Texting Drives 600,000 Patients to Engage in COVID-19 Vaccination Scheduling at Hartford HealthCare

The initiative helps Connecticut to be a leader in the percentage of population that has been vaccinated.

Continuing a recent trend of avoiding the requirement to download mobile apps, and instead simplifying patient engagement via text and simple web pages, Hartford HealthCare helped lead the charge that allowed the state of Connecticut to have one of the highest COVID-19 vaccination rates in the nation.

The health system, based in Hartford, Connecticut, uses a platform from Upfront Healthcare that powers text-messaging engagement between patients and providers.

During the push to vaccinate the Hartford HealthCare community, the health system sent out 1.5 million texts, and 600,000 people engaged with the texts and pursued COVID-19 vaccinations, says Barry Stein, MD, MBA, FSIR, FACR, RPVI, vice president, chief clinical innovation officer, and chief medical informatics officer at Hartford HealthCare.

"I don't think you could do any other campaign where people could reach 600,000 respondents in one shot," Stein says.

The key success factor was keeping the technology simple, and that meant not requiring registering or logging into a traditional web site, visiting a patient portal, or downloading a mobile app. Instead, patients simply click on a text message on their mobile devices and engage by answering a set of questions that leads to scheduling a first or second COVID-19 vaccination.

Responding to the texts sent patients to specially built, simplified "micro sites" that allowed them to schedule their vaccination visits.

"We had a partner [in Upfront] that had the technology knowhow to send the message out in a seamless, provocative way," Stein says. "We had a message from Hartford HealthCare: 'We're here for you, we understand.' We collected the information in a seamless way. And we delivered everything we had promised simply and easily. From the consumer standpoint, it looked so easy."

Hartford HealthCare utilized patient engagement technology from Upfront to get past limitations in logic and artificial intelligence that kept the mission from being completed solely using its Epic electronic healthcare software, Stein says.

"We had a partner [Upfront] that was extraordinarily agile," Stein says. "Every day, we were meeting for 15 minutes, making sure everything was fine. And quickly, we rolled this out."

Barry Stein, MD, MBA, FSIR, FACR, RPVI, is the vice president, chief clinical innovation officer, and chief medical informatics officer at Hartford HealthCare. Photo courtesy of Hartford HealthCare.

The average number of engagements per patient was 4.3, according to Carrie Kozlowski, chief operating officer and co-founder of Upfront.

"They just loved that [the text] was unobtrusive and it was easy," Stein says. "We were engaging them across all the steps of the vaccine, so informing them, reminding them of their first dose, making sure they didn't skip their second dose, all the way through that experience."

Asked how the rest of the population engaged with vaccination resources, Stein says "not every patient in Connecticut belongs to Hartford HealthCare. There are other alternatives that exist." Among those were pharmacies and mass vaccination sites set up by the state and other governmental agencies.

Removing barriers

Hartford HealthCare President and CEO Jeffrey Flaks has made diversity, inclusion, and equity an imperative at the organization, Stein says. So as part of the vaccination effort, the system made special outreach to patient populations in certain ZIP codes and partnered with FEMA to send trailers to several communities to deliver vaccinations, he says.

The vaccination outreach did not require recipients to create an Epic MyChart account or enter a Social Security number, "because that was going to be a deterrent," says Kozlowski.

Instead, the microsites presented patients with vaccine visit options to select from, without having to go through extra steps, Kozlowski says.

"It was a good collaboration across several different technology teams at Hartford with our team to make that happen very quickly, to just remove the barriers for folks that may make an extra step harder, and then less likely to go ahead and get vaccinated," Kozlowski says.

"For that to happen, there's so many different functions that have to quickly sit together and remove legacy unintentional barriers that have significant impact, both internally as well as externally," Stein says. "Our innovation layer had the connective tissue to work in a cross-functional, interdisciplinary way. It wasn't just technology [professionals] meeting Upfront. It was sometimes revenue cycle, legal compliance. We all sat in the room together, figuring out how do we solve the problem to remove the friction.

"The only way to accelerate innovation is to get the right minds in the room from different lenses, looking at the same problem and be accountable to one another to solve them and not to punt them."

The microsite also offered real-time rescheduling of vaccination appointments if a patient needed to reschedule.

"We did not want to be wasting one dose," Stein says. "Not one, because every dose is a potential life saved."

Other uses for text outreach program

With the vaccination success story as a proof point, Hartford HealthCare has moved to expand use of the text messaging/microsite concept to meet other patient engagement challenges.

"In Medicare Advantage plans, it's important to have your annual visit for quality metrics and for good health," Stein says. "A significant amount of patients don't come in for that."

So, the same technology is now being deployed to remind those patients to schedule their annual exam, in partnership with urgent care provider GoHealth Urgent Care. Other kinds of preventive healthcare screenings are also being fit into the text outreach program.

Also, the same technology is allowing Hartford HealthCare employees to opt-in to receive texts before coming to work, where they can attest to their good health for working that day.

In addition to the executive roles he plays, Stein continues his work as a radiologist for Hartford HealthCare. "You've got to be where the work is being done to understand and be in touch with where the problems are," he says. "If you want to solve a problem, especially in healthcare, it's important not to develop distance that can amplify missed translation" of problems as communicated from workers to leadership, he adds.

"I liken technology to administering a drug," he says. "It's got to be engineered correctly. And it's got to be given for the right reason to the right patient. And if you think about it, all the steps and technology, how quickly you can be delivering something has been engineered incorrectly to an incorrect population.

"It's important to partner with partners, both inside and out, that are intentionally listening to the customer, and to the problem that we're trying to solve, and not trying to force their way of doing things."

Editor's note: This story was updated on October 8, 2021.