This is a mega trial with planned enrollment of 150,000 patients across Penn Medicine and Geisinger Health system. The intent was to simultaneously test out 19 different nudges to figure out how to increase flu vaccination rates. The secondary intent was to use learnings from this to inform COVID vaccination efforts. The best performing nudge increases uptake by 11% over previous year baselines. The study was replicated with Walmart with 800,000+ participants.

In a concerted effort to address racial inequities. Penn Medicine partnered with Mercy Health, local pastors and the community in West and Southwest Philadelphia, to set up a community vaccination clinic. The goal was to vaccinate 500 individuals who met the 1A or 1B criteria set forth by the city. Way to Health provided the texting and IVR backends to enable registration and appointment scheduling prior. 557 patients were vaccinated. The next clinic on Feb 27th intends to vaccinate 750. The one after that will hopefully vaccinate 1500.

As the University began to scale up the return of students to campus, there was an urgent need to provide COVID-19 testing capabilities as well as the need to communicate the test results back to students. The plan was to leverage the Automated Results Reporting program already developed at the health system and modify it to suit the University's needs. The key differences being a different LIMS system, integration to the red pass management system and escalations sent to Student Wellness and other student specific programs.

This project leveraged the success and design on the COVID Watch project and modified it to address the specific needs of the University and it's faculty and students. Once test results were being communicated or symptoms were being, the next step was to be able to monitor students and faculty remotely and address any needs they might have. This project modified COVID Watch to check in with patients once a day (as opposed to twice in Watch) and escalations were directed to student wellness services for mental, physical, food and other related issues. The volume of students enrolled remained low given their demographics and other precautions being taken on campus.

Given that testing availability will likely continue to be constrained, symptom tracking based testing could lead to earlier case identification. At the same time, sentinel surveillance will be a critical tool for identifying pre-symptomatic, asymptomatic or mildly symptomatic spread that may evade symptom-based surveillance. Together, this approach provides ability to rapidly identify new cases and conduct contact tracing. This is an RCT that aims to (1) Evaluate the feasibility of a saliva-based screening COVID viral testing program (2) Compare behavioral strategies to improve study enrollment (3)Understand the relationship between daily symptom tracking and identifying infection,

COVID tests are conducted in advance of procedures or as part of occupational health. These results needed to be communicated to patients in a timely manner. While they were also communicated via the patient portal, immediacy is critical and not all patients have the app installed and activated. Phone calls from a nursing team were expensive and time consuming. An automated system to communicate negative test results (the majority) was put into place to optimize resources while ensuring patient communication.

COVID Pulse was designed partly in response to reports that some patients with Covid-19 have little dyspnea, despite concerning hypoxemia (low blood oxygen). This program enrolls patients from emergency departments with depressed oxygen saturations, providing them with pulse oximeters, and escalates to care based on declines in measured oxygen saturation.

A Penn Medicine program that automatically checks in with patients at risk for complications of COVID-19 who are self-isolating at home. Patients are monitored 24x7 via text message and escalations managed by a nursing team with full Epic integration.

A variant of the COVID Watch program that automatically checks in specifically with pregnant women at risk for complications of COVID-19 who are self-isolating at home. Patients are monitored 24x7 via text message and escalations managed by an hospital specific nursing teams with full Epic integration.

Vaccinations are critical to getting the country back on track. This program was designed to reach out to patients who either did not have a patient portal account or have a valid email address on file. The intent here was to try and reach out to patients that Penn Medicine interacted with sometime during the last three years and offer the vaccine based on their availability. The program also asked if they already had received the vaccine or were hesitant. The program reached over 300,000 patients and for the people for whom we had accurate information and indicated interest, the conversion rate was around 60%.