continued. "We used our electronic medical record and identified high-risk patients based on the criteria at the time."

Staff continued to expand the search to include everyone that was eligible to access a vaccine and to include specific races and gender to address disparities.

By identifying the correct patients, the health system targeted communication inviting these patients to receive a vaccine and give them different ways to respond and schedule a vaccine appointment.

"In addition, analytics were used to determine where we should target COVID-related community outreach," Nizami explained. "We looked at Zip codes to identify disproportionately impacted communities and then partnered with community-based organizations to provide COVID outreach, including testing or vaccination access."

MEETING THE CHALLENGE

Through the use of the EMR, patients were identified and notified of their ability to schedule a vaccine appointment. Patients were able to schedule appointments in a multitude of ways, including phone, email and through MyJeffersonHealth.

After notification was sent, staff looked back at the data to see which patients weren't responding, in order to determine if there were barriers to scheduling appointments so that the organization could assist in removing those barriers.

"Bringing patients to the clinics and bringing the mobile vaccination clinics to disproportionately impacted communities was the first step," Nizami recalled. "Leveraging data and technology continued to ensure vaccinations were completed.

"Kiosks and tablets were deployed to different locations, and combining those with the readiness of the EMR kept wait times low to prevent people from leaving their appointments," he continued. 

"These kiosks and tablets supported registrars by being available for e-check-in when all registrars were busy, to keep flow through the clinic with the goal of only needing patients waiting during the standard observation period after their vaccination."

Keeping vaccine appointments efficient and brief was important in addressing barriers such as time away from working hours, childcare duties and more. Feedback from the community served during clinics suggested the lack of lines and efficiency compared to other vaccine clinics in the area was a differentiator in seeking vaccination. Leveraging technology facilitated shorter wait times.

"The technology was also utilized by a variety of members of the care team," Nizami noted. "With the increase in concern about physical interaction, clinicians were motivated to utilize technology to continue to deliver safe and quality care.

"By continuing to use data and monitoring vaccine criteria, our IS&T team continued to update the EMR to create alerts for when patients that were eligible for vaccination were not vaccinated," he continued. "Clinicians could monitor these alerts to offer vaccines to patients that may have been missed."

Relying heavily on data and the EMR during the pandemic highlighted the importance of interoperability. The health system met some challenges due to some campuses not being on the same EMR, but it continued to work together to provide data. It then made it a priority to implement a single EMR across the remaining hospitals in the health system.

"Interoperability between state and federal bodies was also important," Nizami said. "The requirements and criteria for vaccinations were constantly changing and we had to quickly adapt. We also had to provide data to the federal, state and local governments to be compliant with regulations.

"Interoperability with these bodies also allowed the exchange of data, which was crucial during this entire process," he continued.

The technology and data was essential for creating context, he added.

"Taking an interdisciplinary approach to challenges provides the best results."

Nassar Nizami, Jefferson Health and Thomas Jefferson University

"While we're in different locations such as church basements, schools, parks and basketball courts, having the data and technology transformed these locations into clinics," Nizami said. "Our clinicians were able to access the EHR no matter where they were and did not need to rely on paper. This ensured safety, quality and familiarity both for patients and clinicians.

"None of this would have been possible without interdisciplinary work," he continued. "Many teams were involved in making this possible and continuing to improve the process. Executive officers, members from every IS&T domain, informatics, facilities, security, clinicians, community health workers and more all worked together to bring vaccinations to vulnerable populations."

The health system also had many unsung heroes such as the frontline technicians who were regularly at the sites in the community, he added.

"They were committed to delivering care in any setting," he noted. "There were times that large storms would affect technology in these sites and our frontline technicians were there to ensure these clinics could continue running. No one group could have done all of this themselves."

RESULTS

Jefferson Health set out to increase vaccination across these vulnerable populations and efforts were successful.

"When looking at vaccinations based on race as a proportion of the total population vaccinated, only about 1.4% of the Asian population, 1.4% of the Latinx population, and 3.5% of the African American population were vaccinated in May 2021," Henwo​od reported. "These numbers increased to 15.3%, 34.0% and 33.4%, respectively, by June 2022.

"From May 2021 to December 2021, our mobile clinics administered 7,481 vaccine doses," she continued. "Our mobile clinics vaccinated 82.7% of people of color compared to 35.8% at traditional clinics."

Using data and the targeted approach, the health system was able to identify vulnerable populations and increase vaccinations among them.

"This data also helped us identify where our vaccination clinics should be located," Henwo​od noted. "We had more than 20 community-based vaccination locations and 20 pop-up mobile vaccination sites, the majority being in underserved communities and zip codes.

"As previously mentioned, this was a continuous process," she said. "There were challenges met along the way that we had to address to continue to see results. One barrier was language. Serving diverse populations meant encountering language barriers."

