As the pace of COVID-19 vaccination has slowed, the priorities of decision-makers have begun to turn from managing a deluge of interest toward reaching out to those who may be reluctant to get inoculated.
There is a range of reasons for such hesitancy, including distrust of a medical system that has historically failed vulnerable communities, especially people of color; concerns about cost or long-term effects; a lack of awareness of eligibility; and continued blocks to access.
“The increased attention and momentum surrounding the COVID-19 vaccination campaign provides opportunities to address the culture of vaccination and growing vaccine hesitancy through education and positive patient-provider encounters,” said Poonam Bal, director of quality innovation at the National Quality Forum.
Responding to such vaccine hesitancy requires a complex, thoughtful strategy. The solution will not be one-size-fits all. But some innovators and experts say health IT can play a key role in the process.
“Digital health tools can further help on both dimensions of access and hesitancy,” said Kaelin Goulet, managing director and partner at Boston Consulting Group, which tracks vaccine sentiment among other consumer interest issues.
“Access is less about the supply of vaccines, but more tied to things like whether people are able to take off time to get the shot, whether they will have time to recover if they have bad side effects from the vaccine, and if they can travel to the location,” said Goulet.
“In terms of access, improving the ‘user experience,’ from initial information about vaccines all the way through the vaccination itself, is critical.
“Intuitive user interfaces, multiple languages, and clearer language can help reduce barriers to access for patients – and help them plan out when and where they can get vaccinated,” she continued.
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 increased attention and momentum surrounding the COVID-19 vaccination campaign provides opportunities to address the culture of vaccination and growing vaccine hesitancy through education and positive patient-provider encounters.”
Poonam Bal, National Quality Forum
Dr. Gary Call, chief medical officer at HMS, said population health 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 that factor in social determinants of health help to prioritize and create effective messaging and actions to remove barriers and inequities in the healthcare system that have adversely affected many populations,” he added.
Call argued that stakeholders must adopt an analytics-driven health-engagement solution that delivers specific messages to specific 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.
“Technology and analytics are a critical force multiplier to supplement scarce healthcare resources in motivating and enabling consumers to take action regarding vaccination and other COVID-19 safety matters,” said Call.
“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 is up to us to make a positive change in our healthcare system and to provide access to quality care and lifesaving vaccines to all.”
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.
“Many vaccine-specific priorities hinge on the ability to have data flow successfully between electronic health records and an immunization information system,” said Bal. “A focus on submitting data will help drive uptake and enable the healthcare community to have more visibility into a patient’s vaccination status.”
This response must be a community-wide effort, she noted.
“It is imperative to recognize that the burden, responsibility, attribution and credit for immunizations should be shared across all providers performing vaccinations, including primary care providers, specialists, retail pharmacies, occupational health clinics, long-term care facilities and others, given the wide-ranging sites where adults receive vaccinations,” said Bal.
“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 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.”
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.
“The LGBTQ+ community disproportionately experiences discrimination and stigmas in healthcare settings and are two to three times more likely to postpone or avoid care as a result, which may contribute to hesitancy around getting vaccinated,” said Quinn.
“Patient navigators … and virtual care providers can help advocate for LGBTQ+ members and employees by connecting them with culturally competent, quality providers to raise the standard of care for everyone in the community,” he added.
“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.
“Vaccine rollout plans must include more voices at the table to ensure an interdisciplinary approach,” agreed Call, citing the work of Drs. Vernon Rayford and Eric Lewis of Mississippi’s Project ELECT.
“Like many of the oppressive systems and structures we currently live in, we must do things differently if we want things to be different,” he said.
Considering that necessity, it’s important that engagement tools not reproduce the same disparities they are trying to address.
“Digital health has become synonymous with smartphone applications over the past few years, but understanding that we need to reach communities and people who may not be as Internet savvy will be important. This may include less obvious user interfaces, such as SMS and voice, to reach underserved audiences,” said Goulet.
“We must realign our incentives and goals to ensure health equity,” said Call. “Yes, we want vaccines rolled out quickly, but the quick [online appointment scheduling] rollout approach has costs associated with it,” he explained.
“Performance indicators must include race and ethnicity, income and employment status, and other variables. We must employ mobile vaccination sites in neighborhoods, [and] work with churches and community centers to ensure that our most vulnerable populations have access to the vaccine.
“We cannot unsee what the pandemic has helped us to realize – disparities are rampant in our healthcare system,” he added. “It is up to us to make a positive change in our healthcare system and to provide access to quality care and lifesaving vaccines to all.”
Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.
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