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The Quadruple Aim
Quadruple Aim

A Conceptual Framework

Improving the U.S. health care system requires four aims: improving the experience of care, improving the health of populations, reducing per capita costs and improving care team well-being. HITEQ Center resources seek to provide content and direction aligned with the goals of the Quadruple Aim

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Resource Overview

  • Rationale
  • Challenges
  • Approach

Mobile health (mHealth) tools have the potential to play a pivotal role in fostering a sense of greater patient engagement within underserved populations. By facilitating patient use of mHealth applications in collaboration with electronic health record (EHR) and personal health record (PHR) systems there is an opportunity to empower individuals to take a more active role toward managing their health conditions.

The proliferation of consumer mobile health applications and devices is creating new opprotunities for engaging patients in their care and leaves little doubt as to the impact that these tools will have on the way that people manage their health, health information, and health communications with their care providers, family and friends. This shift to increased self-management of health by consumers will change a patient’s relationship with their doctor and the way healthcare is practiced.
The current laws and standards in place to ensure patient’s privacy and health information security will need further review to determine whether mobile health technologies create unique situations that are not yet addressed. This poses many challenges for health centers as to how best to support patient use of these tools and ways in which to incorporate them into their own clincial support systems.

Mobile health characterizes a shift in the point of care for the patient. The point of care has classically been located at the hospital or clinic. Mobile health is beginning to shift this model so that the point of care is more frequently a matter of where the person happens to be located at that time, consequently providing opportunities for more timely care. It is also important to note that these tools help to increase the accessibility of Healthcare to populations where direct access to Healthcare professionals is limited and so health management is more frequently left in the hands of the consumer.

The tools provide in this resource cover a range of different mobile health tools, strategies, and guidelines for consideration as Health Centers seek to leverage these technologies to better engage and activate their patients.

Mobile Health Resources

Electronic Patient Engagement Tools: Adaptation for Use in COVID-19 Vaccination Rollout
HITEQ Center

Electronic Patient Engagement Tools: Adaptation for Use in COVID-19 Vaccination Rollout

Insights and tips from several patient engagement vendors

Last fall, the HITEQ Center published an inventory describing many software tools that facilitate electronic patient engagement (EPE). The inventory detailed feedback from health center users of the EPE tools as well as information from the vendor about features and integration. As the health center workload has expanded to accommodate COVID-19 vaccination, the opportunity of EPE tools to address the needs of both health center and patients in this moment became apparent. HITEQ contacted the vendors included in the original inventory to gather supplemental information on how their products can be leveraged to support COVID-19 vaccine communication and distribution. Four EPE vendors responded.

The core features of the EPE tools are relevant and generally adaptable to a COVID-19 vaccination campaign, including:

  • broadcast messaging for education and outreach (e.g., vaccine safety, availability, eligibility, dosing)
  • 1-on-1 patient and provider or staff communication via text or web
  • patient screening
  • scheduling of 1st and 2nd doses
  • appointment reminders
  • visit check-in/registration
  • post-appointment follow-up (e.g., adverse reactions, next dose reminders)


Following are highlights from EPE vendors who responded:

WELL Health

WELL Health provides patient communication infrastructure that allows bi-directional patient communication in up to 19 languages. WELL Health offers functionality that can assist with many COVID-19 vaccine processes including education, appointment scheduling, no-show management, virtual waiting room/ text-when-you arrive, and adverse event monitoring.

  • Mass and tailored messages can be sent to reassure patients about vaccine safety, keep patients apprised of vaccine availability, and share other important information.
  • Automated Conversations using WELL’s ChatAssist technology can be used to automatically direct patients interested in the vaccine to scheduling resources while guiding patients who decline the vaccination towards educational materials or a conversation with their care team.
  • Automated appointment reminders and confirmations can be tailored to COVID vaccine considerations, including what patients should do if they experience COVID symptoms, how to use the virtual waiting room, and safety protocols related to COVID. Here are three examples WELL provides:    
    • Send a confirmation immediately following the booking of an appointment.
    • Send a reminder 24-to-48 hours before the appointment.
    • Send a day-of reminder 2-to-4 hours before the appointment.
  • Virtual waiting room, which sends a message to patients an hour before their appointment, reminding them to wear a mask and to text when they arrive. When the patient texts that they have arrived, the provider is alerted and the patient receives a confirmation text which advises them to stay in their car or outside until they are ready to be seen. When ready, the patient receives a text to come inside or to a specified location for vaccination.
  • Automated post-appointment messaging can follow-up with patients after their scheduled appointment. ChatAssist can deliver a wellness survey to those who kept their appointment and direct them to schedule a second dose. For patient(s) that no-show, there can be automatic follow-up to initiate a rescheduling conversation.

