President Joe Biden’s May 1 goal to provide vaccinations to all adults ramps up pressure on already overburdened resources. At Epic, we have provided the software support for many health care systems across the country that are running vaccination clinics both large and small. We’ve learned five important lessons.
1. The Less Introduction of ‘New,’ the Better: Public health agencies are looking for online systems to help patients more easily view all the vaccination sites that are available at any given time in a region. We recommend that these systems have a close connection to each vaccinating organization’s normal scheduling and workflow. Specifically, we recommend the system connect to the scheduling tool within the electronic health record so it can show appointment availability, and then have the patient follow the organization’s scheduling process. This gives patients a single place to view vaccine availability while allowing each organization to maintain an optimized and integrated workflow to take patients from scheduling through vaccination and to in turn report that information up the chain.
2. Create Wait Lists to Reduce Anger and Anxiety: Appointment times fill up quickly, so we recommend that the scheduling system list whether there is current availability rather than listing specific available times. To assist in this process, Epic supports standards-based Application Program Interfaces to send appointment availability to other systems. Epic provides flexibility to hold appointments for patient outreach, waitlist-based scheduling, or open availability to all patients.
3. Allow for Flexibility in External Scheduling: The scheduling system should provide a link to each vaccination site where patients can get an appointment. There are varying approaches among organizations that are administering vaccines — for some sites, this might be a public online scheduling page, while others might prompt for account creation prior to scheduling and some could provide a landing page that provides patients with instructions such as calling a phone number if they do not have a system that supports online scheduling. We think the scheduling system needs to allow for that variation in approach.
4. Schedule Second Doses Right Away: Clinicians should be allowed to use the EHR to complete the vaccine administration. To help with second-dose compliance, we recommend scheduling each patient’s second dose right after the patient receives the first dose, while the patient is in the 15-minute observation period, or providing access to a patient portal where patients can schedule themselves. If a patient can’t follow either process, health care organizations should support an outreach process based on the required dosing interval by manufacturer.
5. Beef Up and Reform State Vaccine Data Collection Systems: All states participate in the Immunization Information System that is used to share vaccination information with the Centers for Disease Control and Prevention. The problem is that each state’s collection system is slightly different. To make the transfer of data faster, more efficient and consistent across all states, reforms need to occur. There are two similar pieces of legislation that address this issue: in the House, HR 550, The Immunization Infrastructure Modernization Act of 2021, and in the Senate, S. 674, The Public Health Infrastructure Save Lives Act. In the meantime, to assist in public health reporting, the health care organization should report to the IIS using an Outgoing Vaccination Administration interface. Health care organizations and external systems should evaluate the expected volume of API calls to ensure they have the appropriate hardware, network bandwidth and system configuration.
While we will certainly learn more in the next months, what we have learned over the last year can and should be applied to our vaccination efforts moving forward and as we get closer to our goal of ending this pandemic.
Nick Frenzer is an implementation executive at Epic, the largest provider of electronic health record software and support in the world, and brings experience leading large-scale software implementations around the country to his work coordinating the company’s nationwide support for the COVID-19 vaccination effort.
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