Penn Medicine OnDemand
In 2014, we launched a pilot program offering virtual care services to Penn Medicine employees. By leveraging a temporary structure - or fake back end - we were able to quickly validate feasibility and demand for the program and learn about user preferences. The pilot results were promising - we observed improved access and satisfaction, a sizeable reduction in the use of emergency department services by employees, and an uptick in the connection of patients to primary care providers at Penn Medicine. Based on the success of the pilot, we collaborated with partners from across the health system to move from a fake back end to jump-starting Penn Medicine OnDemand (PMOD) - a fully scaled virtual care telemedicine practice operated by the Center for Connected Care. PMOD is one of the primary tools our health system is using to keep patients and providers safe amid the ongoing COVID-19 pandemic. At the outset, the team adapted in real-time to handle the increased volume. With daily calls skyrocketing from 50-60 to more than 400, the staff has grown from seven providers to over 150. Individuals who feel sick can use PMOD to obtain a virtual evaluation, and patients with upcoming appointments can participate in virtual visits with physicians or advanced practice providers on the platform. The PMOD team is also providing support for patients with urgent COVID-19 symptoms through partnerships with Penn Medicine's COVID-19 Hotline, pre-appointment symptom screening programs, and COVID Watch.
Reducing inequities in telemedicine care
Telemedicine has successfully enabled patients to receive care safely amid the pandemic. However, as novel approaches to care delivery are implemented and expanded, it is critical to explore equity implications. At the outset of the pandemic, members of our team and colleagues from across the health system launched a large-scale study focused on inequitable access to telemedicine. The group found that older adults, minorities, non-English speakers, and lower-income earners face inequities in accessing telemedicine for primary and specialty ambulatory care. Broader research is currently underway to better understand patient and provider-specific telemedicine barriers to inform possible interventions. A change that has already been implemented is that Penn Medicine has added one-click interpreter integration for more than 40 languages for video-based interactions and greater than 100 languages for audio-based visits. Ensuring equitable access to telemedicine has become a major pillar of our implementation work.
CHCI staff: Sri Adusumalli, Chris Snider, Krisda Chaiyachati, Damien Leri, Katherine Choi, Eugene Gitelman | Partners: Penn LDI, Penn Cardiology, Lauren Eberly, Pete Groeneveld, Ashwin Nathan, Amaka Eneanya
Cancer Care @ Home
In late 2019, we began working with a team led by Justin Bekelman, director of the Penn Center for Cancer Care Innovation, to move low-complexity infused and injectable cancer drugs to the home setting. The COVID-19 pandemic added great urgency to our Cancer Care @ Home (CC@H) efforts. When Pennsylvania issued stay-at-home orders, we were able to scale the program in just a few weeks. Over seven weeks, CC@H saw a 700 percent increase in the number of patients participating. Since the program launched in February of 2020, hundreds of patients with breast cancer, prostate cancer, and lymphoma have received timely, safe, and effective treatment in the comfort of their homes. The program is now the standard of care at the Abramson Cancer Center.
Emerging evidence indicates that more than two-thirds of frontline health care workers battling COVID-19 will experience psychiatric symptoms, including post-traumatic stress, acute anxiety, substance use, depression, and suicide. COBALT is a digital platform designed to reduce friction and stigma and offer immediate access to targeted mental health support and treatment for health care workers. After answering a few questions, users receive personalized recommendations for support most relevant to their needs. Resources include articles, podcasts, sessions focused on mindfulness and anxiety reduction, resilience and peer coaches, psychotherapists, psychiatrists, and critical crisis intervention for those most at high risk for self-harm. Thanks to embedded scheduling and telehealth capabilities, COBALT can provide HIPAA-compliant mental health care at a safe distance. In the first 30 days, more than 8,000 sessions were conducted by over 5,000 individuals accessing a wide range of content and virtual support. Six months in, more than 14,000 users have engaged with the platform, there have been over 1,500 appointment bookings, and 111 individuals have identified thoughts of self-harm. The team is currently building on the COBALT platform to provide access to patients as well as exploring partnerships with other health systems to support front line workers beyond Penn Medicine.
