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The New York Times
‘Full of problems’: faulty software blocks vaccine registrations
When coronavirus vaccines first became available, Virginia state health officials turned to software recommended by the Centers for Disease Control and Prevention to schedule appointments. But people complained that the software, called VAMS, was too confusing for the elderly to use. So the state switched to another system, PrepMod – but that also posed problems. Links sent to seniors for their appointments were reusable and found their way to Facebook, leading to a vaccination event in Richmond with dozens of overbookings. Some of these people threatened healthcare workers when they were fired. “It was a nightmare scenario,” said Ruth Morrison, policy director for the Richmond and Henrico County Health District. “People show up confused, angry, thinking they have a date.” Sign up for the New York Times State’s The Morning newsletter and local health departments across the country continue to face delays in dispensing injections, in part because flaws persist in the appointment software tools. you like the ones used in Richmond. Problems threaten to slow vaccine rollout even as supplies and distribution increase rapidly across the country. Large software systems have often been problematic for businesses and governments. HealthCare.gov, a site published after the Affordable Care Act, crashed early on. But problems with vaccination sites have an added sense of urgency as health officials try to vaccinate as many people as possible, as quickly as possible. President Joe Biden said on Thursday his administration would send technical teams to help states improve their websites. He also said the federal government would open a website by May 1 that would let Americans know where the vaccine is available. Many government officials have changed software vendors, only to see little or no improvement. In California, technological incidents have allowed ineligible people to make appointments. Massachusetts residents have been stranded by the website crash. Some North Carolina residents are avoiding online registrations altogether, instead indulging in a free vaccine for all. PrepMod is used by 28 states and localities, after many states avoided the $ 44 million VAMS tool built by Deloitte. Salesforce and Microsoft have also developed vaccination software, with their customers frustrated too. Small tech companies have also developed their own planning tools. “It’s like a patchwork quilt,” said Morrison, who decided after the failed PrepMod trial that his county was going to try something else. “Some of these systems have strengths, but they all have weaknesses as well.” Other health officials have defended the appointment systems, and the software developers have said complaints about their products are exaggerated. Tiffany Tate, creator of PrepMod and executive director of the Maryland Partnership for Prevention, said criticism of her system largely stemmed from health providers’ lack of knowledge on how to use it or the ever-changing needs of states. . “The pandemic is evolving and we need to be able to keep up with it,” she said. “We just have to be a very flexible platform.” Deloitte, whose software is used by nine states, said VAMS was originally intended for small groups in the early stages of vaccine deployment in states, so the company was “responding quickly to meet their changing needs. And updated the system to handle a heavier load. . Health experts say several factors made it difficult to deploy the software. In some cases, developers have condensed work that would normally take years into weeks, leading to problems. In addition, the various approaches to determining eligibility in the dozens of communities using the software made it difficult to develop a one-size-fits-all approach. Some states use more than half a dozen appointment scheduling systems, from tools used by federal, state and local agencies to software used by private hospitals and pharmacies to rudimentary solutions like SignUpGenius. Some sites don’t support appointment scheduling at all, but allow people to browse databases to find available vaccines or sign up on waiting lists. Often, systems cannot communicate with each other. “You’re basically building and testing data systems on the fly as millions of people try to find vaccines,” said Claire Hannan, executive director of the Association of Immunization Managers, which advocates for the health services of the State. Microsoft, which sold vaccination software to several states and Washington, DC, frustrated New Jersey with its system, and in late February, after days of website outages in the nation’s capital, the company admitted that it had “failed”. Microsoft said in a statement it was “focused on helping governments run their COVID-19 vaccination programs as quickly, safely and efficiently as possible.” PrepMod’s woes have resulted in delays in vaccine rollouts in places like Washington state and Pennsylvania. When the Massachusetts vaccine appointment website went down for several hours after increased demand, PrepMod took responsibility and apologized. Andrew Therriault, a data scientist from Boston, said he was “astonished” by the extent of PrepMod’s shortcomings. One problem he discovered was that the system didn’t book a date slot because people filled in their information, so they could be kicked out at any time if someone else beat them at that slot. particular. “I’m trying to imagine someone doing this who isn’t very tech savvy – it basically means they don’t have a chance to compete,” Therriault said. Some of the registration software has also caused major headaches by not allowing unique registration links that expire after one use. Reusable links have hampered immunization efforts in places like California, where health departments use both PrepMod and a Salesforce-powered system, MyTurn. In some cases, health officials aiming to reach black and Latin American communities that had low immunization rates issued MyTurn appointment codes to these groups which ended up being widely shared, including among wealthier white communities. Because the codes did not expire after a single use, these people were able to use them to get vaccinated before it was their turn. Tate of PrepMod said healthcare workers and others who incorrectly shared the links were at fault. “It’s not a problem with our system. It’s a problem with the people who should be responsible, ”she said. The company, she said, added an option for unique links. Salesforce declined to comment, but Darrel Ng, a spokesperson for the California Department of Health, said MyTurn also added unique links. UC San Diego Health, which operates a mass drive-thru vaccination site, uses its existing software rather than MyTurn because the two systems are incompatible, said Dr Christopher Longhurst, chief information officer for UC San Diego Health. Otherwise, those arriving for a second scheduled dose in the hospital system should be separated from those scheduled to MyTurn, he said. “We had to use up all of our second doses in some routes while using new software in other routes,” he said. It would be “incredibly inefficient”. This week, the MyTurn system offered more appointments than it was supposed to at a vaccination site in San Diego run by Scripps Health, forcing the site to shut down for several days because it ran out of doses. “The MyTurn system is fraught with pitfalls,” said Dr Ghazala Sharieff, chief medical officer of Scripps. “These challenges add another layer of unnecessary stress to our team.” Health officials said the use of imperfect tools from outside companies underscored the need to invest in technology for public health departments, many of which still use paper machines and fax machines to keep records. State registers that keep track of residents’ immunization histories – known as immunization information systems – could have been adapted to schedule appointments, said Mary Beth Kurilo, senior director of the ‘American Immunization Registry Association. But the federal government never asked them to do so, she said, and they would have needed more money and time to prepare. Some regions have chosen to avoid technology altogether. In Johnston County, North Carolina, southeast of Raleigh, the Department of Health decided it would have been too difficult for staff to manage appointments online, so injections are first come, first served. The policy has been effective, said Lu Hickey, a spokeswoman for the Department of Health, but that means the county – which also doesn’t require in-person identification – doesn’t know whether people are vaccinated in the city. good order and must rely on honor. system. In Richmond, Morrison said officials are looking for solutions and are even considering trying VAMS again. “We are tinkering with it locally through a lot of manual effort and workarounds that we have put in place to put dressings in place,” she said. This article originally appeared in The New York Times. © 2021 The New York Times Company
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