When the COVID-19 pandemic hit, Penn Medicine's investment in innovation paid dividends. Telemedicine was already in use. We had experimented with delivering care through automation and tested structures for exception management and escalation. We had internal platforms, like Agent and Way to Health, that enabled us to deploy new programs quickly. And most importantly, we had care teams and staff ready and willing to design and implement new approaches to care delivery.
Working with partners from across the health system, we launched upwards of 20 projects in the first 60 days. These shoulder-to-shoulder collaborations with mission-driven colleagues were energizing. We stood up drive-thru testing sites, designed a chatbot to answer patient questions quickly, developed an automated system to watch over COVID-19 patients at home, tracked national sentiment and symptoms on social media, launched a web-based platform to connect frontline employees to mental health care, moved care delivery from hospitals and clinics to the home, implemented testing programs, and so much more.
This past year has dramatically demonstrated both the short-term and long-term returns to disciplined investment in innovation. One year into the pandemic, and we're still going. We hope you'll stay tuned for updates.
David A. Asch, MD, Executive Director, Penn Medicine Center for Health Care Innovation
Penn Medicine OnDemand
Penn Medicine OnDemand (PMOD) is a virtual care telemedicine practice operated by the Center for Connected Care. PMOD was one of the primary tools our health system used to keep patients and providers safe amid the COVID-19 pandemic. At the outset of the pandemic, the team adapted in real-time to handle the increased volume. With daily calls skyrocketing from 50-60 to more than 400, the staff grew from seven providers to over 150. Individuals who felt sick used PMOD to obtain a virtual evaluation, and patients with upcoming appointments participated in virtual visits with physicians or advanced practice providers on the platform. The PMOD team also provided 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. Learn about our efforts to develop and scale PMOD here.
Reducing inequities in telemedicine care
Telemedicine successfully enabled patients to receive care safely amid the pandemic. During this time, members of our team worked with colleagues from across the health system to launch 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. An immediate change implemented in response to these findings was that Penn Medicine added one-click interpreter integration for more than 40 languages for video-based interactions and greater than 100 languages for audio-based visits. Broader research is currently underway to better understand patient and provider-specific telemedicine barriers to inform possible interventions. Learn more.
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.
It is estimated that more than two-thirds of frontline health care workers who battled COVID-19 experienced psychiatric symptoms, including post-traumatic stress, acute anxiety, substance use, depression, and suicide. COBALT is a homegrown digital platform that was developed and launched in the spring of 2020 at Penn Medicine. It is 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. And 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 had engaged with the platform. 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 frontline workers beyond Penn Medicine.
Penn Med with You
Researchers from the Center for Digital Health developed a virtual support tool to support Penn Medicine patients and community members during the early months of the pandemic. Individuals enrolled in Penn Med With You received a weekly well-being check-in and tailored support resources via text message. Resources included COVID-19 updates, information about social support tools, and lighthearted hyperlocal news. Participants were asked to rate the quality of the information and resources they received. The team collected self-reported mood and well-being scores from users longitudinally. Learn more about the program here.
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 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 received twice-daily check-ins via text message with as-needed, timely escalation to a clinician.
- Patients enrolled in COVID Pulse and Home Health received a home pulse ox device and teaching before discharge.
- Home Health patients received 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 could be connected to the right level of care at Penn Medicine. Content for the chatbot came from the COVID-19 FAQ, an interactive app that was 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 made 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. Learn more.
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 aimed 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 was virtual registration supported by Way to Health. During "high-capacity status," providers could enact text message registration protocols that prompted patients to text pictures of their insurance card and ID - negating the need for face-to-face interaction. This virtual service reduced overall throughput time, encouraged social distancing, and decreased 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 – which was archived after operating for over a year – was created in partnership with the World Well-Being Project. Each day, it pulled approximately 4 million COVID-related tweets using the Twitter API. Users were able to 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 aimed to provide actionable information for patients, providers, health systems, and policymakers. More information regarding data access can be found here.
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 onset of the pandemic, 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. In 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 partnered 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 were 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
At the start of the pandemic, returning home after a shift was stressful for frontline staff. Through in-depth interviews, we identified specific journey points driving anxiety and uncovered creative solutions providers employed to reduce the risk of transferring COVID-19 to those around them. We then created a practical Return Home Safely guide for Penn Medicine staff. The guide went 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 provided a worksheet that providers could use to sketch out personalized plans. The tool was 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. At the start of the pandemic, in partnership with the Workforce Wellness Committee, we launched a "Spread the Love" campaign to collect notes of gratitude for frontline staff at Penn Medicine. More than 1,000 messages were shared in March of 2020. The words of encouragement were displayed in the Gallery of Gratitude on screens in Penn Medicine hospitals and on the PennMedicineTogether website.