Penn Med with You
Implementing emergency department discharge pathways for suspected or confirmed COVID-19 patients
We supported the implementation of three emergency department discharge pathways for suspected or confirmed COVID-19 patients. This work involved bringing clinical leads together to define clear enrollment criteria, developing role-specific action sheets to support on-the-ground implementation, executing an Epic build, and conducting staff training. The three discharge pathways are outlined below.
- COVID Watch and COVID Pulse patients receive twice-daily check-ins via text message with as-needed, timely escalation to a clinician.
- Patients enrolled in COVID Pulse and Home Health receive a home pulse ox device and teaching before discharge.
- Home Health patients receive twice-daily video visits, vital sign monitoring, and daily physician case review with in-person services as needed through Penn Medicine at Home.
COVID-19 chatbot and patient triage tool
We designed a public-facing chatbot in partnership with Google and Verily to provide appropriate and timely responses to questions about COVID-19 and risk-stratify patients so that they can be connected to the right level of care at Penn Medicine. Content for the chatbot comes from the COVID-19 FAQ, an interactive app that is continuously updated by students at the Perelman School of Medicine and validated by experts in infectious disease, occupational medicine, women's health, operations, and oncology. The chatbot and patient triage tool make it faster and easier for patients to get answers while simultaneously reducing call center volume - offloading work from frontline clinicians and shortening wait times for patients.
Protecting emergency departments from COVID-related surges
We provided design, regulatory, and coordination support to stand-up surge capacity in tents adjacent to emergency departments at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center. The surge model aims to protect emergency departments from COVID-related volume surges, separate patients suspected of infection, and provide targeted care explicitly designed for the COVID-19 population. A key element of the model is virtual registration supported by Way to Health. During "high-capacity status," providers can enact text message registration protocols that prompt patients to text pictures of their insurance card and ID - negating the need for face-to-face interaction. This virtual service reduces overall throughput time, encourages social distancing, and decreases potential exposure to fomites.
COVID-19 Twitter Map
Researchers from the Center for Digital Health launched a tool to track self-reported COVID-19 symptoms and real-time sentiment trends on Twitter. The dashboard, created in partnership with the World Well-Being Project, pulls between four million and five million COVID-related tweets a day using the Twitter API. Users can view confirmed COVID-19 cases and deaths per capita, top symptom mentions, changes in language about stress, anxiety, and overall sentiment of the pandemic, and more. The dashboard aims to provide actionable information for patients, providers, health systems, and policymakers. New content is added continuously.
An app to optimize critical staffing
COVID-19 presents an ongoing need for intensivists - board-certified physicians who provide specialized care for critically ill patients. We created a critical staffing app to enable administrators to view the COVID-19 status, availability, and competencies of intensivists at multiple sites across the health system. Employees are prompted via text messages twice a week to update their information. Administrators are currently using the app in the Pulmonary, Allergy, and Critical Care Division to make decisions about staff deployment. Plans are in place to scale to other services.
Prototyping personal protective equipment
At the pandemic onset, we worked with industry leaders to develop and test prototypes for personal protective equipment. Efforts included validating best practices for cleaning and sterilizing supplies in stock, producing a face shield that blocked air or moisture from passing through, and creating origami-based masks that offer micron-level filtration, droplet protection, and breathability. Over three weeks, the team moved from ideas to prototypes to user-testing to production. All plans are open-source so that other health systems can learn from these discoveries.
Taking substance abuse support virtual
As an extension of the CORE model, the CORE team is partnering with the Center for Addiction Medicine and Policy to host weekly, anonymous support forums for employees coping with substance use in their families or themselves. Meetings are facilitated by CORE's well-known certified recovery specialists, who are gifted listeners and facilitators and tremendous resources for substance use recovery.
