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Text to vax: Why SMS may be the key to delivering more COVID-19 shots

CareMessage is helping small health clinics stay in touch with patients — and persuade them to come in for vaccinations.

​A health care worker is vaccinated against COVID-19 in December in New York. Community health centers are turning to text messages to urge patients to get a vaccine.

Community health centers are turning to text messages to urge patients to get a vaccine.

Photo: Scott Heins/Getty Images

When PrimeCareHealth in Chicago started signing up patients to receive a COVID-19 vaccine, its staff didn't use fancy apps or AI technology. Instead, the nonprofit relied on an old technology: text messages.

The group, which provides free or low-cost health care, sent its first message about the vaccines in January, using startup CareMessage's service to target patients over 65 with two or more medical conditions. It has now messaged close to 5,000 patients in different groups. The texting service lets customers pick specific groups for mass messages as well as one-on-one messages through which they can receive responses from patients.

"We were thrilled by the response," said Erin Howes, director of quality improvement at PrimeCareHealth, which serves 22,000 low-income patients a year across six clinics, about 50% of whom are Spanish-speaking.

Nonprofit CareMessage, which works with clinics reaching low-income families, people of color and rural populations, offered a text messaging service before the pandemic that helps clinics stay in touch with patients on health care issues or schedule appointments via SMS for chronic conditions like diabetes.

Once the pandemic hit, CareMessage shifted to helping clinics reach patients to get tested for the coronavirus and then to get vaccines. It launched a free version of its product for nonprofits that doesn't require complex integration with other software. At the end of last year, it rolled out a library of messages and surveys that clinics could use to book appointments, create a waitlist or ask patients about their willingness to get a vaccine. It saw a quick uptick in usage and has now sent out more than 3 million vaccine-related messages across 170 providers in about 40 states.

"It's part of our initiative to address increasing vaccine confidence in communities that have a direct impact with COVID," said CareMessage CEO Vineet Singal.

Making an impact

Those with lower incomes, people of color and non-English speaking groups have suffered higher COVID-19 infection rates, while rural populations have had higher death rates — and those groups have had lower vaccination rates than the general population. To address this, the Biden administration has increased the number of community health centers that will distribute vaccines from 250 to over 900 organizations. "Community health centers are a big part of the national strategy to get vaccinations to underserved populations," Singal said. Since those organizations are already delivering health care, they're often more trusted by otherwise underserved communities.

The problem: Many are small nonprofits without the infrastructure to quickly inform, communicate with and track the relevant patients who need or are getting vaccines. Tools like CareMessage have become important for this, providers say.

Despite the proliferation of smartphones, text messaging is still a key way for health clinics to reach certain populations, because they don't use email, are too busy for calls or just prefer to answer text messages later. Some still have feature phones. Others might not know how to use websites to sign up for vaccines. Some patients have limited cell phone minutes for calls, so they don't want to use them setting up an appointment, Howes said. And people in rural areas often have dead zones where they don't get calls but can get text messages later, Singal said.

"It's better than any other tool," said Wes Keyes, executive director at Brother Bill's Helping Hand, a Dallas 501(c)3 food pantry and clinic that serves 10,000 people, about 75% of whom are Latino. "If you give them a phone call, it's more invasive than sending a text." Texts, he said, are more "respectful."

In addition to using it for signing up people for vaccines, Brother Bill's also uses CareMessage to communicate with its clients about events, programs and times when there's extra food or other goods available.

The first time it used CareMessage was at the beginning of the pandemic when an 18-wheeler showed up with frozen food from a group that couldn't use it. Brother Bill's used CareMessage to notify members of the haul, which amounted to 17,000 meals. In about an hour and a half, the meals were all given out. "That was the day we looked at ourselves and said, 'This is the most important tool we have in our entire arsenal,'" Keyes said.

One big benefit for clinics is saving staff time. Another Texas clinic scheduled 900 vaccine appointments via phone calls, which took six people four days, Singal said. Then it did its second batch of 900 using CareMessage, which took two people two days — a 83% reduction in staff time.

"We had a limited number of staff to call constituents for weekly reminders of appointments," Keyes said. "This has been a game changer that's allowed us to have time to talk to people in ways that they're actually interacting with you."

While PrimeCareHealth's electronic health record system can send text messages, it lacks the ability to see who actually read or responded to the messages, and thus how its outreach is performing, Howes said. It also can't filter patients by age or health condition, which is important to reach certain patients.

This direct messaging to individual patients has been used much more during the pandemic, said Orit Mohamed, product manager at CareMessage, which has raised more than $25 million from Y Combinator, Google.org and others. These could be follow-up messages after an appointment to provide information on free transportation, rental assistance or how to access telehealth appointments or how to book a vaccine appointment.

Now that vaccines are more available in the U.S., a key issue for clinics is countering vaccine misinformation. The Texas Association of Charitable Clinics, which works with 70 clinics, are using CareMessage to send out educational or informational texts to patients, said Jody Hopkins, executive director.

