Seattle Visiting Nurses Association transforms vaccine delivery process using Microsoft Power Platform

Banner image for SVNA story - picture of nurse at drive-thru flu clinic

Seattle Visiting Nurse Association (SVNA) is a family-owned healthcare business based in founder Neal Baum’s home state of Washington. During the 11 years since its founding, SVNA has become the largest community mass immunizer in Washington State, delivering flu vaccinations to approximately 40,000 patients a year. Current CEO, and founder’s grandson, Jake Scherf has embarked on a mission to completely transform the company’s vaccination delivery system, using the rapid development speed of agile Microsoft technologies to keep their nursing staff and their patients safe in the face of the COVID-19 pandemic.

Utilizing Microsoft Dataverse, Power Apps and Power Automate, SVNA and their digital partner Signetic were able to develop a solution in an incredible turnaround of just 8 weeks. The solution is used by patients, nursing staff and admin staff to safely deliver flu vaccinations. In this article we will learn about how this remarkable solution came to be, and how it has allowed SVNA to not only safely return to administering flu vaccinations, but to increase their vaccination output from an average of 40,000 patients per year to 60,000 in 2020, despite the year’s challenges.

Moreover, SVNA has been approached to be one of the first vendors to deliver COVID-19 vaccinations in Washington state, and is close to launching an update to their Power Platform solution to enable COVID-19 vaccination delivery across the state.

Thumbnail picture for SVNA story on YouTube

Watch Jake Scherf (CEO, SVNA) and Lukas Svec (VP of Digital Transformation, Signetic) share their Power Platform success story at Microsoft Ignite 2020: https://aka.ms/Ignite/SVNA.

Business Scenario

As with many areas of healthcare, the traditional processes used by SVNA to protect patients in its community were upended by the rise of COVID-19. SVNA used to run a ‘Fight the Flu’ campaign with on-site flu shot clinics in workplaces, schools, and communities across the entirety of the state, but in the midst of a pandemic, these flu clinics could no longer operate as they had before.

By mid-2020 it became clear that businesses and schools would be closed during the flu season, and SVNA would need to find a new way to operate if it were to continue delivering vital flu shots to Washington state communities. With everybody working from home, the challenge became, “Where could the clinics be set up?”, “How could clinicians deliver the shots while maintaining a safe distance?”, and “How would patients be able to schedule an appointment?”

With the flu season just around in the corner, answers to these challenges needed to be found – and fast.

Before Power Platform

Historically, SVNA had run a paper-based operation to deliver flu vaccinations at employer-hosted clinics, with patients filling out paperwork on site that would then need to be processed after their vaccination was delivered. On average it took around 20 minutes to take a single patient through their vaccination, and up to 3 months to receive payment from insurance companies. Clinicians were having to spend their valuable time tracing paperwork instead of providing care to patients.

Picture of old paper based process

Left: SVNA’s previous process; Right: Example of original paper form

As one example of how painful this process could be, some clinicians had to pick up paperwork in Seattle, drive five hours across state to clinics hosted in Spokane, and fill out the paperwork on site. When they needed to restock their inventory of vaccines, they would return to the head office in Seattle and drop off their paperwork – this could be three to four weeks after the clinic visit had been successfully completed. Once in Seattle, the paperwork would then wait to get processed by busy billing staff, who may then have needed to re-contact patients to gain information missed on the original forms before finally submitting for payment. The overall turnaround for payment could creep up to 6 – 8 weeks.