Nourished is a meal delivery platform that enabled hospital staff to safely and efficiently order affordable meals from a curated list of local restaurants via text message. Individually packaged meals were 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. In the first four weeks, close to 4,000 meals were safely delivered to frontline staff at Penn Medicine. In July 2020, 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 reported that it was reassuring to know that Penn Medicine was 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 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. Learn more.
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 had the option to register via text message or an automated phone system. And, as the date of their appointment neared, they received automated reminders and guidance about what to expect after vaccination. The platform also nudged 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 percent of whom were Black, were vaccinated at our community clinics in the first 60 days. Intentional flow design and pre-registration enabled 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 percent 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.
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 and 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. PennOpen Pass was also used to screen non-employees on Penn's campus, including vendors, contractors, visitors, and patients. Between June 2020 and May 2021, over 4 million remote screenings were conducted on PennOpen Pass by more than 75,000 campus members. During this time, the program coordinated care for over 25,000 members of Penn's University and health system campus who triggered a Red Pass evaluation. Learn more.
To reopen businesses and universities safely and effectively across the U.S., institutions needed to develop approaches to rapidly identify COVID-19 cases and manage their spread while balancing program effectiveness, feasibility, costs, and scalability. Last fall, the Perelman School of Medicine, the Nudge Unit, Way to Health, and others at Penn Medicine launched Covid SAFE. Covid SAFE is a saliva-based surveillance program that uses a test developed by Penn Medicine scientists. The test was intended to be rapid and relatively cost-effective, using internally developed reagents to avoid potential supply chain shortages. The team conducted clinical and randomized control trials that used insights from behavioral economics to test different recruitment strategies. Close to 5,000 participants were enrolled in the program, and over 67,000 tests were performed. The program provided confidence that mitigation measures were working and allowed Penn employees to feel safe in their workplace. Thanks to an increase in the vaccinated population and a decline in COVID-19 cases in Philadelphia, the Covid SAFE surveillance testing program was closed in June 2021.
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. 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 efficient and scalable workflows for patient progression, introduce a walk-thru option, and engineer a wayfinding strategy adherent to social distancing guidelines. 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, enabled 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 the Penn Presbyterian ED Super Track, is currently launching across the department with an opportunity for broader deployment.
We piloted and iterated 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 was developed and launched in the spring of 2020 when COVID-19 projects being run by faculty and staff needed support. The platform seeks to match volunteers from the University of Pennsylvania and Penn Medicine with initiatives that need staffing. Users can create project listings to recruit helpers or sign up as helpers by detailing their skill set and availability. Learn more.
COVID-19 FAQ app
COVID-19 FAQ is an interactive app. During the early days of the pandemic, its mobile-friendly, searchable interface made the latest COVID-19 guidelines quickly accessible to frontline clinicians. Users were able to up-vote content, flag answers for issues, and submit new questions. The content, which was 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, served as the source of truth for clinicians answering patient and employee questions over the phone. It also served as the backbone for the COVID-19 chatbot and patient triage tool.
The PennMedicineTogether website provided 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. After launching in March 2020, the website was viewed more than 5,000 times in the first five days.
We created an automated report that aggregated information from multiple sources, enabling health system executives to monitor actionable COVID-19 data in real-time. In a sleek dashboard format, users could 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 expanded telemedicine and remote care capabilities to keep patients receiving prenatal and postpartum care safe at home. By alternating between clinic and telehealth visits, exposure rates were lowered for patients and providers. The programs under this umbrella leverage digital tools and remote monitoring to manage and support patients at home.
Pregnancy Watch was designed for pregnant patients who exhibited COVID-19 or influenza-like illness symptoms. Leveraging the COVID Watch model, automated text messages were sent twice-daily to patients who were isolating at home and tracked symptoms. Patients that experienced worsening symptoms like shortness of breath were escalated immediately to a pool of OB/GYN providers. This program continues to be offered to patients at the Hospital of the University of Pennsylvania and Pennsylvania Hospital.
THEA enabled 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 prioritized discharge to get new mothers out of the hospital sooner and delivered patient-centered support services in the home using an augmented intelligence chatbot. During the pandemic, the program scaled to serve mothers delivering via C-section and those with higher-risk pregnancies.
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. During the pandemic, we supported 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.