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March 1, 2021

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How a delayed software launch hindered Washington’s vaccine rollout

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Jan. 21–After a full day vaccinating seniors and health care workers, Mark Tan has gone home and spent hours manually entering their data into the state’s immunization registry.

That laborious process, played out across the state, has bogged down vaccinations and left state officials blind to where unused doses remained. Tan, the owner of a small pharmacy on Bainbridge Island, still had a stack of about 150 patient forms he hadn’t yet entered last week, despite 15-hour days.

His pharmacy is one of more than 800 coronavirus vaccine providers statewide grappling with a state immunization system ill-fitted for the pandemic. The process was supposed to be streamlined by specialized mass vaccine software, but the state Department of Health didn’t launch it until Jan. 15, more than a month after the first COVID-19 doses arrived in Washington.

The delay meant that pharmacies, doctors’ offices and hospitals were responsible for setting up their own systems: to register patients, schedule appointments, gain consent and report vaccinations to the state. Many providers have been sifting through hundreds of emails and phone calls a day, an inefficient process that threatens to stymie the state’s efforts to ramp up vaccinations.

“The amount of logistics we had that first week was crazy. Everything was makeshift,” said Tan, who received his first shipment on Dec. 23. “If all we had to worry about was getting vaccines into arms, then we could scale up.”

When Washington filed its COVID-19 vaccination plan with the Centers for Disease Control and Prevention in October, the state said it would rely on a software tool called PrepMod to help vaccinators process patients and data. Developed by a nonprofit in Massachusetts, the program would streamline the process for both patients and providers.

A patient could visit the website to search for a vaccine clinic and complete registration ahead of time. All of the information would be transferred to the clinic, which could administer the shot as the patient’s data is transferred seamlessly to the state. The system can also automatically send appointment reminders via email and text.

PrepMod had been running for four years already at public health departments nationwide, for flu and other mass vaccinations. In September, Massachusetts became the first state to adopt it for the coronavirus, and others came onboard in the following months.

Some COVID-19 vaccine providers in California, however, have reported problems with PrepMod, according to recent news reports. It has affected the vaccine waiting list registry and access to vaccine registration, one official told the Los Angeles Times.

The Washington Department of Health (DOH) signed a nearly $400,000 contract with PrepMod and this fall began customizing the software and integrating it with the state’s existing immunization records system. But the development hit some delays.

It took longer than expected to verify security features, and PrepMod delivered an internal quality-testing site in December instead of November, as planned, DOH spokesperson Danielle Koenig said.

Tiffany Tate, the executive director of PrepMod, said her organization has worked to the best of its ability to get states online.

“Our system has been available and working since September,” she said. “It’s not new. … If they’re saying we delayed their production staging, well that’s fine. What’s most important to me is that we’re able to shift the focus onto the business of getting people vaccinated.”

In the absence of a centralized system via PrepMod, Washington created a webpage with a list of vaccine providers in each county, with instructions on how to reach them. But that list had problems.

For a while, one of the only options listed in Kitsap County was Member Plus Family Health, a small doctor’s office on Bainbridge. The office had been “very proactive” in applying to be a vaccine provider, hoping to serve its patients, but it was caught off guard when the first shipments were announced, said Laurie Isenman, the practice manager.

“Suddenly, we got back from our Christmas break, and we had 300 vaccines delivered to our door, yet we couldn’t give them to our patients,” she said.

Washington’s phased approach only allowed vaccinations of certain health care workers and long-term care residents. With only four people on staff, Isenman fielded hundreds of inquiries a day from people outside their practice.

“It was just one phone call at a time scheduling people,” she said.

Tan, the pharmacy owner, had a similar experience. He received an email from the DOH on Dec. 21 notifying him that he would receive 300 doses in two days. But the state had not provided logistical support — such as gloves, hand sanitizer or manpower — except for an online checklist and some other information about staging a mass vaccine clinic.

Tan reached out to Bainbridge Prepares, a nonprofit focused on emergency response to earthquakes and other disasters. Quickly, the group recruited volunteers and stood up a vaccine clinic at the local senior center.

Loren Bast, the organization’s executive director, scrambled to find an online scheduling tool. He landed on Time Tap, an off-the-shelf business appointment booking system. It’s been working well so far, Bast said, as the organization has administered more than 1,000 doses. Now that the state has launched PrepMod, he’s skeptical about switching.

“It’s sort of like issuing a fire extinguisher after your house is half on fire,” Bast said. “We basically had to find a garden hose and do what we could.”

The system he set up is labor-intensive. After making an appointment online, a patient checks in at a registration desk staffed by two volunteers and is handed a clipboard with forms to fill out.

Next comes the shot. Then the patient gives one of the forms to a volunteer assigned to data entry. That person spends between three and five minutes entering each patient’s information into the Washington State Immunization Information System — and that’s if the process runs smoothly. Sometimes, the patient isn’t listed in the state’s vaccine registry and the clinic has to create a new entry.

The registry was designed to track childhood vaccines and other routine immunizations, and requires pointing, clicking and typing (unless the provider had an existing interface with its medical records). While it’s not overly complicated, the manual data entry adds up. It’s not designed for mass vaccinations.

“Our state registry data entry is really slow right now,” said Koenig, the DOH spokesperson, “so we are standing up other systems to capture this while providers are trained on using the state registry to its fullest potential.”

Without consistent reports from vaccine providers, the DOH has struggled to articulate why it has a large gap between the number of vaccine doses distributed to the state and the number that have been administered. As of Jan. 20, Washington had administered 346,765 doses out of 805,000 it received, or just 43%, according to the CDC.

“We need a better system of tracking who got the vaccines,” said Dr. Ali Mokdad, a professor at the University of Washington Institute for Health Metrics and Evaluation. “The state has to know what the problem is in every location… Come on, we have Amazon and Microsoft. We are the technology state.”

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