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The pace of COVID-19 vaccines has slowed and decision-makers are now focusing on managing an avalanche of interest rather than reaching out to people who might be reluctant to get vaccinated.

There are many factors that can lead to such hesitancy. These include distrust in a medical system that has historically failed vulnerable groups, especially those of color; concerns over cost or long-term consequences; lack of knowledge about eligibility; and ongoing barriers to access.

Poonam BAL, National Quality Forum Director of Quality Innovation, said that the COVID-19 vaccine campaign has attracted more attention and momentum. This provides an opportunity to address vaccination culture and increase vaccine hesitancy by education and positive patient-provider encounters.

Such vaccine hesitancy can be addressed with a complex and thoughtful strategy. The solution is not one-size fits all. However, experts and innovators agree that health IT can play an important role in this process.

Kaelin Gulet, managing director, and partner at Boston Consulting Group (which tracks consumer sentiments and other issues of interest to vaccines), said “Digital Health Tools can further help on both dimension of access and Hesitancy.”

Goulet stated, “Access is not about the supply of vaccines. It’s more tied to things such as whether people are able take off time for the shot, if they will be able to recover from bad side effects, and if it’s possible to travel to the location.”

“Improving the user experience from the initial information about vaccinations to the actual vaccination is crucial for access.

“Intuitive user Interfaces, Multiple Languages and Clearer Languages can help lower barriers to Access for Patients – and Help them Plan when and Where they Can Get Vaccinated,” she stated.

Where hesitancy is concerned, “one of the powers of digital tools is also disseminating information quickly and accurately – helping bubble up better and more accurate information to help inform decision-making will be key,” she said.

“The COVID-19 vaccine campaign is gaining more attention and momentum. It offers opportunities to address vaccination culture and increasing vaccine hesitancy with education and positive encounters between patient and provider.”

Poonam Ba, National Quality Forum

Dr. Gary Call, chief medical officer at HMS, said engagement technology can also help address many of these challenges.

“Engagement platforms enable trustworthy stakeholders, such as health plans and providers, to communicate with people who are in greatest need of the vaccine, including certain racial and ethnic groups, individuals who face language and cultural barriers, and those with limited access to care,” said Call.

“Analytics platforms which factor in social health determinants of well-being help to prioritize messages and take actions to reduce inequities within the healthcare system, which have adversely affected many communities,” he said.

Call suggested that stakeholders need to adopt an analytics-driven approach to health-engagement that delivers targeted messages to certain segments of the population.

He pointed to several best practices HMS has identified, including choosing language carefully, making obtaining vaccines easy, providing relevant information, addressing barriers upfront and taking steps to improve reach rates.

Call said that analytics and technology are critical to motivating and enabling patients to take action about vaccinations and other COVID-19 safety concerns.

“These tools are currently underutilized due to healthcare system fragmentation, lack of funding and lack of appropriate direct incentives to stakeholders throughout the system,” he added.

“It’s our job to make a change in the healthcare system. To provide access and quality care to all, it is our responsibility.”

Dr. Gary Call, HMS

Bal and Call both point to interoperability as a way to promote information-sharing about vaccination rates for healthcare providers, who can in turn engage patients.

Bal said that many vaccine-specific priorities are dependent on data flowing between electronic health records (eHR) and immunization information systems. “An emphasis on the submission of data will drive uptake and allow the healthcare community to have greater visibility into a patient’s vaccination status.”

She noted that this response must be community-wide.

Bal stated, “It is crucial to recognize that the burden and responsibility for immunizations should all be shared among all providers including specialists, retail pharmacies and occupational health clinics, as well as long-term care facilities, and other sites where adults are vaccinated.”

“Just as HL7 standards offer a framework for exchanging electronic health information, there needs to be a similar structure in place for immunization registries, and reporting this information should be mandatory regardless of the payer or place of administration,” said Call.

“One power of digital tools also is the ability to rapidly and accurately disseminate data – helping to bubble higher quality information to inform decision making will prove key.”

Kaelin goulet Boston Consulting Group

Colin Quinn, cofounder and CEO of Included Health, an LGBTQ-focused service recently acquired by Grand Rounds Health and Doctor On Demand, said people who have been historically left behind by the mainstream healthcare system must be centered in a vaccine response.

Quinn said that “the LGBTQ+ community experiences discrimination, stigmas and treatment in healthcare settings more than any other group and is two to three-times more likely to delay or avoid care. This may lead to hesitancy around getting immunized.”

He added that “Patient navigators… and virtual caregivers can help advocate on behalf of LGBTQ+ members, employees, and connect them with culturally competent and quality providers to raise standards of care for everyone in our community.”

“Through this 24/7 support, patient navigators and virtual care partners can ultimately help improve the healthcare journey for LGBTQ+ members and, therefore, combat the hesitancy they may experience towards the COVID-19 vaccine,” said Quinn.

Call agreed, citing the work Drs. Project ELECT by Eric Lewis of Mississippi, Vernon Rayford.

He stated that, “Like many of our oppressive systems and structures, we must act differently if things are to be different.”

Considering that necessity, it’s important that engagement tools not reproduce the same disparities they are trying to address.

“Digital health is synonymous with smartphone apps in the past several years. However, we must understand that we have to reach communities and people not as tech-savvy. Goulet said that this may include using less obvious interfaces such as voice and SMS to reach underserved populations.

Call stated that we must reorient our incentives and goals in order ensure health equity. “Yes, we want vaccines rolled out quickly, but the quick [online appointment scheduling] rollout approach has costs associated with it,” he explained.

“Performance indicators have to include race and ethnicity as well as income and employment status. To ensure the vaccination of our most vulnerable citizens, we need to set up mobile vaccination centers in communities.

“We cannot hide what the pandemic aided us to see, namely that there are large disparities within our healthcare system,” he stated. “It is up for us to make a change in our healthcare and to provide lifesaving vaccines and quality care to all.”

Kat Jercich has been named senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.

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