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Digital Front Door Tech Fuels San Antonio Vaccination Success

Analysis  |  By Scott Mace  
   July 07, 2021

An app guides patients from door to destination and uses location services of mobile platforms.

The COVID-19 pandemic spawned a plethora of "digital front door" strategies, but few have pushed technology as broadly in the service of enhancing the patient experience as a mobile application deployed in the greater San Antonio/Bexar County region of Texas by University Health.

Using mobile-phone push notifications to simplify scheduling, University Health has been able to complete 476,000 vaccinations since the beginning of 2021, and used the app's ability to maintain a full vaccination schedule, enabling the health system to use almost all its vaccine supply, as opposed to numerous systems that experienced waste, due to the vaccine's propensity to expire if not delivered within a few hours of being readied for use.

The system worked, in part, by taking a lightweight, self-service approach to patient engagement, deliberately eschewing the need for a login and password typical of hospital-run mobile patient interaction sessions, or massive staff involvement in scheduling appointments. It also cast a much wider net among the greater San Antonio community than such applications typically reach.

"We spread the word in the community that if you download this application, you would receive notification of when vaccine supplies were available," says Leni Kirkman, executive vice president, chief marketing communications and corporate affairs officer at University Health.

By doing so, University Health saw "an incredible spike in the number of users" of its University Health Go app, available in the Apple App Store and Google Play app stores at no charge, built and powered by technology provider Gozio.

"Having a fully featured mobile app in place has proved instrumental to both our pandemic response and vaccine distribution strategy," says Selene Mejia, University Health digital marketing manager. "The ability to communicate in real-time gives our patients peace of mind as we navigate a fluid COVID-19 care environment. It has allowed University Health to establish a direct relational link with the community, advance vaccine administration in our region, and target vulnerable and underserved populations."

Gozio's technology allows patients to self-schedule appointments, then applies patented turn-by-turn digital wayfinding to direct patients to those appointments.

As preparation for the rapid administration of vaccines at the start of 2021, University Health was able to initially reach 80,000 people who had downloaded the application, as well as others who had signed up for notifications by email, when vaccines became available.

Due to the rapid nature of this notification system, University Health found itself reaching out to many out-of-state members of the public eager for vaccines, including residents as far away as California and even some foreign countries, Kirkman says.

University Health continually reevaluated how best to reach its larger community to accelerate the vaccination program. "The partnerships we did with nonprofits across the community, with schools, with churches, with elected officials" made a big difference, Kirkman says.

In fact, fewer than half of those vaccinated were existing patients of University Health. "When more people in our community are vaccinated, there's less chance of our patients and our employees getting COVID-19," Kirkman says. University Health even provided vaccine for another health provider, when that provider did not get an allocation of vaccine, she says.

"We looked at this as something this community needed to make us safer, to get our kids back in school, to make it safe to go to a restaurant," Kirkman says. "So, we did outreach to our most vulnerable patients, and through those partnerships and outreach, tried to get those folks in as part of those guiding principles. We were here to serve this whole community and even people from other states. We're all in this together. There's no border for COVID."

The wayfinding component was essential to directing patients appropriately. The massive size of University Health's facilities—2 million square feet, expanding to 2.5 million—makes it too easy for disoriented patients, or even the newest group of resident physicians, to get lost. "Having it right there on your phone [makes it] easy to navigate," Kirkman says.

The software's content management system also made it a handy tool to deploy to the mobile devices of University Health staff, to disseminate ever-changing COVID-19 directives and protocols to staff, she adds. "We wanted it to be in the doctor's pocket," she says. "We were promoting it as 'all things information.' "

The digital front-door nature of the software allows health systems such as University Health to integrate other mobile apps, such as Epic MyChart, into a seamlessly connected mobile experience. Popular telehealth apps can also be integrated into the software, if a health system requests it, according to Gozio.

Also helping University Health's success was its July 2020 go-live on Epic. "Epic had already developed a module for vaccine distribution," Kirkman says. "We were one of the first to implement it" so that patients could select a time for their vaccination, without requiring them to make appointments through traditional ways such as phone or email.

The Epic go-live yielded one other benefit. To complete staff training on Epic, University Health had leased space in Wonderland of the Americas, a struggling shopping mall that happened to be centrally located in San Antonio, both geographically and by population distribution.

When the arrival of vaccines was imminent, University Health was able to make this leased space its public vaccination hub, without jamming its existing offices with patients seeking vaccinations, Kirkman says. When vaccination slots opened on December 31, 2020, the public filled 9,000 such slots in a mere three hours, she added.

Part of the software's appeal is the ability of Gozio to rapidly deploy it, says founder and CEO Joshua Titus.

"When we walked into [University Health], they had no app whatsoever," Titus says. "Four weeks later, they had an app in their hands ready to go to the [app] stores."

Titus describes the software not as a replacement for other mobile hospital apps, but as "somewhat of an aggregator of what's already in the system. If they have patient portals, we can tuck those in."

Bluetooth beacon technology lies at the heart of Gozio's wayfinding capability. Within hours, the company can map out precise locations of all of a hospital's facilities, reaching where GPS cannot, as GPS is blocked by the concrete contained within buildings, Titus says. The app even keeps track of where patients have parked their cars, he adds.

By using Bluetooth and not instead requiring Wi-Fi access, this location technology allows app users to navigate to their destinations without requiring access control or the involvement of the hospital's IT staff.

Although mobile device makers have talked for years about mapping indoor spaces, little progress has been made on mobile devices in general, although Gozio will take advantage of some indoor location-services features of the new version 5.2 of Bluetooth, Titus says.

Editor's note: This story was updated on July 9, 2021.

“We looked at this as something this community needed to make us safer, to get our kids back in school, to make it safe to go to a restaurant.”

Scott Mace is a contributing writer for HealthLeaders.


The quick adoption of a mobile app led to 476,000 vaccinations being administered rapidly in greater San Antonio area.

This lightweight approach didn't require a login or password, simplifying installation of the app.

The wayfinding component uses Bluetooth beacons to provide door-to-door navigation to services.

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