Tearful elderly patients who are thrilled to hold new grandchildren for the first time, chronically ill patients who are relieved to know they’ll be protected when venturing to the grocery store or other errands, and joyful staff who are helping seeing our communities out of the pandemic with every additional vaccine they provide: The emotions run high at Penn Medicine’s COVID-19 clinics.
In just five weeks since beginning patient vaccinations, Penn Medicine has administered more than 62,000 doses of vaccine to patients and the public, pushing forward in the face of ongoing challenges, including shortages of vaccines, varied prioritization guidelines in states and Philadelphia, and vaccine hesitancy.
Here’s how it’s being done.
Pivot from Vaccinating Staff to Reaching People and Places with the Greatest Need
After mining electronic medical records for all patients who met eligibility criteria based on city or state guidelines, each eligible patient received an email with a link to MyPennMedicine (the online patient portal), which would allow them to schedule a time and date for the vaccination. But it quickly became clear that patients in the earliest vaccine eligibility groups — many of whom are 75 and older or fighting serious chronic illnesses — were not as likely to respond to this technology. “Initially only 30 percent of the patients took us up on the offer,” said Patricia Sullivan, PhD, chief quality officer for Penn Medicine. The health system’s approach quickly pivoted, adding several new outreach methods, such as calling people directly, adopting a texting based platform and having practice management staff make appointments when they arrive for a visit. The Penn Medicine Call Center made hundreds of outbound calls. “The hard part is that they only reached a small percent of patients — most didn’t answer their phones,” Sullivan said. But when they did, staff were able to schedule 80-plus percent for appointments.
Initially, Penn Medicine patients received vaccinations in the hospitals and ambulatory center locations where they were first given to employees, a “soft launch to ensure the process was working,” said Nishaminy Kasbekar, PharmD, chief pharmacy officer of Penn Presbyterian Medical Center. But, with the success of these clinics under its belt, Penn initiated a two-prong strategy to vaccinate both patients and members of the community. Within weeks, there were vaccine clinics up and running within our hospital facilities as well as off-campus sites such as the Theatre of Living Arts on South Street, and dedicated efforts to reach Black and brown communities hardest hit by the pandemic in Philadelphia.
That direct outreach was especially critical. With PJ Brennan, MD, chief medical officer for the Health System, and Phil Okala, the Health System’s chief operating officer, leading the effort, the team worked with Reverend Dr. William Shaw — pastor of White Rock Baptist Church in West Philadelphia and chair of the Board of the Hospital of the University of Pennsylvania — and a coalition of other West and Southwest Philadelphia faith leaders to set up a series of community-based clinics in a church, recreation center, and a school.
To help overcome vaccine hesitancy, Eugenia South, MD, an assistant professor of Emergency Medicine, Paris Butler, MD, an assistant professor of Plastic Surgery, and other minority physicians developed a community engagement effort to provide both pastors and their congregants with virtual opportunities to connect with Black physicians to learn more about their own vaccine journey and the vaccine itself, ask questions and dispel common myths. “There is a challenging narrative out there that the vaccination is not safe,” Okala said, in an Inquirer article about the first pop-up clinic at Christian Compassion Church. “The outreach is to make sure people are well informed, understand the science, and will work with faith leaders to make sure communities are vaccinated at an equal rate with the rest of the population.”
Signing up for these clinics was simple, thanks to the efforts of members of the Center for Health Care Innovation and Way to Health. In contrast to the widely reported difficulties of accessing the matrix of eligibility and scheduling websites, no link, app or even a computer was needed. People could register through texting or through an automated phone system. “The platform was made to be no-or-low tech for the end-user,” said Kathleen Lee, MD, director of Clinical Implementation, who led the design effort with Lauren Hahn, Innovation Manager. “On the back end we automated response collection, appointment reminders, and even form labeling to ensure a smooth and efficient operation on clinic days. The platform also nudges folks automatically to serve as ambassadors for their community, prompting individuals to sign up for someone who otherwise might not be able to do it themselves."
Handling Logistical Challenges and Regional Differences
Beyond finding sites — and getting people to sign up to receive the vaccine — the success of each clinic also depends on having all the necessary supplies and equipment, from basic medical supplies like PPE, wipes, and bandages to defibrillators and other emergency equipment and medications in case of a reaction to tables, chairs, clipboards and signs. Because of the vast quantity of necessary supplies, “we leave all the supplies on the trucks between clinics,” Sullivan said “We just add what we need to bring the numbers up to par for the next clinic.”
Having adequate people to staff the clinics — including doctors, nurses, and pharmacists — is essential as well, but this has not been an issue, Sullivan said. In fact, “our first sign-up was completely full within 40 minutes. It was oversubscribed,” she said, stressing that “they are all volunteering their time.” She credited Nida Al-Ramahi, Operations Lead, “for the effort, for the heavy logistical lift that has gone so smoothly.”
Penn Medicine is also reaching out to its suburban communities which so far have been receiving smaller supplies of vaccine. Sullivan said they have partnered with Delaware and Montgomery Counties to vaccinate residents and Penn patients. Once Penn Medicine receives its own vaccine supply in addition to the county’s supply, the health system plans to provide 450 doses per day at Penn Medicine Radnor and, upon receiving approval, 150 doses per day at Penn Medicine Valley Forge.
In Lancaster County, Penn Medicine Lancaster General Health is partnering with other health systems in the region and county government to increase the number of residents vaccinated. Led by LG Health, the coalition is setting up a Community Vaccination Center at a suburban shopping mall which will operate seven days a week.” With Michael Ripchinski, MD, chief clinical officer for LG Health, leading the endeavor, the Center, which will open mid-month, could vaccinate up to 6,000 people a day.
According to Alice Yoder, executive director of Community Health and Collaboration for LG Health, the site is “centrally located in the county and offers easy access. We’ll be able to get in a lot of people in a short period of time.”
But barriers still remained to reaching all of the community members, she noted, including available transportation, being homebound and vaccine hesitancy. To address these issues, LG Health formed the Vaccine Access and Equity Committee. The diverse committee comprises LG Health as well as several social organizations, including the NAACP and the Spanish American Civic Association, County of Lancaster, Office on Aging and several other diverse partners. “We’re working to identify key locations to distribute vaccine when it becomes available,” she said. One of the first sites was Brightside Opportunity Center, where they were able to vaccinate just over 500 people.
“We are also focusing on vaccine education to answer questions with the hope of reducing vaccine hesitation and readiness so that when the vaccine is available,” she said, “we will get it out the door and into people’s arms.”
Find the latest information about vaccination through Penn Medicine here.