A Communications Campaign to Build Confidence in Covid-19 Vaccines: The Boston Medical Center Experience.

Health systems could play an important role in efforts to build vaccine confidence in communities that have been hardest hit by Covid-19. Boston Medical Center (BMC) health system, New England's largest safety-net hospital, along with its community partners, implemented a Covid Response Program aimed at building vaccine confidence. The program was supported by a multifaceted and multilingual communications campaign including: 1) traditional and social media channels with trusted messengers, 2) consistent and accessible core messaging, 3) transparent dialogue, and 4) partnership with state and local health government officials. Between December 2020 and June 2022, BMC disseminated 650 social media posts leading to 12 million impressions and more than 1.8 million post engagements. The campaign included a TikTok video later featured during the presidential inauguration, resulting in more than 3.7 million views. BMC's HealthCity digital publication released 20 articles gaining more than 73,000 views while the FAQ/vaccine scheduling site, translated into seven languages, reached 844,000 page visits. At six months into the vaccination program, 70% of BMC primary care patients 18 years or older had received at least one shot and 60% were fully vaccinated, having received either two mRNA doses or one adenovirus vaccine. The proportions rose to 82% with one dose and 75% fully vaccinated at 12 months. By 24 months into the program, 83% of BMC primary care patients had received at least one shot and 77% were fully vaccinated; however, notable differences existed by race/ethnicity. Seventy six percent of Black patients and 75% of Latino patients were fully vaccinated, compared with 85% of Asian and 81% White patients. Key lessons learned include the importance of a multilingual, multimedia campaign and the need for bidirectional communication that could quickly shift to address evolving issues.

Consensus Statement: Feature and Function Recommendations to Optimize Clinician Usability of Direct Interoperability to Enhance Patient Care.

BACKGROUND: Secure clinical messaging and document exchange utilizing the Direct Protocol (Direct interoperability) has been widely implemented in health information technology (HIT) applications including electronic health records (EHRs) and by health care providers and organizations in the United States. While Direct interoperability has allowed clinicians and institutions to satisfy regulatory requirements and has facilitated communication and electronic data exchange as patients transition across care environments, feature and function enhancements to HIT implementations of the Direct Protocol are required to optimize the use of this technology. OBJECTIVE: To describe and address this gap, we developed a prioritized list of recommended features and functions desired by clinicians to utilize Direct interoperability for improved quality, safety, and efficiency of patient care. This consensus statement is intended to inform policy makers and HIT vendors to encourage further development and implementation of system capabilities to improve clinical care. METHODS: An ad hoc group of interested clinicians came together under the auspices of DirectTrust to address challenges of usability and create a consensus recommendation. This group drafted a list of desired features and functions that was published online. Comments were solicited from interested parties including clinicians, EHR and other HIT vendors, and trade organizations. Resultant comments were collected, reviewed by the authors, and incorporated into the final recommendations. RESULTS: This consensus statement contains a list of 57 clinically desirable features and functions categorized and prioritized for support by policy makers, development by HIT vendors, and implementation and use by clinicians. CONCLUSION: Fully featured, standardized implementation of Direct interoperability will allow clinicians to utilize Direct messaging more effectively as a component of HIT and EHR interoperability to improve care transitions and coordination.

Barriers to proliferation of electronic medical records.

BACKGROUND: Error reduction, quality improvement and lowering of cost can all be achieved through electronic integration of healthcare providers. Proliferation of standard electronic health records/ electronic medical records (EHR/EMR) software is an essential precursor of this integration. Proliferation of EHR/EMR software has not occurred in the United States. OBJECTIVE: To characterise users and non-users of EHR/EMR software, identify potential barriers to proliferation, examine the extent of standardisation across reported EHR/EMR and suggest possible solutions to identified barriers. METHODS: We performed a secondary analysis of member survey data collected by the American Academy of Family Physicians (AAFP) in January 2003. The purpose of the survey was to measure interest in an AAFP-sponsored EHR/EMR service. We examined demographic and purchasing data from the survey by gender, population density, region and age. We also counted the number of different software vendors reported by users of an EHR/EMR to assess the number of users with unique software. RESULTS: Of the 35,554 members contacted, 5517 (15.5%) responded. Of those responding, 1297 (23.5%) reported use of an EHR/EMR. Of the members responding, 81% reported interest in EHR/EMR software and 61% reported cost as a major reason for not purchasing it. At least 264 different EHR/ EMR software programs are currently in use. On average, the percentage of respondents with the same EHR/EMR software is 0.4%. DISCUSSION: The number of AAFP members with unique EHR/EMR software is very large. Fragmentation, caused by the use of hundreds of unique systems, is a major barrier to proliferation of these systems. Many of the barriers to proliferation could be mitigated through the tools and techniques available through Free and Open Source Software (FOSS).

Electronic health record functionality needed to better support primary care.

Electronic health records (EHRs) must support primary care clinicians and patients, yet many clinicians remain dissatisfied with their system. This article presents a consensus statement about gaps in current EHR functionality and needed enhancements to support primary care. The Institute of Medicine primary care attributes were used to define needs and meaningful use (MU) objectives to define EHR functionality. Current objectives remain focused on disease rather than the whole person, ignoring factors such as personal risks, behaviors, family structure, and occupational and environmental influences. Primary care needs EHRs to move beyond documentation to interpreting and tracking information over time, as well as patient-partnering activities, support for team-based care, population-management tools that deliver care, and reduced documentation burden. While stage 3 MU's focus on outcomes is laudable, enhanced functionality is still needed, including EHR modifications, expanded use of patient portals, seamless integration with external applications, and advancement of national infrastructure and policies.

The alternative route: hanging out the unmentionables for better decision making in health information technology.

Expert panels and policy analysts have often ignored potential contributions to health information technology (IT) from the Internet and Web-based applications. Perhaps they are among the "unmentionables" of health IT. Ignoring those unmentionables and relying on established industry experts has left us with a standards process that is complex and burdened by diverse goals, easy for entrenched interests to dominate, and reluctant to deal with potentially disruptive technologies. We need a health IT planning process that is more dynamic in its technological forecasting and inclusive of IT experts from outside the industry.

Getting from A to C: lifecycle lessons for e-health deployment.

The 35-year history of continuous development of hospital information systems and the current efforts to develop an electronic health record in outpatient settings suggest a lifecycle that must take place before electronic technology is adopted in the highly decentralised US healthcare system. This six-stage lifecycle, called the ABCs of change, involves Acceptance of the need for change, Alignment of the actors to fulfil that need, Breadboard development of the desired, integrated system, a Blueprint for the system to be commercialised, Configuration methods for adapting the system to individual provider and patient needs, and Capital sources for the desired change. This article shows how that six-stage model is relevant to understanding prior development attempts and how current efforts to bring electronic health records to small, primary-care practices follow it. We conclude that it is a useful model for insight and for future planning.