Helping providers return home safely
Returning home after a shift can be stressful for frontline staff. Through in-depth interviews, we identified specific journey points driving anxiety and uncovered creative solutions providers are employing to reduce the risk of transferring COVID-19 to those around them. We used these insights to create a practical Return Home Safely guide for Penn Medicine staff. The guide goes beyond basic guidelines for social distancing and practicing good hygiene to offer tips on what to bring to work, best practices for leaving the hospital, and suggestions for reducing the risk of spread when arriving home. It also provides a worksheet providers can use to sketch out personalized plans. The tool has been distributed to employees via the PennMedicineTogether website.
Gallery of Gratitude
For those working extra hard in the face of COVID-19, knowing how much that work is appreciated can give a much-needed boost. In partnership with the Workforce Wellness Committee, we launched a "Spread the Love" campaign in March to collect notes of gratitude for frontline staff at Penn Medicine. In the first month, more than 1,000 messages were shared. The words of encouragement are displayed in the Gallery of Gratitude on screens in Penn Medicine hospitals and on the PennMedicineTogether website.
Nourished is a meal delivery platform that enables hospital staff to safely and efficiently order affordable meals from a curated list of local restaurants via text message. Individually packaged meals are transported directly from the restaurant's kitchen to a controlled hospital access point for contactless delivery to prevent the possible spread of COVID-19. Thanks to the enthusiasm of local restaurant partners and generous donors, Nourished was up and running in less than two weeks. The initial pilot took place at Penn Presbyterian Medical Center and then scaled to the Hospital of the University of Pennsylvania and Pennsylvania Hospital. Over the first four weeks, close to 4,000 meals were safely delivered to frontline staff at Penn Medicine - an especially meaningful outcome as this has been a challenging time for the Philadelphia food industry. In July, we handed the platform over to restaurant owners and operators who are diligently working to create a long-term plan for the success of the program.
CHCI staff: Ryan Schumacher, Davis Hermann, Cathy Reitz, Caitlin McDonald, Jessica Sung, Mike Begley, and Christianne Sevinc | Penn partners: Workforce Wellness Committee | Engineering partners: Chariot Solutions, Accenture, Way to Health, Icon Interactive, Syncro Medical, DXC Technology | Participating restaurants: Cafe Ynez, Baology, On Point Bistro, Pumpkin, and El Mekury | Donors: Fuel the Fight and Frontline Foods
COVID Watch enables patients who are confirmed or likely to have COVID-19 but not sick enough to need hospitalization to be monitored at home. Penn Medicine clinicians enroll patients in the program directly from the electronic medical record. From there, Way to Health utilizes twice-daily automated texts to remotely monitor patients, with protocols for escalation to telemedicine or hands-on care when necessary. Between March and November 2020, close to 10,000 patients were enrolled in COVID Watch – 87 percent of them “watched over” using text messages alone. For the 13 percent of patients who needed extra help, the median response time for escalations was 12 minutes. Patients in the program report that it is reassuring to know that Penn Medicine is checking in to see how they are doing, and the automation of the platform makes it incredibly efficient to staff and reduces reliance on physicians. Based on the success of the COVID Watch model, we have launched several spinoff programs - COVID Pulse monitors the sickest patients using a pulse oximeter, and Pregnancy Watch and Cancer Watch are tailored to the specific needs of those patient populations.
Developing a framework for equitable COVID-19 vaccination clinics
To date, the COVID-19 vaccine rollout has been highly inequitable, with white individuals being vaccinated at higher rates than Black individuals in 38 states. In early 2021, Penn Medicine forged a strategic partnership with Mercy Catholic Medical Center and a coalition of faith and community leaders to ensure equitable vaccine distribution in vulnerable communities in West and Southwest Philadelphia. Within two weeks, the team developed and launched plans for a series of community-based vaccination clinics in churches, recreation centers, and schools.
Community leaders helped inform the strategy, activate their networks, and build trust in the community to reduce vaccine hesitancy. Eligible patients have the option to register via text message or an automated phone system. And, as the date of their appointment nears, they receive automated reminders and guidance about what to expect after vaccination. The platform also nudges folks to serve as ambassadors for their community, prompting them to sign up friends and family members who may not be able to do it themselves.
