When the coronavirus vaccine was first offered, Virginia health officials turned to software recommended by the Centers for Disease Control and Prevention to schedule appointments. But people complained that the software, called VAMS, was too confusing for older people to use.
So the state switched to another system, PrepMod – but that also matters. Links sent to seniors for their appointments could be reused and find their way to Facebook, leading to an immunization event in Richmond with dozens of overbooked reservations. Some of them threatened the medical staff when they were turned away.
“It was a nightmare scenario,” said Ruth Morrison, policy director for the Richmond and Henrico County health districts. “People were confused, angry, thinking they had a date.”
State and local health departments across the country continue to face delays in dispensing drugs, partly due to flaws still in appointment software tools such as those used in Richmond. These problems threaten to slow down vaccine rollout even as supply and distribution are rapidly being made available across the country.
Large software systems are often a problem for companies and governments. HealthCare.gov, a website released after the Affordable Care Act, went down very early. But problems with vaccination sites are even more pressing as health officials are trying to vaccinate as many people as possible, as quickly as possible.
On Thursday, President Biden said his administration would dispatch engineering teams to help states improve their websites. He also said the federal government will open a website on May 1 allowing Americans to search for available vaccines.
Many government officials have transformed software vendors, seeing little or no improvement. In California, the risks of technology allowed ineligible people to take over appointments. Massachusetts residents have been plagued by downed websites. Some North Carolina residents are avoiding the online registration entirely, opting instead for a vaccine that is free to all.
PrepMod is being used by 28 states and localities, after many shunned the $ 44 million VAMS tool built by Deloitte. Salesforce and Microsoft have also developed vaccine software, which has similarly disappointed their customers. Smaller tech companies have also introduced their own scheduling tools.
“It’s like a patchwork quilt,” said Mrs. Morrison, who decided after the failed PrepMod trial that her district would try something different. “Some of these systems have strengths, but they also have weaknesses.”
Other health officials have defended the appointment system, and the developers behind the software say complaints about their products have been overblown.
Tiffany Tate, creator of PrepMod and chief executive officer of Maryland Partnership for Prevention, said criticism of her system was primarily due to lack of knowledge by medical providers about how to use it, or from the constantly changing needs of states.
“A pandemic is developing and we have to keep up with it,” she said. “We just have to be a very flexible platform.”
Deloitte, whose software is used by nine states, said VAMS was originally intended for smaller groups at the early stages of the states’ vaccine rollout, so the company “responded quickly to meet their changing needs ”and are updating the system to handle larger volumes.
Many factors complicate the software implementation process, medical experts say. In some cases, developers condensed work that usually took years to weeks, resulting in malfunctions. In addition, different approaches to determining eligibility in dozens of localities using software have made it difficult to develop a suitable approach to all.
Some states use more than half a dozen appointment scheduling systems, ranging from tools used by federal, state, and local agencies to software used by private hospitals and pharmacies to solutions. rudimentary methods like SignUpGenius. Some websites do not support appointment scheduling at all, but do allow people to browse the database to find available vaccines or get a waiting list. Usually, the systems are unable to communicate with each other.
“Essentially, you’re building and testing data systems as millions of people are trying to find vaccines,” said Claire Hannan, executive director of the Association of Immunization Managers, advocacy agency. state health departments, said.
Microsoft, which sold vaccine software to several states, and Washington, DC, frustrated New Jersey with its systems, and in late February, after days of website crashing in the capital of the country, admitted company it was “missing”.
Microsoft said in a statement that it “is focused on helping governments manage their Covid-19 vaccination programs as quickly, safely and efficiently as possible.”
PrepMod’s woes have resulted in delays in vaccination in places such as Washington State and Pennsylvania. When the Massachusetts vaccine appointment website was shut down for hours after the demand spiked, PrepMod took responsibility and apologized.
Andrew Therriault, a Boston-based data scientist, said he was “astonished” by the extent of PrepMod’s deficiencies. One problem he discovered is that the system doesn’t pre-book an appointment time when people fill out their information, so they can be kicked off at any time if someone else beats them at that particular time. there.
“I try to imagine someone doing this without being too tech savvy – it means they don’t have a chance to compete,” said Therriault.
Some registry software also causes a headache by disallowing unique subscription links to expire after a single use.
The reusable links have hampered immunization efforts in places like California, where health departments are using both PrepMod and the system provided by Salesforce, MyTurn.
In some cases, health officials wanting to reach out to low immunization Black and Latino communities issued MyTurn appointment codes to these groups that were widely shared, including communities. white, richer. Because the code doesn’t expire after one use, these people can use them for vaccination before their turn.
PrepMod’s Ms. Tate said healthcare staff and others improperly shared links was at fault.
“That’s not a problem with our system. It’s a problem with those responsible, ”she said. The company added an option for unique links, she said.
Salesforce declined to comment, but Darrel Ng, a spokesman for the California health department, said MyTurn also added unique links.
Dr. Christopher Longhurst, Chief Information Officer at UC San Diego Health, said UC San Diego Health, which runs a mass vaccination site, is using its existing software instead of MyTurn because of the two systems. System is not compatible. Otherwise, those who come for a second dose scheduled in the hospital system will be separated from those scheduled at MyTurn, he said.
“We’ll have to use up a second dose in some lanes while using the new software in others,” he said. It “will be extremely inefficient.”
This week, the MyTurn system launched more appointments than expected at an injection site in San Diego operated by Scripps Health, forcing the site to close for several days due to a run out of doses.
“The MyTurn system has a lot of problems,” said Dr. Ghazala Sharieff, Scripps’ chief medical officer. “These challenges are adding another layer of unnecessary stress to our team.”
Health officials said outside companies’ dependence on imperfect tools shows the need to invest in technology for public health departments, many still using paper and fax machine for record keeping.
Mary Beth Kurilo, senior director of the American Society of Immunization Registry, said state registries that track residents’ immunization history – known as the immunization information system – could have been. be adjusted to schedule appointments. But the federal government never asks them, she said, and they will need more money and time to prepare.
Some areas have chosen to avoid the technology entirely.
In Johnston County, NC, southeast of Raleigh, the Department of Health decided that employees would have to put too much strain on managing their online appointments, so pre-vaccinations are served first.
Lu Hickey, a spokesperson for the Health Department, said the policy was working, but that means the county – which also doesn’t require direct identification – doesn’t know if people are getting vaccinated properly. order or not and must be based on honor. system.
In Richmond, Ms. Morrison said officials were looking for solutions and was even thinking about retrying the VAMS.
“We are building it together at the local level through a lot of efforts and manual workarounds that we’ve put in place to get Band-Aids to work,” she said.