From an obstacle to an opportunity

Jake Scherf, SVNA’s CEO and grandson to SVNA’s founder Neil, knew that this situation needed to change. When considering how the company would tackle the problem of COVID-19, it was obvious that paper was not the way forward. They needed to reduce shared surfaces, and sharing of paper forms and pens was out of the question. If the solution was to be digital, then why not, not only tackle the problem of COVID, but also remove the operational headaches of their staff? This line of thinking brought SVNA from considering this an obstacle, to recognizing the opportunity to eliminate paper altogether. They could modernize and transform their processes to meet the challenges of their field and office staff. A few key opportunities with the new solution were:

  • Improving safety and efficiency – Paper processes, in addition to being a risk during a time of COVID-19, were also impractical in the modern workplace. With many of SVNA’s nursing staff having to travel to clinics all over the state, it could be weeks before the completed vaccination paperwork found its way back to the office to be processed. SVNA was looking to improve the efficiency of their operation by removing transit time for information.
  • Reducing time spent on incomplete information – Chasing missing details in incomplete forms was a time-consuming job and could be rendered unnecessary if there was a way of ensuring the patients’ data was entered, in full, at the beginning of the process.
  • Insights for the future – When SVNA received a grant from King County and City of Seattle to provide immunizations for uninsured citizens within Washington state, it became clear that they required more robust data tools to keep track of – who had insurance, who did not have insurance, when individuals received their shot, where that shot was delivered, etc. SVNA planned to implement a system that would enabling handling and analyzing the collected data to provide better insights for future years.

Power Platform Solution

With these challenges and goals in mind, in June 2020 – Jake, his grandfather Neil, and SVNA’s Chief Operating Officer Greg Curry sat down together to try to determine a new model for what they dubbed ‘the COVID year’. Out of this group discussion arose a vision to introduce contactless drive-through clinics, pivoting from 3-day employer-run clinics to 3-week pop-up clinics in parking lots across the state.

Quote from Jake Scherf - “We knew we were going to have to completely redesign our business model to meet our patients in the field. That’s where the idea for the drive-through immunizations came from.”

In order to realize this vision, Jake turned to SVNA’s digital partner Signetic to kick off a digital solution. He and his grandfather knew that there must be something out there that would meet their needs at the right price point. They didn’t know the details of how it would work or the name of the technology that would get them to where they wanted to be, but they had a vision of what it could look like, and how it might be used to solve their problems.

During the kick-off discovery session with Signetic, they were able to put a name against this technology: Microsoft Power Platform. Jake and his colleagues had been using Microsoft for their office software. Their COO Greg and Billing Manager Jenny were proficient in Excel, but Power Platform was totally new for them. The capabilities of the platform turned out to be conducive to solving SVNA’s problems in a modular manner and its monthly licensing subscription was ideal for SVNA’s seasonal business model. In addition, the platform would enable the rapid development timeline SVNA needed, especially with the use of Microsoft’s Healthcare Accelerator to kick-start development of a suitable data model.

Through the discussion Lukas Svec, VP of Digital Transformation at Signetic, realized that there were three core elements necessary for the solution to fulfil SVNA’s goals:

  • a method for patients to book appointments and enter their data,
  • a method for nurses to know what clinics they had been assigned to and what patients they would be immunizing,
  • and an administrative layer for admins to control what clinics the clinicians were assigned to, and to track and analyze data.

Equipped with Microsoft Dataverse, Power Apps and Power Automate, Signetic got to work, and in an impressive turnaround of just 8 weeks, the solution began its working life out in the field. It was initially released to one clinic at the beginning of September, and soon within a matter of 8 weeks, was rolled out to 63 more clinics across Washington state. To date, the solution has empowered SVNA to immunize 60,000 patients safely and successfully in 2020 alone.


Patient registration – custom website

The first element the solution needed was a way for patients to book an appointment and enter their insurance and health information. As this needed to be externally facing, and since the development partner Signetic had a long history of creating professionally developed websites, a custom website was chosen as the delivery mechanism for this element.

Screenshot of SVNA website

 

SVNA’s new custom website, allowing prospective patients to select a nearby clinic site, pick a suitable date and time for their vaccination, and fill in their personal details

This custom website was built using the Microsoft Dataverse SDK, which gave Lukas and the Signetic team the confidence that the data gathered via the website would be fed directly into Dataverse and handled there. The ease of hooking into these APIs meant that Signetic could complete the patient-facing website component in just 2 weeks

Quote from Lukas Svec - “Because Microsoft Dataverse exposes a lot of APIs to connect into, it was very easy for us – as professional developers who build websites every day – to build a website on the front end, knowing how we were going to connect to the data on the back end.”

