Hospital IT leaders offer up-close views of their vaccine deployment strategies
As part of the HIMSS Accelerate Health Digital Series on Thursday, two technology professionals – who focus on different but equally essential facets of a multifaceted COVID-19 distribution process – described how they're putting an array of IT systems and strategies to work managing a hugely complex logistical process.
Presented as part of the Accelerate Digital Series, the online presentation, The Role of Healthcare IT in COVID-19 Vaccine Deployment, was designed to offer some insights into the "strategies and policies and technologies that are enhancing this massive undertaking where the rubber meets the road at the state and local levels," as the session's moderator, HIMSS Director of Government Relations Valerie Rogers put it.
Samuel Wetherill, VP of pharmacy services at Delaware-based ChristianaCare, and Patti Cuartas, executive director and associate CMIO at New York's Mount Sinai Health System, each offered some of their experiences since early December, when vaccines became available.
One of the biggest challenges over the past three months – and one that's thankfully improving by the day in the U.S. – is availability.
"We're very grateful that we now have a new Johnson & Johnson vaccine that will help us roll out to additional community locations," said Wetherill. "Our health system works directly with the state to ensure that we do not overlook underserved populations and make sure that we have enough vaccines to not only do their first dose, but also the second doses of vaccine."
Technology is a critical enabler, of course. But much of the legwork to enable distribution actually happens on two legs.
"We have community workers that work for our health system that have identified those populations – those that are over 65, those that may not have English as their primary language, and other folks that are underserved or underprivileged – and we make sure that we target those individuals. And we actually go out to those communities to ensure that we can do the vaccination events," he said.
The recent addition of that third J&J vaccine – joining the Moderna and Pfizer doses already in circulation – means that similarly expanded community outreach can happen in New York, said Cuartas. She noted that its one-dose regimen will be a huge help.
"Mount Sinai health system has been given the go-ahead to vaccinate homebound patients," she explained. "So having to just go to the home once helps tremendously with that population – and other populations: going to shelters, for example. Just going once will really improve our ability to vaccinate all populations and make this equitable."
Adaptation and expansion plans
So far, demand has well outpaced supply, which has allowed health systems a bit more control in targeting their efforts toward the patients and communities most in need.
"We can't wait until the vaccine supply outweighs demand!" as more vaccine supply comes online, said Cuartas, with some understatement. The logistics issues will only expand in scope and complexity.
That means trying to gain visibility into supply chain variabilities and "trying to think ahead and predict," she said. That's a must-have when it comes to knowing "when to schedule [and] how many to schedule."
To help, Mount Sinai has partnered with an outside vendor to help with scheduling, she said, not just for the raw logistics, but to gain the kind of granular insights that can help understand the needs of different patients, and identify those who might need more outreach.
"Not everyone is able to use the technology," she said. "Some people still need a high-touch approach, like a phone call or reaching out to their PCP – getting connected to where they should get the vaccine."
Meanwhile, Mount Sinai uses its Epic electronic health record system as an inventory management tool, said Cuartas, which has helped "predict and then allocate" as vaccines roll out.
ChristianaCare is using some of its own in-house systems "in a different manner that we had done in the past," said Wetherill.
That includes new patient outreach projects ("text messaging folks and emailing them to let them know their turn is up to go and register for vaccine administration"), and also updating vaccine information systems that have been used in pre-COVID-19 times, he said.
"We had one that the health system used for flu vaccine for our employer caregivers. And so it was a natural extension to be able to use that technology and convert it towards being able to be compatible with the COVID-19 vaccine so that we can document some of the key information we need in order to be able to maintain health equity," he said.
"It was great to be able to use that technology," he added. "It flows to the state [public health] system, which allows us to have easy access to be able to submit that information to the state so they can track. The state in turn goes back to the number of people that we vaccinated to ... look at the allocation process to make sure we get the allocations that we request."
One challenge for ChristianaCare is that each state has its own vaccine-recording capability or IT system, said Wetherill.
"We're a health system that spans multiple states. One of the challenges behind that is that we have different reporting requirements for states and each one of them have defined fields within their systems that need to be populated. That poses a little bit of a challenge for us, although a lot of it is being managed going by the state."
Mount Sinai has similar hurdles on a more local level.
"We have challenges within the state, because we have hospitals that are within the city and then outside of the city, and the data that is fed to the city is different," said Cuartas. "It goes into the citywide immunization registry, and then the data that is sent to the state goes to the state immunization services."
HL7's FHIR spec helps with that cross-system exchange "so we can close the loop," she said. "We are really able to send that data and get it back."
Some patients will inevitably travel, even during the pandemic. "We've also taken into account exchanging data through [Epic's] CareEverywhere and Carequality, so we can bring in external data to complete the record for our patients," she said.
Mount Sinai also relies on a repurposed health maintenance tool in the EHR to capture information about patients depending on their criteria and diagnosis and sends out reminders, said Cuartas.
"If somebody is diabetic, let's say it'll remind you of A1C, you know, every six months – whatever the criterion is. Same thing for vaccines. The patient is eligible, make sure you get them into the first vaccine, and then we'll wait until the second dose is given to close the loop.
"That's information we can share through CareEverywhere and Carequality so that if the patient received the vaccine elsewhere, we can bring that in as well."
"We're using a very similar process," said Wetherill, noting a handful of occasions where a patient arrived for a second dose, but wasn't sure whether the first one was Moderna or Pfizer. The registry, he said, has been "very, very useful to allow us to look up that information to ensure that you get the correct second dose."