The slow rollout of vaccine programs was frustrating for everyone, and looking at the problems now will lay the foundation for improved mass vaccine programs in the future. The themes that emerged, says Michael Ganio, Pharm.D., senior director of pharmacy practice and quality at the American Society of Health-System Pharmacists, included understanding cold chain supply chain management and planning and communication between health departments, clinics and pharmacies — and ultimately, the public. Here is where the lack of intake forms and bidirectional communication hindered the registration process.
“A lot of that comes down to the technologies that seem kind of basic but are necessary to make this successful,” says Ganio. “Scheduling patients and finding open appointments is being done anywhere from a homegrown system to some locations leveraging existing electronic health records. Many sites worked out those kinks to maximize efficiency.”
As the numbers of vaccinated Americans continue to increase, Ganio says that various organizations will continue to address the kinks in the system and the patient experience will improve. With the news that a booster shot may be necessary, the process of vaccine distribution, scheduling, and data submission to registries will be an ongoing activity.
“If we have to come back around and do this again, hopefully any kind of scheduling system is more streamlined,” says Ganio. “One of the challenges here is just the supply and demand, which led to the issues around many of the initial rollouts. Rather than having to roll out to administer a booster, for example, hopefully at that point the supply is plentiful and it’s just contacting your local pharmacy or health system and scheduling your dose. We will have to keep an eye on these things as we head toward the end of the year.”
There are some lessons to learn. Each state is different when it comes to scheduling and communicating with patients. “I think in retrospect we could have worked on the database interfaces sooner,” Ganio says. “Hindsight being 20-20, we should have worked on the systems for scheduling and coordinating appointments and having a centralized location where a patient or caregiver could go to find an appointment.”
“If health department staff or an individual could go to register for a vaccine, and that information feeds into the registration system through an HL7 message — or whatever the message might be — as it does with an EHR to the pharmacy system, that’s the ideal. A lot of the lessons that we’ve learned will hopefully support public health initiatives in the future.”
Technology solutions that support bidirectional communication are a key area to look to improve. Most health-system pharmacies can use the electronic health record to push out communication through patient portals. But that doesn’t guarantee there is an interface between the health-system EHR and the state, which means the patient could have to schedule twice. They might have to find an appointment that works for them, and then go back to the provider site to have to register in their system to document the information needed to provide the immunization.
As Ganio points out, there are interfaces that report the administered vaccine through an IIS (immunization information system). But consider the reverse direction. “If health department staff or an individual could go to register for a vaccine, and that information feeds into the registration system through an HL7 message — or whatever the message might be — as it does with an EHR to the pharmacy system, that’s the ideal,” he says. “A lot of the lessons that we’ve learned will hopefully support public health initiatives in the future.”
This bidirectional communication goes beyond a situation like COVID-19 vaccines. When you have pharmacists engaging with healthcare providers and sharing patient medical information, Ganio points out, pharmacists are then in a position to optimize medications on the outpatient side. “Ultimately, we see this goal of not a single electronic health record, but universal access to something where everyone who is responsible for the care of that patient, including the patient, has access to their healthcare record.”
Opportunities for Pharmacy
Going forward, though, Ganio says there’s an opportunity to highlight the role of vaccines in public health. “Any pharmacist will tell you all about the benefits of getting a vaccine,” says Ganio. One example is that having vaccines available was touted as the way out of the pandemic, and it’s hard for many people to see the continued importance of mask-wearing as vaccine rates increase and caseloads decrease.
“There is an opportunity to communicate that, while these vaccines were developed quickly — the mRNA technology is fascinating, and it’s great to see it get its moment — it’s important to help patients understand that most side effects are going to occur within a two-month period,” he says. “All this together is important to communicate to patients that these vaccines are safe and effective.” CT
Maggie Lockwood is a VP at ComputerTalk for the Pharmacist. You can reach her at firstname.lastname@example.org.