Clinician mobile experience – Power Apps canvas app

For the clinicians, a different approach was needed. The clinicians would need to have access, while out in the field, to all of the information for their upcoming patients. With many of the nurses being semi-retired, or in some cases fully retired – an easy-to-use interface was critical in order to get the data into their hands as efficiently and painlessly as possible. As such, this element was the perfect candidate for a mobile Power Apps canvas application.

Screenshots of mobile Power Apps canvas app

SVNA’s mobile canvas Power Apps application, used by its nursing staff to set their current availability, view details of their upcoming appointments, and complete vaccinations

The application holds many useful features for clinicians out in the field and, as with all Power Apps, is available to them directly from their mobile phone or tablet device.

  • From the Main Menu, clinicians can immediately see how many vaccinations they have on hand and choose to navigate to different areas in the application.
  • The My Profile section allows nurses to toggle whether they are flagged as available for assignment and provide an availability comment to the admin staff.
  • The Clinic Assignments section allows nurses to view the date and location of the upcoming clinics they have been assigned to.
  • The Appointments section shows details of all the patients the clinician is due to see during their shift, with the ability to filter the data and to see, from within the gallery view, key information about each patient.
  • The Appointments Detail screen provides, for each patient, all the information that was entered into the system during registration and allows the clinician to confirm the shot was delivered.

Since the application was built on top of Dataverse, the nurses have access to the data immediately; patients can come to the clinic, book an appointment right from their vehicle, and immediately be registered on the nurses’ applications. Additionally, all information about the nurses’ availability and the shot completion is automatically fed back into Dataverse to be able to be viewed by the admin staff.

Photos of nurses at SVNA mobile flu shot clinic

Administrative layer – model-driven Power Apps

For the admin staff, a more data-focused direction was required. Admins would need to see large swathes of data, understand them immediately, and be able to act on them – for this a Power Apps model-driven app was the perfect medium.

Screenshot of PowerApps model-driven apps

SVNA’s model-driven Power App allowing administrative staff the ability to manage clinic sites, nursing staff, and billing

With this app, the admin staff are able to add new clinic sites, assign nurses to clinics depending on their availability, set up unique private patient registration sites for specific companies’ employees, see all patients registration responses and data, process billing for completed vaccinations, and track trends – such as seeing which locations are most popular at which particular times of day, and information on the distribution of available vaccinations between nurses.

Solution Architecture

To summarize, the solution is built entirely using Microsoft Dataverse as its central data repository and consists of three main parts:

  • A public facing website for patients to book appointments – this is a custom website that uses the Microsoft Dataverse SDK to retrieve clinic site data and save back information about incoming patients and their bookings.
  • A ‘Clinician’s app’ – this is a Power Apps canvas app used by clinicians in the field. It surfaces the data stored in Dataverse in a user-friendly manner and allows nurses to immediately save the vaccination completion data back into the data store.
  • An admin app – this is a Power Apps model-driven app for admin users to get direct views and manipulate the data in Dataverse. It also allows managing the various entities involving in the system, for example, adding new clinic sites.

Additionally, Power Automate cloud flows are used within the solution to reach out to patients, automatically sending confirmation bookings on receipt of their registration along with a private link to reschedule their appointment. Other stages utilize Power Automate to streamline the process, with flows being used to sanitize incoming data and to automate parts of the billing process.

