The provider’s IT playbook for efficient, equitable Covid-19 vaccine administration

The next big challenge for providers in the course of the Covid-19 pandemic has arrived — vaccination.

Providers around the country are grappling with administering the vaccine amid several hurdles. These include coordinating with state agencies and ensuring equitable administration of the vaccine. As with other challenges presented by the pandemic, many providers are leveraging technology and IT solutions to help them achieve their vaccine administration goals.

Where the vaccine rollout stands today

While the vaccine development was rapid – Pfizer and BioNTech as well as Moderna received the Food and Drug Administration’s emergency use approval in December, less than a year after SARS-CoV2 manifested itself — the vaccine administration process has been criticized for being slow and mismanaged. As of Jan 26, only 23 million vaccine doses had been administered, even though about 44 million doses had been distributed, according to data from the Centers for Disease Control and Prevention.

And even though newly-installed President Joe Biden is taking steps to speed up the process by leveraging the weight of the federal government, the bulk of the vaccine administration process will fall on providers and retail health clinics. And providers say that just as technology came to aid in patient care during the early days of the pandemic, the vaccine administration process will also see technology serving as a linchpin in their efforts.

The technology driving vaccine administration

Intermountain Healthcare in Salt Lake City has leveraged partnerships with its vendors for an end-to-end solution, Dr. Tyler Haberle, associate chief health information officer said in an email. The solution, accessible through a webpage, will include options for patient-driven screenings, registration and scheduling, and consent collection.

Through the webpage, vaccine-eligible individuals will receive an Intermountain VaxPass, a QR code, that they can present at the health system’s facilities, Haberle explained. People will receive the code on their cellphone, which can be scanned to gather their information, and then they can get the vaccine.

Other health systems are also exploring the use of QR codes. Though Ochsner Health in New Orleans is currently using its Epic patient portal for vaccine appointment bookings, its IT team is working to implement QR codes that could help move people through the process faster. Their aim is to get to a point where Ochsner is vaccinating an individual every 90 seconds, said Dawn Pevey, system vice president of service lines, in a phone interview.

Ochsner plans to eventually provide individuals access to mobile label printers where they can print out the QR codes and stick them to their Covid vaccine cards, explained Amy Trainor, vice president of clinical systems at Ochsner Health, in a phone interview. Nurses will scan the code, which will provide an array of information, including clinical considerations like allergies. Once all these have been reviewed, the individual will receive the vaccine.

While providers are investing in such technology to boost vaccine administration, there are concerns about how it may exacerbate the existing digital divide.

“There has to be a way to help people with varying degrees of health literacy and IT literacy to navigate this process,” said Dr. Ohm Deshpande, executive director of  clinical operations at Yale New Haven Health in Connecticut, in a phone interview. “There is a surprisingly high number of people looking for human support.”

A human and telephone component will be critical, in addition to the use of computers and smartphones, he said.

Among those who need human support during the vaccination process are many groups that are at high-risk for poor Covid-19 outcomes, like the elderly.

To provide additional support for those individuals who cannot access the internet or have trouble navigating the webpage, Intermountain has set up a centralized call center. Call center workers will help them generate the VaxPass and reserve an arrival window to get the vaccine. In this case, the patient can arrive without the VaxPass, and health system employees will be able to pull it up for them, Haberle said.

Coordination beyond the provider-level

Coordination with state and federal agencies is one of the major obstacles facing providers as they work to get people vaccinated.

Ochsner Health, Yale New Haven Health and Intermountain Healthcare will all be following state guidelines for vaccine administration. But, as Yale New Haven’s Deshpande points out, there needs to be statewide or regional coordination.

“Just saying ‘here is the vaccine, you guys figure it out’ at the health system-or the hospital-level is just not a recipe for rapid success that we absolutely just need right now,” Deshpande said. “The importance of state or regional coordination and clarity about division of labor and allocation and the ability to plan is just the most critical thing at this juncture.”

He believes the use of data interfaces will be critical so that providers know where people are receiving their vaccine doses.