Well Health and HITEQ Vendor Discussion from March 2021 can be seen here.



In addition to functionality described in the HITEQ EPE Inventory, CareMessage has focused on product adaptation to help reduce vaccine-related call volume. CareMessage offers two tools, one is a paid version, which is a full EPE platform that includes EHR integration, while the other is CMLight, a free version that does not integrate with EHRs but supports sending outreach and reminder messages. Nineteen new message templates are available from CareMessage providing information on vaccine safety, availability, eligibility, cost, immigration status, side effects; and appointment reminders. CareMessage makes these COVID-19 Vaccine messages as well as COVID-19 general messaging freely available in this shared spreadsheet.  

With CareMessage, broadcast messages can be sent to the general patient population or to targeted lists based on age, diagnosis(es), or other factors. If the health center’s EHR is not integrated to CareMessage, patient lists can be uploaded via SFTP. If the health center uses Azara DRVS population health management system, the file upload can be automated. In the full platform version, patients can respond to a broadcast message by text to indicate that they wish to schedule a vaccine; this triggers staff response via private one-on-one messaging.

CareMessage continues to offer CMLight, a free version that does not integrate to EHRs but can facilitate text outreach and reminders. Health centers can be up and running on CMLight in a matter of hours.  All that is requires is creating a username and login and then uploading a patient distribution list and message templates (and again, CareMessage makes these message templates freely available). CMLight can support vaccine appointment reminders including collecting Yes or No responses on whether or not patients can attend COVID-19 vaccine appointments.  

Guidance on workflows for use of CareMessage, both the full platform and CMLight, relating to COVID-19 vaccination is available here.

Care Message and HITEQ Vendor Discussion from March 2021 can be seen here.



Luma offers an end-to-end solutions for COVID-19 vaccination campaigns, including:

  • broadcast messaging to all patients or targeted groups with vaccine education, information about availability and how to schedule an appointment,
  • self-screening surveys to determine eligibility for vaccination and complete consent forms,
  • self-scheduling with an automated waitlist which notifies the patient if a preferred, previously unavailable date & time becomes available
  • appointment reminders to minimize no-shows and vaccine waste
  • check-in on arrival, and
  • post-appointment follow-up for adverse reactions. 

For new users, the broadcast and scheduler functionalities which are likely to be critical for vaccine rollout support can be live in less than 1 week.

A guide to the use of Luma at each step is available here. Additional information for COVID-19 is available here. A video interview with Luma’s Chief Technology Officer on Vaccine Distribution Workflows in Action which offers tips on messaging, scheduling and use of wait lists in vaccination campaigns can be found here.



Relatient customers are finding the product’s standard features of broadcast messaging, scheduling and appointment reminders easily deployed to support COVID vaccinations. Given shortages of vaccine, the reminder function has become essential in efforts to reduce no-shows and avoid waste once vaccines are defrosted and prepared for use. Relatient users are also making use of scheduling and reminders to ensure that patients receive the second dose that is required for the currently available vaccines.

Additional information about customer use of Relatient to facilitate COVID-19 vaccination campaigns is available in this case study and this blog post.

To facilitate the complex and often labor-intensive task of patient scheduling, Relatient has also developed a freestanding Patient Self-Scheduling solution for organizations distributing COVID Vaccines. This self-service offering can be implemented within a few days to help organizations that are not already using Relatient in a full, bidirectional interface with their EHR scheduling systems.  More information on the patient self-scheduling feature is available here.


Disclaimer: This and all other HITEQ publications and activities do not represent an endorsement of any specific vendor, tool, or service by HRSA, HHS, the U.S. Government, nor the HITEQ Center or any member of the HITEQ team. Information is shared for information purposes only, health centers and health center partners are encouraged to do their own due diligence to confirm all information and ensure that any choices or decisions made serve the specific needs of the organization and its constituencies.

All HITEQ activities and services are supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $768,000 with 0 percentage financed with nongovernmental sources. The contents are those of the presenter(s)/ author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.


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This resource collection was cultivated and developed by the HITEQ team with valuable suggestions and contributions from HITEQ Project collaborators.

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