Solution architecture diagram of SVNA Power Platform solution

High level solution architecture – information fed into Dataverse from the custom website is surfaced and edited in Power Apps, with Power Automate used for notifications and data processing

As a secure, relational data store, Dataverse provided a strong backbone for the solution, allowing SVNA to responsibly capture and store sensitive patient information, safe in the knowledge that it was being held securely and access could be controlled. The customisable views of the data-rich entities allowed Signetic to configure all data displays to the exact needs of SVNA’s admin staff, and the ability to create relationships between different entities provided a rich data backdrop that will enable meaningful insights for years to come.

Dynamics 365 Healthcare Accelerator

Since the time frame for development of the solution was so tight – as the flu season rapidly approached – the team at Signetic recognized the benefits of starting off the engagement by installing Microsoft’s Healthcare Accelerator for Dynamics 365. This template pre-populated SVNA’s Dataverse environment with healthcare-specific data definitions and relationships (such as those between patient and practitioner), giving the team at Signetic a platform to jump-start the data modelling process. In particular, the Accelerator’s pre-made ‘Patients’ and ‘Appointments’ tables were used to rapidly develop the tables that would become the building blocks of the custom website and canvas app solution.

Having the accelerator installed enabled the team to focus on the custom requirements needed to get SVNA back to work faster instead of having to ‘re-invent the wheel’ by re-creating a healthcare data model. It is this rapid development that is at the heart of the accelerator program, which includes a whole suite for extending the Common Data Model and tailoring it across multiple different industries.

Impact and benefits

Within a matter of months, SVNA has revolutionized its vaccination delivery system, enabling its clinicians to be out in the field protecting their patients while remaining safe from the threat of COVID-19.

Patients can be vaccinated contact-free from within their own vehicle:

  • Efficient and distanced vaccination delivery reduces the risk of contamination.
  • The shift to vaccinating families together, as opposed to the parents at their place of employment and children at their schools, has also seen the process become much more streamlined for the patients, who have remarkably noted that this year’s vaccinations have been ‘the easiest yet’. Additionally, having parental support for children, especially young children, makes vaccinations less intimidating and leads to a much better experience overall.

Staff can use their own phone or tablet to interact with the solution, eliminating the need to share paper:

  • No sharing of paper or shared devices means fewer shared surfaces, which in turns leads to lower risk of infection. The fact that nurses can use their own devices helps keep costs down for SVNA and gives nurses the familiarity and ‘any-time access’ they require.

All the information about the patient is available from the very beginning of the process:

  • Nurses can see in advance the details of the patients they will be treating, crucially allowing them to prepare for young children, disabled individuals, or the elderly, who may have different requirements.

Easy to use:

  • SVNA managed to rotate as many nurses as possible through their pilot site to get them familiar with the application, but as the number of patients ramped up from 10 in the first day, to 100 by the end of the week, to 1000 and then 10,000 in the following weeks, some of the nurses who did not come onto the program until later needed to dive straight into using the app at a busy clinic. Other nurses who were already familiar with the software were able to teach their newer colleagues how to use the app and by the first 5 patients they had the hang of it.

Quote from Jake Scherf - “It used to take us 20 minutes to process a single patient from sign-in to vaccination. Now we see patients turned around in 30 seconds, leaving everyone safe and satisfied.”

Jake’s original vision was not just confined to making the process work in a time of COVID. Similarly, the benefits have spread further than simply allowing SVNA to practice safely during the pandemic:

  • Patients are processed faster, with SVNA seeing an improvement of 90% in vaccination throughput
  • Removed the need for chasing patients for missing information on their paper forms by requiring mandatory information for successful registration
  • Admins have instant access to patient data from the moment the vaccination has been marked as complete rather than having to wait for information in transit
  • Insurance claims can be made daily without needing much manual interference
  • Administrators have seen the time taken to schedule vaccinations cut significantly
  • SVNA now expects the same administration team to be able to support quadruple the number of clinicians in its network
  • In addition, the solution has enabled SVNA to save over $50,000 in billing expenses, allowing these funds to be directed towards scaling and community outreach rather than supporting manual administrative processes
  • Expect to reach and immunize almost twice as many individuals during the 2020 flu season as in previous years.

