2021-05-13 Meeting notes

Martha Montgomery

Amy Parker Fiebelkorn

Alice Asher

Priti Patel

James Lee

I.  What is a Vaccine Ambassador?

• Trusted in the community (i.e. CHW) and an important piece of the community–for 1) homeless and 2) SUD
• PErhaps two separate types of ambassadors–one for each population
• Third group–sex workers, Human Trafficking/Adolescents (subset), LGTBQ/Transgender

Hire 60 Ambassadors total–would be based in the health centers.  

NACHC:  We call this role "extenders"

II.  NACHC:  What is missing is infrastructure and approach for model of care–i.e. IIS.   It's important to build patient and care team-friendly interface (care plan), to monitor infectious disease, as we are going TO these patients.  

CDC: End goal→increase uptake of vaccine in these populations.  

NACHC:  This could be an incubator project–test the technology now for spread and sustainability.   Working with Healthcare for the Homeless Council, this could lead to a demonstration of the use of CHWs or extenders in point-of-care documentation and care management.  

CDC:  Use the technology now that has been put into place for COVID vaccine, that can then be built out eventually for Hep A/B, other vaccines.  May be ok to decrease the amount of people we hire and focus more on getting this system up and running.  

NACHC: 

Cassie re: CHW Learning Community→ this model is focused on CHWs reaching out with patients to get COVID vaccines.  However, this work is not always being documented.  The need is great to standardize best practices here.

Ted:   Some work being done around extenders, SDOH, and looking at "patient visits" per UDS.  Often patients are receiving care 4x the amount that is being reported–these visits are often by extenders and are not covered

CDC:  Suggest a monthly "community of practice" call to discuss the work being done, what works/doesn't work, record and analyse/summarize qualitative work to develop tangible "guide"

Allow the Ambassadors to link to the other services...not just COVID-vaccine

We want avoid "parachuting in/out".  We want to encompass trust building, going to where the patients are, and addressing the most important need of the day, which may/may not include a COVID vaccine.  

Maybe call them "Health Ambassador"—rather than just focusing on Vaccine.  Comprehensive approach.  

Consider other roles as well–Dental Health

Look for long-term partners:

• National Healthcare for the Homeless Council
• Public Housing

• See above
• NACHC team will identify anyone else who needs to be on the weekly calls

• Qualitative:  surveys, case studies
• Quantitative

Julia (draft):

• Vaccine preferences

• Vaccine status

• Vaccine administration

• SDOH

• Demographics

• Location/contact methods

• Health concerns/conditions

• Goals (free text)

• Social interventions

• COVID infection status

• Kathy to include data in a loose way
• Plan for spread/scale by sharing in Homeless conference, NACHC conferences etc...

• Martha will create agenda, which will include review of all workplans/budgets

Lee, James Tseryuan (CDC/DDID/NCIRD/ISD) (Guest):  Raymonde Uy  - do you know what % of HCs EMR have 2-way communication capacity with their state IIS?

Ray:  Hi Lee,  , this is quite a difficult question to answer. We do not know as different EHR vendors and different deployments/customizations are in a wide spectrum of supporting interoperability. Even HCs using the same vendor do not connect to their state IIS by default

They (vendors/software) have the capacity, but creating these connections to registries "cost money", and vendors charge for these. HCs, being resource-limited by default, may not have the bandwidth and resources to do this kind of "connection" work.
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What would happen is that HCCNs and PCAs takes on the role of being a mini health information exchange that supports a one-way (unfortunately) connection to the IIS.
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Yes-- if we take that approach we are building infrastructure to reach patients with needs and address public health -- both are inexorably linked
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Also-- Kathy was correct: we will use the care plan framework to respond to each need including vaccine/COVID prevention
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The care plan framework: 1) health condition or need--> 2) Goal --> 3) Interventions/plans --> 4) Evaluation and outcomes
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It is a patient-centered framework because it directly incorporates the patient's own concerns and goals
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For vaccines that are given we will create a message to the IZ Gateway to satisfy public reporting requirement
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Actually we could create a direct connection to the IZ Gateway if we want but data would also flow to the health care organization's own system so the direct connection isn't required technically
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For our other immunization work we are targeting IZ Gateway bidirectional exchange
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