Yale New Haven Health is integrating its systems with a state-based call center whose employees will be able to schedule appointments directly into its Epic EHR. In addition, the system has set up a bi-directional interface with CT WIZ, a system that aggregates vaccination information. This will enable Yale New Haven to access statewide vaccination information and understand where and when each patient received their doses, Deshpande said.

Similarly, Intermountain has developed an interoperable, bidirectional interface to connect the state of Utah’s Immunization Database with its EHR system, Haberle said.

“This allows for real-time push and pull of vaccination data on Covid vaccines, as well as other vaccines,” he said.

The interface will provide Intermountain’s clinicians with support as they work to administer the right vaccine for a particular patient at the right time. The technology will also make reporting to the state easier for the health system, Haberle said.

Combating vaccine hesitancy

Vaccine hesitancy threatens to unravel distribution and administration plans across the country. About a quarter (27%) of the American public said they probably or definitely would not get a Covid-19 vaccine even if it was free and deemed safe by scientists, according to a Kaiser Family Foundation survey published in December.

To curb hesitancy, most providers are relying on communicating directly with patients to dispel rumors and increase confidence in the vaccine.

Ochsner Health and Yale New Haven Health are using social media to amplify their message.

Misinformation is one of the key reasons for Covoid-19 vaccine hesitancy, said Yale New Haven’s Deshpande. Circulating messages and pictures of people who have received the vaccine will be helpful. Providers might even consider having people post selfies after getting vaccinated and circulate those images via social media.

“[We’re] encouraging our employees and people who get vaccinated to do a grassroots effort and do the hand-to-hand combat that’s required,” he said. “The peer [influence] piece cannot be overstated.”

Though word-of-mouth information about the vaccine from peers is key, information directly from clinicians is also valuable. Ochsner Health is posting information from its physicians to social media channels and to its patient portal. Further, the system is hosting Facebook Live sessions with its medical leadership so they can answer people’s questions, Ochsner’s Pevey said.

Another mode of connecting with patients is through community advocacy and faith-based groups who can help distribute messages about the vaccine, said Intermountain’s Haberle.

“There are many community organizations that have trusted relationships with various underserved communities in our service area, and we will continue to leverage these relationships to deliver vital information that can be relayed by a trusted source,” he said.

Ensuring equitable vaccine administration

The Covid-19 pandemic has disproportionately affected communities of color as well as low-income Americans. To ensure the vaccine is being distributed first to those who need it most, providers will need to factor in risk level and socioeconomic needs as they make their plans.

Ochsner Health is using a texting system to alert specific populations when they are eligible to get vaccinated. Existing information in the system’s databases, including demographic patient information, will help the provider target at-risk populations, said Ochsner’s Trainor.

“For example, we had some availability in one of our parishes on a Sunday for some vaccine [appointments] and we were able to look at the zip codes surrounding that area and send texts to eligible patients saying, ‘we have availability now,’ and within an hour the whole schedule was filled,” she said.

Ochsner will also take patient preference into account when communicating with them, so they may use text for some, call others and use email when requested.

Other providers are collecting demographic information during the vaccination process. Yale New Haven Health is gathering race, gender and zip code information at vaccine administration points, so the system “can understand where we are doing well from a health outcomes standpoint and where we have opportunities,” Deshpande said.

Yale New Haven Health uses a single integrated Epic EHR system across its five hospitals, two medical groups and two federally qualified health centers. This allows the health system to capture enormous amounts of data. It will use this data, along with data from the U.S. Census Bureau, to track its vaccine administration efforts and ensure it is equitable.

The data can also be used to determine what type of intervention may be most effective in a specific area. For example, a mobile van may be most effective in some communities, while the use of affiliated home health agencies may be best for vaccine administration in others, like areas with lots of nursing homes and assisted living facilities, Deshpande said.

Though it appears the beginning of the end of the pandemic is near, there is still a long way to go. Vaccine administration is going to be complicated. But by combining out-of-box thinking with the latest technology available, providers can keep the administration plan on track and help put an end to the once-in-a-century crisis.

Photo: Geber86, Getty Images