Quote from Jake Scherf - “As we scale this will make us much more efficient. We’ve already been able to cut out 5 seasonal billers so that’s streamlined our operation, and the system is really easy to scale so adding a new clinic, adding a new clinician is handled just in the click of a button.”

The solution has also made SVNA more attractive for seasonal nursing staff, who want to work for a company that will remove barriers and not place additional responsibilities on them above caring for their patients. By empowering each user to fulfil their individual role to the best of their abilities, without diluting their attention with unnecessary tasks, the application far outstripped other EHR (Emergency Health Record) solutions SVNA’s nursing staff had before.

“This is the first time I’ve opened an EHR app and thought – ‘This is everything I need, at the time I need it. I immediately know how to get the job done.’ I’ve never had that feeling before.” – SVNA Nurse

 

Looking ahead

SVNA CEO Jake Scherf is certain that regardless of what the future might bring, this solution will continue to be critical to the ever-increasing success of SVNA, even past a time of COVID. In his own words –

Going forward this application is going to be a central part of our operations, especially when we’re back in businesses too. In the past when we had set up clinics, we could only estimate how many people were going to show up for the clinic based on last year’s estimates, and any additional hiring the company may have made; it was really always a best guess on the number of people who would show up. That is one of the best uses of this application: I now know right before the clinic exactly how many people have registered, when is going to be the busiest times, how many staff do we need there to reduce wait times. It’s going to be a central part of our operations going forward.”

Not content to rest on their laurels, Jake and the SVNA team are looking to continue to support and improve the solution and, along with Signetic, build upon its current functionality. Due to the inclusion of the Healthcare Accelerator, the data model is already prepared to allow SVNA to conduct additional health screenings with BMI tests and blood pressure checks, something Jake had been looking into extending the business towards in the past but had never had the capacity or time to explore before the Power Platform.

Quote from Jake Scherf - "“It’s really intuitive to use, even for somebody who doesn’t have a deep technology background.”

The team is also looking to expand their toolset and add Power BI integration to be able to better analyze and visualize the data they are collecting.

In the long term, Jake hopes to extend SVNA’s operations outside of his home state and grow into Phoenix and Los Angeles, as well as increase the number of vaccinations that can be delivered in Washington State. Meanwhile, Signetic is looking to share SVNA’s success with other healthcare providers, with a ‘return to work’ model during the pandemic.

Finally, SVNA’s success and reputation led to Jake being approached for SVNA to be one of the first vendors for providing COVID-19 vaccinations in Washington state. When considering all the unknowns of what a Coronavirus vaccination might look like, what process would be required and when it might be available, Jake and Lukas were confident that with the Power Platform they would be able to adapt to whatever is thrown at them and turn around a solution whenever needed, and in fact are already in the process of a COVID vaccination implementation that is due to launch imminently.

About the partner

Banner image for Signetic - Microsoft Gold Partner.

Signetic (rebranded from Seattle App Lab) has spent the decade since its founding helping clients drive digital and business transformation. With the rise of Microsoft’s Power Platform during the last two years, Signetic has shifted to focus on utilizing Dynamics 365 and Power Platform technologies to solve the business needs of a multitude of clients, like Hopelink – a nonprofit Community Action Partnership in Washington serving 85,000 community members through six assistant programs.

Signetic’s tried and tested process-led methodology and history of excellence allowed them to become a Microsoft Gold Partner in 2020. Its staff of diverse Fortune 500 leaders, industry experts, and entrepreneurs showcase talents ranging from custom solution development, business intelligence, and business applications in medical, nonprofit, and geological science verticals. With an elite team based both in Seattle and Nepal, Signetic has been able to push the boundaries of rapid development, utilizing a 24-hour cycle to quickly push high quality solutions out to its customers.

“The Power Platform has opened doors for us. It’s contributed to 40 percent of our year-over-year revenue growth.” – Chandika Bhandari, President, Signetic

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