By offering COVID-19 vaccine self-scheduling, St. Luke’s in Duluth, MN sharply increased the number of patients using their portal. But it didn’t happen overnight. Listen in, as our guests reveal their strategies.
Title: How St. Luke’s Doubled Portal Enrollment during the Pandemic
Clark Averill, IT Director
Missy Francisco Carlson, Patient Experience Program Manager
Host: Christine Parent, Associate Vice President, MEDITECH
Clark: So far, to the journey of vaccine, we haven't wasted any doses and we've always fulfilled the strategy of getting the vaccine into people's arms.
Christine: Welcome to another episode of MEDITECH podcasts, the leader in healthcare technology empowering you to be a more informed healthcare consumer and provider. Hear the latest from our friends and colleagues on topics we think you should know about.
Today I'm joined by Clark Avril, Director of Information Technology, and Missy Francisco Carlson, the Patient Experience Program Manager at St. Luke's Health System in Duluth, Minnesota. Clark and Missy are at the center of St. Luke's Patient Engagement Strategy which has seen their patient portal enrollment double since the start of COVID19 pandemic. Together, Clark and Missy have found innovative ways to stay connected to their patients even when in-person appointments were limited resulting in a well-connected patient population.
Welcome to you both. We're so glad to have you here. St. Luke's has always been a strong proponent of patient engagement and encouraging your patients to enroll in their patient portal.
What steps do you take to encourage both enrollment and engagement?
Clark: Well thank you, you know our primary strategy is really to make sure that the patients are aware of our patient portal. We've changed our internet front page to make sure that it's front and center. As people go to our internet site to look for information, they know that we have a patient portal, and how to register, and the ability to register right from there. As well as we make sure that our caregivers mention it during the care process so we'll ask our patients when we're registering them at the front desk. We've asked our physicians to engage the patient to ask how they'd like to communicate with the provider or get their results and then of course we've also used it for scheduling. We make sure that patients are aware that they have that ability.
Missy: We've also partnered with our marketing department to create literature that we're able to place out around the community, around the organization, and in particular just recently, in our waiting area for our COVID watch area, if you will. We try to really engage and make sure that others know that is an option because satisfaction really skyrockets when our patients are able to connect with their providers and physician in an easy and a quick way.
Christine: Absolutely, especially during these pandemic times that we just underwent. I understand the COVID19 had a significant impact on your portal enrollment numbers. Can you walk us through this and how? Clark, let's start with you.
Clark: The enrollment numbers when COVID started, we were sitting at about 27,000 patients had been enrolled in our patient portal. Of course, as COVID really took hold, we had to stop having inpatient visits or in-person visits. We can really convert it to virtual visits very quickly, almost overnight. To schedule those virtual visits or to reschedule those physical visits that became virtual, part of that process was to ask the patient if they wanted to be enrolled in our patient portal and send them the registration link.
We also started to really push to deliver results over the portal just because that is a lot of reasons for extra visits to get your lab results, to feature XL reports, things like that. We made a concerted effort to use a portal for information delivery as well as questions. When you have to reduce your in-person visits, you need to have other methods to work with your patients.
We also were seeing during the majority of the past year between three and four hundred patients registered per week. As we got closer to the COVID vaccine rollout, we saw those numbers increase to a thousand per week. We had a couple of weeks where we had 2,000 patients enroll. A lot of patients had pent-up demand knowing that that would be one of the platforms that we use for the vaccine rollout.
Missy: In order for us to provide them with a portal account, if you will, we had to gather email addresses from our patients and what that did for us was actually kind of a win-win two-fold situation. Once we gather more emails, we are actually able to send more patient satisfaction surveys out to our patients so our return rate definitely went up which is great because we always want to hear back from our patients on what we are doing well and where we can evolve.
I also commend the vendor that we work with, they were very, very quick. We were also able to add a second patient satisfaction survey specifically for virtual visits. We had an in-person survey that happened for our patients. Or if they were doing a virtual visit, we did a separate survey so our staff can see what is the difference and again where could we evolve if needed.
