Home‎ > ‎Community news‎ > ‎News content‎ > ‎

Journal of the American Medical Informatics Association: “Veterans’ Response to an Automated Text Messaging Protocol During the COVID-19 Pandemic” (29 May 2020)

posted 10 Jun 2020, 07:23 by Hollie O'Connell






10 June 2020 



We are delighted to share the new Journal of the American Medical Informatics Association publication “Veterans’ Response to an Automated Text Messaging Protocol During the COVID-19 Pandemic” (Saleem, Read, Loehr et. al) from our community of practice members from the US Department of Veterans Affairs (VA) who have employed ‘Annie’ as part of their coronavirus disease 2019 (COVID-19) response, adding several protocols, including a Coronavirus Precautions Protocol (CPP).  Annie, as with Nellie, both use the same methodology as Flo and although these locations are very different, Annie has continued to demonstrate the same positive and sustainable outcomes as her UK cousin.

After the first known cases of COVID-19 were diagnosed in the U.S. in February 2020, many health care organisations, including VA facilities, were overwhelmed with calls seeking guidance and support.  Recognising Annie’s proven techniques in delivering a rapid public health response, the VA identified the role that Annie could play in reaching their Veterans remotely and enabling clinicians to continue to provide high quality, safe healthcare as part of their COVID-19 response.  A specific protocol for coronavirus precautions was developed, helping the Veteran to be able to monitor their symptoms safely and advising them when it was necessary to contact their VA care team
 or a nurse triage line.

Veterans can self-enrol, or be added by a member of their care team to the specific CPP protocol which lasts for 2 months with Annie interacting with each Veteran to deliver approved education around coronavirus precautions, guides the monitoring of temperature and other clinical symptoms, and advising them to call their care team or a nurse triage line when they meet certain clinical thresholds.  Check-ins were sent daily for the first two weeks with wellness and educational interactions also following. 

Evaluation included over 1000 Veterans on their use of Annie in this cohort with demonstrable outcomes delivering substantial resource savings for the VA, as well as non-VA community healthcare.  In addition, the majority of Veterans reported at least one positive sentiment e.g. that they felt more connected to the VA, more confident, or more educated and/or felt less anxious by receiving Annie’s interactions. 
In addition to interactions with Annie bringing a sense of connectedness and reduction in anxiety, a decrease in avoidable contacts with the VA was evident with Annie as an extra member of the team, allowing clinical resources to focus on those Veteran’s most in need.  Of the 1,134 Veterans who answered the question ‘Would you have taken any of the following actions if you were not receiving Annie’s Coronavirus Precautions messages?’, 532 (47%) reported they would have otherwise reached out to the VA in at least one way (either secure message, phone call, visit or some combination of those).  In addition, 159 (14%) Veterans report they would have interacted with community (non-VA) care (called or sought care).

Patient quotes:

Just knowing there is a link and the brief message asking ok or not helps being, even momentarily, in the moment and requires some action .... a crutch for corona!


They gave me a sense that despite all the chaos there was someone that cared just about me.


To know that Annie alerts keep me positive and happy to know that someone cares about my well being! Keeps me mindful of what I need to do if I have to go out



The publication explains that the findings from this study have implications for other healthcare systems to help manage a patient population during the coronavirus pandemic.

The full journal article is open access and available here, or if you would like to learn more about the pathway please contact Lisa Taylor via our contact us form.