Close to 3,000 patients, 85% of whom are Black, were vaccinated at our community clinics in the first 60 days. Intentional flow design and pre-registration enable an on-time model with minimal to no wait time to ensure a positive patient experience, and high-touch follow-up through outbound phone calls has resulted in a less than .04% no-show rate for second doses. In the coming months, the Vaccine Collaborative aims to sustain and scale efforts to serve underrepresented communities to ensure equitable vaccine distribution. The team also published a how-to guide in NEJM Catalyst to help cities, health systems, non-profits, and other organizations equitably distribute the COVID-19 vaccine via community clinics.
CHCI staff: Kathleen Lee, Lauren Hahn, Christina O’Malley, Neda Khan, Mohan Balachandran, Michael Kopinsky, Krisda Chaiyachati, Deirdre Darragh, Roy Rosin, David Asch, Raina Merchant, and Vivian Williams | Partners: This effort was driven by an expansive multidisciplinary team with representation from senior leadership, public safety, physical plant and supply chain, information services, environmental safety, community engagement, communications, and clinical experts from across the health system.
PennOpen Pass is a daily symptom tracker designed to reduce the risk of COVID-19 spreading within the Penn community. Participants enrolled in the program log in every day (weekends included) to indicate if they have any symptoms or have had exposure to a known or suspected case of COVID-19. Users who report no symptoms and no recent contact with someone who may have COVID-19 get a Green Pass. Those who report recent exposures to known cases or who themselves have symptoms receive a Red Pass. Individuals reporting to campus must show their Green Pass on entry into buildings, wear face coverings, and practice physical distancing. Users who receive a Red Pass receive assistance, which may include COVID-19 testing, self-isolation, contact tracing, and medical care. If a member tests positive for COVID-19, PennOpen Pass triggers contact tracing efforts conducted by Environmental Health & Radiation Safety, the Center for Public Health Initiatives, and Campus Health. The program has been expanded to Penn Medicine hospitals and practice sites and enhanced through daily reporting and analytics, robust Red Pass management automation for scalability, and additional clinical and auxiliary staffing. The team is preparing a comprehensive solution for non-employees on Penn's campus, including vendors, contractors, visitors, and patients. Over the first six months, the program enrolled over 60,000 users, completing more than one million symptom checks.
The COVID-19 pandemic has caused tremendous suffering, mortality, and economic disturbance worldwide. To safely and effectively reopen businesses and universities across the U.S., institutions need to develop approaches to rapidly identify COVID-19 cases and manage their spread while balancing program effectiveness, feasibility, costs, and scalability. For this to work, widespread COVID-19 testing is required. Unfortunately, currently approved testing options are expensive and require reagents that are limited in supply, severely hindering scalability. Emerging evidence indicates that saliva testing with the option of self-administered sample collection can accurately identify COVID-19 viral infection. However, implementation of a COVID-19 saliva-based screening program has not been well tested. Covid SAFE is a saliva-based surveillance program that uses a test developed by Penn Medicine scientists. The test is intended to be rapid and relatively cost-effective. It uses internally developed reagents to avoid potential supply chain shortages. To design, test, and scale its use, members of the Nudge Unit are conducting an observational clinical trial. Participants are asked to submit a saliva sample regularly, and those with positive testing are referred for appropriate management. Since enrollment in clinical trials is sometimes lower than optimal, we're also conducting a randomized trial that uses insights from behavioral economics to test different recruitment strategies. Covid SAFE is currently operating as a screening program for over 4,000 members of the Penn Medicine community and has conducted over 24,000 tests.
Designing drive-thru testing sites
Drive-thru testing was identified as an early priority for patient care and community health - with the additional need that suspected COVID-19 patients not congest emergency departments where they could create contagion. Within 48 hours, drive-thru testing sites were established in West Philadelphia and Radnor. The setup for these sites required immense design and logistical support. We worked with clinical and operational partners to create workflows for intake and lane protocol, introduce a walk-thru option adherent to social distancing guidelines, and produce signage. We also launched an automated dashboard to track patient flow and a registration process to minimize face-to-face contact. The registration process, powered by Way to Health, enables patients to navigate the process, receive guidance, and stay informed about next steps following testing via text message.