Christine: That is great. First of all, I commend you all for 2,000 patients enrolled in one week. That's really amazing to hear and I have to say, Missy, from the patient satisfaction surveys you mentioned on the virtual visits, I'd love to hear more about what some of those surveys actually represented in many organizations such as yourself. That's very interesting data to be able to then set forth your strategy as you move forward even post-pandemic.
You mentioned self-scheduling a little bit through the patient portal. What impact has doing so had on your organization and how do you ensure equity for those patients who do not have portal access?
Clark: Well, that's a great question. First of all, prior to COVID, we allowed patients to request appointments but the request actually put them on a waitlist. A staff member would look at the request. The patient would be able to note afternoon or days that they were available but it didn't have a true schedule. It just said okay, I'm available on Monday afternoons or Tuesday mornings. That resulted in the natural ping-pong effect of a patient sends a message. We call them. They're not available. They call us back. We're not available. We call them and so on and so forth.
Just prior to the delivery of the vaccine, we had been working with one of our primary care clinics to implement direct patient booking for a select appointment type, primarily annual wellness visits. Everybody knows that they should have an annual wellness visit and people again would request appointments but we wanted to give the patient the opportunity to pick the day and time when that appointment could be scheduled. We had implemented that via the portal and it was very successful. It eliminated all that phone calling that was going back and forth and we got positive patient experiences because they were able to pick the date and time of their appointment. Basically, we took an appointment type, we made it able to be self-scheduled and it was very successful.
As we started to discuss how we were going to handle the vaccine and especially the volume of vaccinations, we thought that we couldn't use a weightless because the volume was going to be so high and then to have that natural ping-pong effect that you're not going to get people back all the time on the first call. What we did at St. Luke's is we distributed our appointments kind of a third, a third, a third. Forty percent of the available first dose vaccine appointments were dedicated to the patient portal for patient direct scheduling.
We took the other thirty percent and we said those appointments are reserved for patients that have visits already scheduled in our clinics that meet the criteria to get the vaccine. They would basically have, the patient would already have a visit scheduled, an in-person visit and after their appointment, we would say if you'd like the vaccine or during the visit we'd say if you like the vaccine we have availability today since you're here. We would send them down from our clinic.
The other thirty percent, we kind of reserve for those people that either don't have portal access or aren't patients of St. Luke's. We had a call-in number or a call-out number and we would have people on the phones that would be scheduling those. How we handled the patients that we were going to call is we basically took a list of our patients that were qualified to receive the vaccine. The first initial list was over 65 and of course has changed since then but we took that over 65 that didn't have portal accounts and then we randomized that list so everybody got an equal opportunity to get the vaccine. It wasn't just alphabetical or by preference or something like that. We used that randomized list to book those other thirty percent and we felt that was very equitable.
Since that time, because of our enrollment numbers of the portal and how easy that scheduling is for the first dose, we've changed the self-scheduling to fifty percent. We did want to encourage people to use the portal because long term it's a much better communication structure than trying to use the phone and of course we don't routinely use email because of protected health information. That was our strategy for the vaccine clinic as we rolled it out and it's been very successful. When we have open appointments, we usually see them filled within an hour or two. We do update our internet site to say okay appointments are going to be available at 2:00 pm tomorrow. We base that availability on the amount of vaccine we get.
We've always been able to fill our schedule in so far through the journey of the vaccine. We haven't wasted any doses and we've always fulfilled the strategy of getting the vaccine into people's arms right at 100 percent within the time that we're allotted for that. It's been a very, very successful rollout of getting the patients scheduled for their first dose. We schedule their second dose when they're getting their first dose. We actually have to have the patient in front of us. We don't let them schedule the second dose independently just because we want to make sure that we get that shot in their arm and then we schedule their second dose at that time. We do have them reserved so they can pick the day and time once you're over the threshold of 21 days since we're doing the Pfizer vaccine.
