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Vaccine enthusiasm may have waned in recent months, with vaccine hesitancy prevalent among those who are reluctant to get their COVID-19 shots. But when the Pfizer/BioNTech, Moderna and Johnson and Johnson vaccines were first approved for emergency use authorization from the Food and Drug Administration, Americans rushed to get inoculated, which initially created challenges when it came to vaccine supply and distribution.
Now, with vaccines in ample supply and Americans cooling to the idea of getting their shots, it seems as though the crush of demand has abated. But the future of the ongoing pandemic is still uncertain, and there are future pandemics to consider as the nation and its healthcare system eye ways to better overcome distribution challenges.
Arizona-based nonprofit health system HonorHealth was able to use existing technologies to meet the initial challenge, administering more than 800 doses in two days during one stretch. The system was able to use this tech to create, deploy and reproduce a successful mass vaccination workflow in drive-through clinics, walk-in clinics and mobile settings.
Anthony Blackford, pharmacist and HonorHealth’s IT senior application analyst, and Rebecca Wiesner, HonorHealth’s director of IT applications, spoke about their approach at the HIMSS21 annual conference in Las Vegas in their session, “Mass Vaccination: The Use of Technology for the Road Ahead.”
The initial challenge was significant. In 2020, the system was asked to partner with the county and state to become one of five points of distribution for Maricopa County, home to about 4.5 million people. HonorHealth was tasked with focusing on the North Valley region, in which roughly 12,000 healthcare personnel would need to be vaccinated under Arizona’s prioritization plan.
The system partnered with the county to be a distribution site, but it had to figure out how to do mass drive-through vaccinations in an effective and efficient way. Luckily, HonorHealth had time on its side, getting a head start by organizing a steering committee in August 2020 to work on things like workflows, location and infrastructure. It was still unknown at that point when COVID-19 vaccines would be developed and become available, but the system wanted to be ready for whenever that happened.
Aftering partnering with the Mayo Clinic, HonorHealth was able to create a mass vaccination drive-through in a local parking lot, with five tents and clearly demarcated driving lanes for vehicles. The site administered its first vaccine dose on December 14, 2020, and went fully operational on the 17th, delivering about 800 vaccines on the first day.
“We didn’t book too many vaccine appointments because we weren’t sure how it was all going to work out,” said Wiesner. “We weren’t in the business of mass vaccination historically, so we had to figure out a way to do it quickly and efficiently.”
Why not leave mass vaccination efforts to the county and the state?
“We, like every other healthcare provider, wanted to vaccinate our staff,” said Wiesner. “We wanted to safely service the general public and the community, and we wanted to be one of the first to offer this to our employees. We really had a drive to do that. We all just worked together — it was all hands on deck. Everyone on the organization had a role to play in some fashion. In some cases, people pulled out of general responsibilities to help with this, but we all came together to get it done.”
To accomplish this, HonorHealth used some of the tools that were already in its toolbox. It used its electronic health record, with which it was already intimately familiar, and developed a prioritization tool to help identify the clinicians and providers who were on the front lines of care.
The health system developed a prioritization plan with its staff and partners at Mayo, and offered appointments to those individuals first. HonorHealth also quickly developed a chatbot using its own technology, and when people started filling it out with their general information, that gave the organization a handle on how many people were interested and who should be scheduled first.
Through the patient portal, vaccine candidates were notified and invited to book appointments.
“We decided to offer bulk dose appointments right from the get-go,” said Wiesner. “It was very important for us that people did go and get their second doses. We wanted a high compliance rate for that.
“We had those second-dose appointments, so we could go back to the county or state and tell them how many doses we needed, and we were allocated those accordingly,” she said.
Text messages were sent to vaccine candidates to let them know when they could bok their appointments, and HonorHealth also used an alert system for COVID-19 symptom check-ins and home monitoring.
“We realized we had built a fairly efficient process,” said Wiesner. “We were able to adapt it to our walk-in clinics, our general clinic and also to our mobile clinic. We did outreach for underserved populations to deliver doses of the vaccine. All clinics, including mobile, use the same procedures as in the mass vaccination clinic. We use that exact same workflow, and it was something we hadn’t necessarily fully prepared for. But we were happy that it was modular and would work with any scenario.”
According to Blackford, it’s important for any health system to know its limitations when embarking on a similar initiative.
“We had to integrate as much scalability as possible,” said Blackford. “The number of patients can quickly multiply during pandemics. We also didn’t want to change things around for clinicians. We only changed things if there was an amazing benefit to be gained. Things can change that are outside of your control, like who’s eligible … so we had to make adjustments along the way.”
One of those adjustments was streamlining the system’s training documentation. Patient monitoring, meanwhile, came into play when the vaccination efforts were moved into clinics. Patients were given vaccination cards, and in the event they were lost, the HonorHealth staff printed and kept records of the visit summary; the newly-vaccinated could leave with a record of their vaccination, or access it later via the patient portal.
HonorHealth kept everything in its system because it made it easier for staff to do their own reporting and check-in reports, said Blackford.
“One of the nice things about mass vaccination is that you know when they get their doses,” he said. “It’s very easy to check to see if all that information is correct.”
From December 2020 to May 2021, HonorHealth administered more than 111,000 total vaccine doses, and saw a second-dose compliance rate of 99%.
Looking ahead, HonorHeath is putting together a coalition to provide verified copies of vaccine records, and is eyeing a potential booster shot, which will likely require another round of semi-intense distribution. But the heath system feels ready.
“We feel much more prepared now,” said Wiesner.