Enabling digital discharge
In conjunction with emergency department nursing leadership, we designed a paperless discharge program to deliver digital after visit summaries to patients, utilizing automated text messaging and myPennMedicine. Initially conceptualized for discharging patients in a mass surge scenario, a paperless discharge process reduces contact and exposure between patients and staff. Nurses can perform discharge education remotely via phone call or tablet. Once discharged, patients receive a text message with a link to their digital after visit summary on their personal device. This program, initially piloted in Fast Track, has launched in the emergency department at Penn Presbyterian Medical Center and will roll out to Princeton Health in 2021.
We have been piloting and iterating on workflows and capabilities for E-Consults for more than a year. E-Consults streamline communication between primary care providers and specialty providers by enabling providers to request specialist feedback through the electronic health record. In April 2020, our E-Consults model was activated in all primary care practices and departments to help providers manage patients while reducing face-to-face contact amid the COVID-19 pandemic. Providers can now enact E-Consults with specialists in diabetes, endocrine, cardiology, rheumatology, renal, genetics, sleep, gastroenterology, and other specialties. Providers at Penn Medicine conducted more than 150 E-consults in the first two months of adoption at scale, and approximately 30 to 40 percent of cases prevented unnecessary specialist visits.
Step UP is a self-service web application that seeks to match volunteers from the University of Pennsylvania and Penn Medicine with COVID-19 initiatives in need of support. Users can create project listings to recruit helpers or sign up as helpers by detailing their skill set and availability.
COVID-19 FAQ app
COVID-19 FAQ is an interactive app. Its mobile-friendly, searchable interface makes the latest COVID-19 guidelines quickly accessible to frontline clinicians. Users can up-vote content, flag answers for issues, and submit new questions. The content, which is continuously updated by students at the Perelman School of Medicine and validated by experts from infectious disease, occupational medicine, women's health, operations, and oncology, serves as the source of truth for clinicians answering patient and employee questions over the phone. It also serves as the backbone for the COVID-19 chatbot and patient triage tool.
The PennMedicineTogether website provides a wide variety of resources to help faculty and staff from across Penn Medicine take care of their physical health and access life necessities and care for their families. In the first five days, the website was viewed more than 5,000 times.
We created an automated report that aggregates information from multiple sources, enabling health system executives to monitor actionable COVID-19 data in real-time. In a sleek dashboard format, users can view the number of confirmed inpatients with COVID-19 by entity, patients under investigation, pending test results, telemedicine visits, hospital and emergency department occupancy rates, ventilator availability, and more.
Telemedicine and remote monitoring for prenatal and postpartum care
We have expanded telemedicine and remote care capabilities to keep patients receiving prenatal and postpartum care safe at home. By alternating between clinic and telehealth visits, we can decrease exposure risk for patients and providers. The programs under this umbrella leverage digital tools and remote monitoring to manage and support patients at home.
Pregnancy Watch is a remote monitoring intervention for pregnant patients exhibiting COVID-19 or influenza-like illness symptoms. Leveraging the COVID Watch model, automated text messages are sent twice-daily to patients who are isolating at home and tracking symptoms. Patients experiencing worsening symptoms like shortness of breath are escalated immediately to a pool of OB/GYN providers. This program is currently being offered at the Hospital of the University of Pennsylvania and Pennsylvania Hospital.
THEA enables pregnant patients to monitor their blood pressure at home and report it to physicians via text - eliminating the need for multiple in-person appointments.
Healing at Home prioritizes discharge to get new mothers out of the hospital sooner and delivers patient-centered support services in the home using an augmented intelligence chatbot.
Heart Safe Motherhood improves postpartum care for women diagnosed with hypertension. Patients receive automated, real-time feedback to self-reported blood pressure readings based on a provider-determined algorithm, and the platform alerts providers to values that require intervention. Providers are also able to prescribe antihypertensive medications remotely before the development of morbidity. In response to COVID-19, we are supporting additional care teams to implement Heart Safe Motherhood to reduce the amount of time patients spend in the hospital and minimize follow-up visits in the early postpartum period.