How to optimize health IT systems for immunization drives

Government bodies have organized vaccination drives from the days of paper, pen and file folders. Nations across the globe have successfully run vaccination programs on a large scale.

In countries such as India, with the second-largest population, a vaccination campaign to eradicate polio was delivered at specified centers and going door-to-door. India was declared officially polio-free in March 2014. All without technology!

Routine vaccination administration has always been either by a scheduled or walk-in appointment. Vaccinating populations for polio, smallpox or similar diseases has always been a part of a multi-year plan for governments.

However, COVID-19 vaccination drives are being planned in collaboration with public health officials to prioritize administration by age groups, identify vulnerabilities among population groups, manage a demand-supply gap, track vaccinated groups and more.

Managing large-scale vaccination programs in any country is a phenomenal task wherein technology can streamline these processes. Governments worldwide have been gearing up their IT arm in the background to assist in the vaccination delivery process. The right technology applications can turn the COVID-19 vaccination program into a game-changer for the healthcare industry.

IT aiding COVID-19 vaccination programs

Health IT can only be an enabler in vaccination drives. To effectively digitize the immunization process, it is important to map all workflows and stakeholders of the immunization platform or application being used.

The primary stakeholders in a vaccination program include the patient, physician, vaccination administrator, and the public surveillance authorities who track vaccine administration and efficacy, especially in an outbreak.

Some of the intervention points where technology can be an enabler in vaccine administration include:

1. Vaccine tracking. Maintaining the cold chain for vaccines is an important activity, especially when vaccines are transported over long distances and require storage under specified conditions. Tracking technologies include sensors to monitor the temperature of the vials and dashboards to track the supply chain logistics across various distribution channels. 

2. Searching for vaccine providers. Vaccine finders are simple web portals for conveniently locating appropriate providers in the vicinity. For COVID-19, the CDC is currently managing this web portal and lists the vaccination centers and providers across the country.

3. Checking eligibility. Most countries use a staggered approach to administer vaccines, with the more vulnerable receiving the doses earlier. A simple checklist or a questionnaire on the web portal can help people know about their eligibility based on the public health services guidelines. The CDC has made recommendations on eligibility based on the Advisory Committee on Immunization Practices, an independent panel of medical and public health experts.

4. Scheduling a vaccination. This works like any other scheduling protocol, like scheduling an appointment, and can help avoid overcrowding at vaccination centers.

5. Communication. There is some amount of vaccine hesitancy across the globe, and every government is making substantial efforts to allay the fears of the masses through social media campaigns, chatbots, helpline numbers, and others. Education programs, both for healthcare personnel and the public, are being rolled out. Vaccination certifications and communicating adverse events to the center are also a part of the communication program. Communicating the vaccination status of an individual with a digital report is an important part of the COVID vaccination drive. Several nations are debating the use of digital health certificates with vaccination QR codes to permit admission to their countries. QR code-based vaccination certificates can be saved on mobile phones and allow public health authorities to track vaccine drives, authenticate vaccine vials, and thereby inventories. The certificate does not disclose any personal health information. However, the World Health Organization does not back the use of vaccine passports for travel yet, due to it not being equitable to countries unable to achieve mass vaccinations.

6. Data reporting and analytics. Large-scale vaccination programs are monitored by automated reports for the public health administrators. The Community Health Plan of Washington uses data aggregated from multiple sources like claims, EHRs, labs, and social determinants of health to stratify risks for their members and use the information to plan their vaccination outreach and distribution priorities. 

HL7 Integration and terminology standards of vaccinations

No record-keeping agency stores the history of vaccination records. The best place to look for immunization histories for adults are in childhood health records, if available, or to get the information from parents and caregivers if they recollect the details.

In the post COVID world, the vaccination records in standalone systems can be transferred to EMR systems if using healthcare data standards. In HL7 2.x, a VXU message is used to record immunization histories, communicate subsequent doses, record observations and generate reports about individuals and aggregated populations.

The same objectives can be achieved in HL7 FHIR, with the Immunization resource, to record the current and historical administration of vaccines. HL7 and FHIR are used to transmit vaccination information from one system to another. With large-scale vaccination programs, vaccinations may be captured in Immunization Information systems or state registries. They can be shared with the EMR systems electronically using standard HL7 2.x or FHIR messages.

The USCDI data standards align with the interoperability and patient access final ruling and require the use of the HL7 standard code set of CVX to record vaccines administered and API standards for exchanging patient’s electronic health information.

There are currently four CVX codes listed for COVID-19 vaccines. These are for the four generic variants of the vaccines currently available. The NDC codes are used to capture specific pharmaceutical variants.

Platforms for immunization digitalization

Many technology firms have recently launched their platforms exclusively for vaccination delivery workflows. Microsoft, Salesforce, Accenture, and Infosys have developed a vaccine management platform for end-to-end management of vaccination processes.

A centralized vaccine management platform is designed to provide real-time access to vaccine administration data, check eligibility, allow scheduling, support outreach campaigns, public reporting, and decision-making.

Healthcare providers, vaccine recipients, and public health organizations are the primary users of these platforms. Whether these platforms are easing out the burden of administration or adding an extra layer of work for those on the ground will probably be known only after a few months of usage.

Technology around vaccination workflows, especially in a current scenario when a large population must be vaccinated, could be a deterrent if not implemented correctly. Following steps must be taken to ensure technology is an enabler for this immunization drive:

• Create simple, intuitive interfaces that are usable across all age groups and demographics. For example, older adults invariably face technology challenges such as scheduling online appointments. Setting up an IVR call center with a human interface in multiple languages can help in such cases.

• Consider all workflows and map touchpoints of all stakeholders, including vaccinators, users, and public health officials, to the actual interaction. For example, automated confirmation messages of every vaccine appointment scheduled, including the appointment booked through an IVR call center in the example above.

• Should support ease of integration into the EMR to allow patient data to be enriched with immunization records. The QR codes in vaccination information statements allow scanning the code into EMRs, immunization information systems, or other electronic devices.

Some glitches may be there in the initial phases but address them quickly to keep up the learning curve. Technology should not be a hindrance in such a large global vaccine drive. Technology is not about choice but enablement to get populations vaccinated as fast as possible.

Dr. Joyoti Goswami is a Principal Consultant at Damo Consulting.