There is a long held IT myth that adults 75 years and older are not capable of or don’t want to use the latest technology. Renown Health shattered that myth when they rolled out Epic’s MyChart for COVID-19 vaccine appointments. It turns out with proper planning and support; older adults are more than capable of using a patient portal.
Decentralized Approach to Vaccination
The US has taken a decentralized approach to COVD-19 vaccination. Each state has allowed designated dispensing sites (pharmacies, hospitals, or other types of healthcare organizations) to implement the tools and practices that they deemed best for their communities. Although this has resulted in a hodgepodge of approaches when viewed at a national and state level, this decentralized approach has, for the most part, achieved the goal of getting vaccines into communities quickly.
Renown Health
, a not-for-profit integrated healthcare network serving Nevada, Lake Tahoe and northeast California, is one of the dispensing sites for the COVID-19 vaccines in Nevada. Given the size of their community, the team at Renown knew that a paper or manual based process would not work.
Healthcare IT Today sat down with Kristopher Zierolf, Director of IT Applications and Stacey Sunday, Manager of Communications and Public Affairs at Renown to learn how they overcame this challenge.
Avoiding a Self-inflicted Denial of Service Attack
“If you use paper you are manually writing information,” warned Ziefolf. “You are potentially creating duplicate medical record numbers, transcribing digits, and creating a data mess you’ll live with for years. You’ll have a data mess on your hands that could take years to unwind.”
To get a handle on the size of the challenge, the IT Team at Renown, queried their Epic EHR. It showed them that there were approximately 100,000 records for people over the age of 70. The team quickly realized that if all those people tried to go onto the Renown website at the same time to book an appointment, they would crash it.
“We didn’t want our own community to end up being a denial-of-service attack on our site,” said Zierolf.
Using their call center was also not an option. With a limited number of phone lines and agents, their call center would have been easily overwhelmed and people would have experienced long wait times or would be unable to get through at all.
“Every option was considered,” stated Zierolf. “But in the end Epic’s MyChart patient portal was the best option. Once that decision was made, getting a workable, scalable and stable solution in place was very quick.”
Preparing MyChart
One of the reasons MyChart made sense for Renown was the estimated 70% adoption rate by their patient community. This high percentage was, in part, thanks to the recent uptake of telehealth services during the pandemic. It is ironic that COVID-19 helped accelerate the adoption of MyChart which has become a key component in the fight against the virus.
The first step taken by the Renown IT team was to double the capacity of MyChart servers and infrastructure. After that was done, they developed a workflow process such that any vaccination booked through the portal would automatically create the orders in Epic for the first dose.
Zierolf likened the whole process to taking a number at a deli counter. “We’re using ticket scheduling where we’ll look at our EHR data to ensure that the right people were getting appointments – over 70 years old and living in Washoe County. We pre-load an order on their account with a health maintenance topic which effectively lets us know they’re due for a vaccine. Then when they get their first one, the system knows that they need to be recalled for a second one. The patient essentially gets a ticket that gives them the ability to schedule their 2nd does when a slot opens up. When we publish a schedule of available 2nd dose appointment, they go to MyChart and all the times are available to them.”
By using MyChart, Renown planned to avoid the overcrowding and long lines that have plagued other vaccination sites across the US.
“We don’t want to put our at-risk population at more risk,” said Zierolf. “We don’t want them crowded in with each other or camping overnight in the cold, especially in Reno. We’re still trying to get as many people vaccinated as possible, but we also wanted to make sure that we had the right amount of vaccine on-hand so that people wouldn’t have to wait or be turned away. On the other-hand we wanted to maximize the doses we did receive so that we didn’t have vaccine left on the shelf.”
Through integration, the system automatically notifies WebIZ, Nevada’s immunization information system once a person has been inoculated. This automation ensures nothing falls through the cracks.
Spreading the Word
Once the system was ready, the Renown communications team then swung into action. They created a press release that went to all their media partners that provided details on how they were going to administer the vaccine. One of the key parts of the message was the following:
Renown Health will contact residents when it is time for them to receive their vaccine. Please do not contact a Renown doctor/health care provider at this time to schedule a vaccine appointment. Instead, all are encouraged to register for a Renown MyChart account if you have not already.
Renown Health has been able to distribute and administer the COVID-19 vaccine to a record number of people in the shortest possible time. Much of this success is due to the use of a convenient patient electronic medical record, called EPIC MyChart, which allows people to be notified that the vaccine is available, schedule their appointments online, complete the consent form and have full documentation.
“We took some heat because it was an online way to sign up for an appointment,” admitted Sunday. “There were a lot of questions from the media and the public. Our contact center has been the front-line of our community’s anxiety and fears during this Pandemic. They have done a phenomenal job at helping to answer questions and walk people through the steps they need to get themselves booked.”
One local news station interviewed an elderly lady who said it took 45 minutes to figure things out and over 12 steps just to place yourself in the queue for an appointment. There was also confusion over how people would be notified that an opening for the vaccine was available.
To combat this, Sunday and the team at Renown, created a step-by-step guide on how to download MyChart and get added to the queue for a vaccination appointment. They took time to walk through these steps with their media partners who all ended up posting those instructions on their sites.
Once word spread about how to use MyChart, members of the community helped each other to get registered through the online portal. For those that did not have data plans, access to a device or could not physically use a device, there was always the Renown contact center that could help them.
Future Rounds of Vaccinations
As the tiers for eligible people begin to expand (65 and over, 55 and over, etc.), the Renown team hopes to roll out even more seamless technology for that tech-savvier demographic.
“As we get into these populations that are potentially more mobile, we can be paperless,” said Zierolf. “We can do some of the administration via cell phones or we can actually scan the dose and then administer it to the patient very quickly. We have those tools at our disposal, and they are ready for deployment. But we’re also being very mindful that the goal isn’t to show off our technology–the goal is to get vaccines administered as fast as possible.”
Not Perfect, but Good Enough
By scaling their infrastructure to handle the anticipated demand, crafting a detailed step-by-step guide, and proactively engaging with media as well as community partners, Renown has shown that MyChart is not an insurmountable barrier for those 75 and older.
While far from perfect, using MyChart to book COVID-19 vaccinations has been more than good enough to get the job done…and right now, in the middle of a pandemic that is still seeing 65,000 new cases each day, good enough is what we need.
