Electronic Health Reporter

By Paul Brient, chief product officer, athenahealth.

On December 14, 2020, less than one year after COVID-19 sent our nation into lockdown and a period of uncertainty, the U.S. began rolling out a new set of vaccines. COVID-19 challenged and stretched our healthcare system, with great strain on our heroic providers, hospitals, and pharmaceutical professionals.

Since the introduction of the COVID-19 vaccine, we’ve improved distribution greatly and as of May 10, 2021, the FDA even expanded Emergency Use Authorization (EUA) for the Pfizer COVID-19 vaccine to include adolescents aged 12-15, further accelerating the vaccine rollout across the nation. As we’ve taken great strides recently to expand immunization to the wider population, we can reflect on the progress we’ve seen across the healthcare industry.

The past year has been filled with healthcare IT innovation which includes the almost instantaneous shift toward telehealth technologies, with utilization increasing from less than one percent to more than one-third of all visits, and new enhancements including virtual check-ins, COVID-19 screeners, virtual waiting rooms, and high-volume vaccine workflows.

One thing that healthcare IT companies were unprepared for was the incredible spike in inbound patient appointment request volumes as testing (and vaccine distributions) ramped up. In the early days of vaccine availability, scheduling systems found their servers crushed by demand. This sudden and unprecedented surge of patients attempting to schedule appointments exposed scalability issues in many scheduling systems, rendering it challenging to book appointments online.

True cloud-based SaaS systems, such as athenahealth, fared better than traditional on premise or remote hosted systems. Even so, the first release of roughly 6,000 appointment inquiries at one of athenahealth’s New Jersey customers in January resulted in an immediate onslaught of traffic and exposed several previously undetected configuration issues. Fortunately, these configuration issues were able to be quickly resolved, and athenahealth was able to support and meet its clients’ vaccine workflow needs and the intensity of the appointment request volume throughout the rest of the vaccination push.

With the high number of COVID-19 cases (currently 33.3 million in the U.S. alone), the COVID-19 vaccination effort has brought forth a new set of administrative challenges. Moderna and Pfizer-BioNTech require two doses and, while this is not a new concept for vaccines, the scale, scope, and importance of ensuring that patients follow-up and receive their second dose required a myriad of steps.

Vaccine registries (and perhaps soon: proof of vaccination or “vaccination passports”) have gone from the domain of a few public health officials to the key to winning the battle with the virus. Complicating this issue, every state across the nation has its own vaccine registry — each with different requirements and approaches. As a result, the vaccine administration process has faced scrutiny and received a bit of an overhaul. These reconstructed processes, much like the incorporation of virtual visits into care delivery options, will pay dividends well into the future.

While the healthcare industry has made great strides in inoculating patients, there are still lessons to be learned, especially when it comes to COVID-19 vaccine workflows and the role EHRs play in supporting providers and patients. Here are the ways in which EHR technologies can and are improving COVID-19 vaccine workflows to heal industry pain points:

Patient Outreach

EHR-generated emails and messaging have been driving vaccination interest. Patients can be cautious, particularly when it comes to electing to sign up for a new vaccine, but a thoughtful dissemination of information from a healthcare provider they trust, can help patients understand the health benefits and overall importance of inoculation. EHRs play an important role in creating custom messaging and patient outreach workflows much like they did to help get high-risk patients back into the healthcare system after the initial COVID-19 shutdown in March 2020.

Registration and Distribution

The sheer volume of patients seeking COVID-19 vaccines has necessitated a shift to scalable, modern digital technologies – like practice websites, patient portals, and expanded use of text message communications. The integration of vaccine manufacturers and their assigned codes to providers’ workflows helps make the ordering process seamless. These workflows also capture patients’ insurance information during registration and prior to claim creation, which ensures successful claims processing and payment.

The majority of appointment scheduling workflows date back to the 1990’s and can require a phone call to the front office staff or, in larger practices, a patient access center. These tools have helped patients with scheduling appointments as well as appointment reminders. Virtual visits and the elimination of in-person waiting rooms, have pushed adoption of patient intake management solutions that will serve patients and practices even when the pandemic is in the rearview mirror. These solutions can help streamline front office workflows, empower patients, and allow physicians to spend more time interacting with patients and less time reading paper forms.

Reporting and Patient Identification

With patients booking their vaccinations at clinics outside of their primary care provider, it’s more important than ever to be able to track millions of vaccinations through vaccine registries. These registries play a critical role in assessing how well we are doing as a country in terms of vaccinating a majority percentage of the population. As one might expect, there have been a variety of changes required by registries as they seek to be the best possible tool in this battle. This has required EHR vendors and their practices to adapt to the changing requirements and regulations.

Getting Paid

While free to all patients in the U.S., COVID-19 vaccines are still generating an enormous amount of insurance claims – which requires powerful, revenue cycle management tools. Vaccines have been paid for by the government, but the fees for the administration of the vaccine are paid for in the “usual” way for healthcare services. This has resulted in a high volume of low-dollar claims (the typical reimbursement for a COVID-19 test and COVID-19 vaccine administration is $42 and $25 respectively. The sheer volume coupled with the cost of processing claims, has created a bit of a hidden challenge to the healthcare system as we have seen the overall volume of claims more than double at some of our clients.

Looking Ahead: The Progression of Transformative Capabilities

As of June, the CDC reports that 168.5 million people in the U.S. have received at least one dose of the COVID-19 vaccine and 135.9 million people have been fully vaccinated. We’re on our way to seeing the light at the end of what has been a long tunnel. Now that the mass vaccine sites have given way to distribution at traditional healthcare locations, healthcare workers have had to incorporate high volume vaccine administration into their daily workflows.

These workflows must be capable of doing the following: identifying patients that are high priority for receiving the vaccine; engaging patients around COVID-19 vaccination; managing the coordination of patients across the two vaccine doses; properly documenting vaccinations according to guidelines; and reporting across clinical measure, registry and billing needs. These changes are imperative for ending this crisis and, they’ll yield dividends well beyond, as we look forward to a more accessible, high-quality healthcare system for all.