Messages coming from local clinics are also important because they come from a trusted local group, Keyes said. Large, government-run operations don't have that level of trust. Many of his patients are waiting to get it from his clinic even if vaccines are already available elsewhere, he said.

Protocol | China

China’s edtech crackdown isn’t what you think. Here’s why.

It's part of an attempt to fix education inequality and address a looming demographic crisis.

In the past decade, China's private tutoring market has expanded rapidly as it's been digitized and bolstered by capital.

Photo: Getty Images

Beijing's strike against the private tutoring and ed tech industry has rattled the market and led observers to try to answer one big question: What is Beijing trying to achieve?

Sweeping policy guidelines issued by the Central Committee of the Chinese Communist Party on July 24 and the State Council now mandate that existing private tutoring companies register as nonprofit organizations. Extracurricular tutoring companies will be banned from going public. Online tutoring agencies will be subject to regulatory approval.

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Shen Lu

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After a year and a half of living and working through a pandemic, it's no surprise that employees are sending out stress signals at record rates. According to a 2021 study by Indeed, 52% of employees today say they feel burnt out. Over half of employees report working longer hours, and a quarter say they're unable to unplug from work.

The continued swell of reported burnout is a concerning trend for employers everywhere. Not only does it harm mental health and well-being, but it can also impact absenteeism, employee retention and — between the drain on morale and high turnover — your company culture.

Crisis management is one thing, but how do you permanently lower the temperature so your teams can recover sustainably? Companies around the world are now taking larger steps to curb burnout, with industry leaders like LinkedIn, Hootsuite and Bumble shutting down their offices for a full week to allow all employees extra time off. The CEO of Okta, worried about burnout, asked all employees to email him their vacation plans in 2021.

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It’s soul-destroying and it uses DRM, therefore Peloton is tech

"I mean, the pedals go around if you turn off all the tech, but Peloton isn't selling a pedaling product."

Is this tech? Or is it just a bike with a screen?

Image: Peloton and Protocol

One of the breakout hits from the pandemic, besides Taylor Swift's "Folklore," has been Peloton. With upwards of 5.4 million members as of March and nearly $1.3 billion in revenue that quarter, a lot of people are turning in their gym memberships for a bike or a treadmill and a slick-looking app.

But here at Protocol, it's that slick-looking app, plus all the tech that goes into it, that matters. And that's where things got really heated during our chat this week. Is Peloton tech? Or is it just a bike with a giant tablet on it? Can all bikes be tech with a little elbow grease?

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Karyne Levy

Karyne Levy ( @karynelevy) is the West Coast editor at Protocol. Before joining Protocol, Karyne was a senior producer at Scribd, helping to create the original content program. Prior to that she was an assigning editor at NerdWallet, a senior tech editor at Business Insider, and the assistant managing editor at CNET, where she also hosted Rumor Has It for CNET TV. She lives outside San Francisco with her wife, son and lots of pets.

Protocol | Workplace

In Silicon Valley, it’s February 2020 all over again

"We'll reopen when it's right, but right now the world is changing too much."

Tech companies are handling the delta variant in differing ways.

Photo: alvarez/Getty Images

It's still 2021, right? Because frankly, it's starting to feel like March 2020 all over again.

Google, Apple, Uber and Lyft have now all told employees they won't have to come back to the office before October as COVID-19 case counts continue to tick back up. Facebook, Google and Uber are now requiring workers to get vaccinated before coming to the office, and Twitter — also requiring vaccines — went so far as to shut down its reopened offices on Wednesday, and put future office reopenings on hold.

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Allison Levitsky
Allison Levitsky is a reporter at Protocol covering workplace issues in tech. She previously covered big tech companies and the tech workforce for the Silicon Valley Business Journal. Allison grew up in the Bay Area and graduated from UC Berkeley.
Protocol | China

Livestreaming ecommerce next battleground for China’s nationalists

Vendors for Nike and even Chinese brands were harassed for not donating enough to Henan.

Nationalists were trolling in the comment sections of livestream sessions selling products by Li-Ning, Adidas and other brands.

Collage: Weibo, Bilibili

The No. 1 rule of sales: Don't praise your competitor's product. Rule No. 2: When you are put to a loyalty test by nationalist trolls, forget the first rule.

While China continues to respond to the catastrophic flooding that has killed 99 and displaced 1.4 million people in the central province of Henan, a large group of trolls was busy doing something else: harassing ordinary sportswear sellers on China's livestream ecommerce platforms. Why? Because they determined that the brands being sold had donated too little, or too late, to the people impacted by floods.

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Zeyi Yang
Zeyi Yang is a reporter with Protocol | China. Previously, he worked as a reporting fellow for the digital magazine Rest of World, covering the intersection of technology and culture in China and neighboring countries. He has also contributed to the South China Morning Post, Nikkei Asia, Columbia Journalism Review, among other publications. In his spare time, Zeyi co-founded a Mandarin podcast that tells LGBTQ stories in China. He has been playing Pokemon for 14 years and has a weird favorite pick.
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