To address this challenge, staff deployed phones dedicated to the use of translating at the clinics. Patients would have a phone with a translator that would go with them through the entire vaccine appointment.

This experience provided further motivation to add more non-English languages to the EMR. Currently, the health system offers Spanish in the patient portal and is working to add more.

"We also recognized barriers to undocumented persons seeking vaccination and worked with community partners to provide safe space and locations to address language barriers and successfully facilitate further engagement of this population," Henwo​od said.

"We not only wanted to provide accessible vaccines, but we also wanted to ensure safety," she continued. "Though the vaccine clinics were a quick turnaround, we were successful in ensuring the same safe and high-quality care to patients in those settings as we do in our brick-and-mortar clinics."

Lastly, and what staff see as an important measure of success, is the feedback from the community.

"The mobile clinics were seen as a safe space, especially for patients who had language barriers or were undocumented," Henwo​od said. "34.1% of our patients at our mobile vaccination clinics were non-English speaking compared to 14% from on-campus clinic vaccination efforts. They knew they could navigate the system safely and felt comfortable getting vaccinated in our clinics."

ADVICE FOR OTHERS

"Taking an interdisciplinary approach to challenges provides the best results," Nizami advised. "The department of IS&T were close partners with the clinical team throughout this entire process. To achieve work in a dynamic clinical setting, you need to have strong relationships across different teams.

"As was said before, we could not have done this without a team approach," he continued. "Achieving results required everyone working together toward the same goal. In addition to teamwork, leveraging data is crucial. There is a lot of data out there and we have access to it, but what is important is how we use it to make decisions and improve outcomes."

Lastly, prepare now, he said.

"The pandemic was an example of never knowing what the future could hold," he explained. "Teams should already be working together to constantly improve processes and outcomes. Encouraging teamwork and partnerships prepares you for crises like the COVID-19 pandemic, where you have to act quickly and work together to address rapidly changing situations."

MORE DAVIES-WINNING USE CASES

The first of Jefferson Health's other use cases focused on data-facilitated, targeted central line-associated blood stream infections (CLABSI) reduction.

"Across the United States, we saw a rise in CLASBI cases from 2019-2020," Henwo​od recalled. "An increase in CLASBI SIR can lead to higher patient morbidity, mortality and longer hospital stays. CLASBI was identified as one of the priority quality and safety measures for intensified focus and action planning by Jefferson Quality and Safety leadership.

"Along with the other measures, CLASBI was incorporated into a new Epic Radar dashboard aimed directly at prevention and treatment, called the OnPoint Quality and Safety Huddle Dashboard – custom-built by the Jefferson team," she continued. "To develop the dashboard, a lot of background data analytics work was done."

Data analytics drives the organization's quality and safety awareness and allows teams to know where they are and where they need to be.

"The platform was designed to be immediately interpretable with big, easy-to-read meters, much like a car's dashboard, and would provide all that the user needed to take corrective actions at the push of a button," she explained. "The dashboard was designed to work as a true partner, allowing frontline clinicians to address issues and facilitate interventions most efficiently.

"Released in a phased approach through 2020 and 2021, the OnPoint Quality and Safety Huddle Dashboard led to a marked decrease in CLABSI SIR in each division following implementation, culminating in a 28% reduction in CLABSI SIR for the health system as a whole in 2020-2021."

The other case focuses on transitions of care.

"We have seen a shift from volume-based fee-for-service to an outcomes-based payment model since the passage of the Affordable Care Act," Henwo​od reported. "We have concurrently increased our focus on improving a patient's experience when transitioning from one level of care to another.

"Communication is a crucial part of this process, which is why we launched a multidisciplinary effort to develop a comprehensive transitions of care program that would be both replicable and sustainable, address communication challenges, and mitigate fragmentation through the patients' acute care journey," she continued.

The health system also aimed to foster accountability and collaboration in a multidisciplinary service delivery structure that provides the right care to the right patients at the right time – to treat each person holistically.

"We now have the tools to identify patients discharged from all locations in a timely manner without our nurse team sifting through spreadsheets and risk scores to locate them," Henwo​od said. "Custom templates were developed in our EMR to guide our staff in consistent evidence-based scripted calls during our transition of care connection.

"Disease-specific questions and care plans were built to direct our attention to a patients' ambulatory sensitive conditions, which included self-management plans, and barriers to follow-up care," she said. "As members of comprehensive primary care (CPC+), we are tasked with attempting to contact 75% of patients transitioned out of an inpatient or post-acute setting."

As a result of the efforts, the patient population is successfully engaged 78% of the time and the health system has seen a significant reduction in its Hospital Readmissions Reduction Program year over year, with a savings of 18%.

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