Missy: Our patient comment reports are coming back to us telling us that our patients really appreciate the online self-scheduling. Kind of in this fast-paced world, it's easy, it's quick to do. It gives instant gratification for our patients to be able to get the vaccine in a way that works for them. We know our patients are very happy about it and I think St. Luke's has actually done a great job. Just like Clark said, no waste and really maximizing it so that everyone in our community can get the shot as quickly as possible.
Christine: Well, that's amazing! It sounds really like the direct patient booking had an immediate and tremendous impact and when COVID hit you're able to then leverage some of that technology to keep up with the demand and allow for patients to do that self-scheduling. Just talking about the demand of the patients requesting vaccination, how have you been able to keep up with the intensity, and also are there any new routines or areas that you want to speak to that were also introduced?
Clark: We were very fortunate that we had just moved into a new emergency department area, just probably about three months ago. We were able to repurpose our old emergency department area for the vaccine clinic which gave us a good patient workflow from a separate door to come in. A registration area that was already set up for registration. Separate rooms to have the vaccine delivered and then a large waiting area. We actually repurposed the ambulance garage as our waiting area so we had a very nice opportunity for patient flow. We are very lucky. I know that there are a lot of facilities that don't have that but from a peer documentation standpoint, it is a pretty laborious process with other vaccines. The flu, your other vaccines that you get to document because there are a lot of you have to obviously get patient contacts. You've got to have the order. You've got to have the lot number and all of that is an opportunity for data entry mistakes as well as a lot of time. Of course, it doesn't take long to give a shot but the time spent documenting that shot is much greater than the time spent giving the shot.
We were able to implement the quick vaccine routine from MEDITECH, which was a brand new feature that MEDITECH had developed and we implemented that very, very quickly. It basically takes that documentation from one to two minutes per administration of vaccine down to about 15 seconds. The pharmacy pre-loads basically all of the vaccine vials and their lot information for the next day's clinic into the system. Then the administrator of the vaccine simply validates that the lot that they're picking is a lot they're giving the patient. They basically can inject the patient, document the administration, and move on. Then have the patient go to the waiting area to make sure there's no adverse effects.
That process has been extremely well received. The clinicians love it because it's so much faster. We're hoping to take advantage of that same routine in some of our other delivery processes. Especially if we hold flu clinics in the future but that has saved a tremendous amount of effort by the staff that are giving the vaccine. Of course, we're running through, we're putting in about 500 vaccinations per day and 500 times a couple of minutes is a lot of time saved. It's a very major staff satisfier as well as it ensures that we don't have data entry issues. It's a lot number which is very important in case you have a bad batch or something.
Missy: From a patient satisfaction standpoint, what we were able to do is really utilize our PFAC or our Patient and Family Advisory Council as volunteers of Saint Luke's. We were able to provide them with the vaccine very early on but because of that what we really wanted to do is talk to them about the patient process flow throughout that entire journey, if you will. They were very informative for us.
They brought up some things that us as individuals that work in healthcare didn't necessarily see or bring to our attention. Then we also listen very much so to our patients afterwards too. After they've been through the process, we do have patients that are vocal and will tell us right, this sign was confusing or the handicap access was a little bit further than preferred. That gives us an opportunity to work out those little kinks but we've been very fortunate in receiving feedback so that we could adjust as needed to make sure that everyone is being accommodated.
Christine: Well, that's amazing. Sometimes in these times of challenge, we're always seeking new ways to innovate and using your PACK, your Patient Advisory Committee to do some of that early workflow analysis that was really very well done. I'd be interested to hear some of the adjustments that you made along the way but that's very interesting. Like I said, innovation is always around, and great opportunities through some of these challenges.
Thanks for listening. Next time we'll continue our conversation with Clark and Missy to hear about Saint Luke's strategy for improving the patient experience including how they are leveraging increased portal enrollment to build stronger connections with their patients. Stay informed and subscribe to MEDITECH podcasts and be sure to check out our resource page for links from this episode. We'll talk to you next time.