The New York Times
‘Enraged with Problems’: Faulty Software Snarls Vaccine Sign-Ups
When coronavirus vaccines became available, state health officials in Virginia used 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 older adults to use. Then, the state changed to another system, PrepMod – but that also had problems. The links sent to the elderly for their appointments were reusable and reached Facebook, leading to a vaccination event in Richmond with dozens of overbookings. Some of these people threatened health workers when they were refused. “It was a nightmare scenario,” said Ruth Morrison, policy director for the Richmond and Henrico County health district. “People appearing confused, angry, thinking they had an appointment.” Subscribe to the New York Times State newsletter The Morning and local health departments across the country continue to face delays in vaccine dispensing, in part because flaws in naming software tools such as those used in Richmond remain. The problems threaten to delay the launch of the vaccine, even as supplies and distribution are increasing rapidly across the country. Large software systems are often problematic for businesses and governments. HealthCare.gov, a website launched after the Affordable Care Act, crashed at first. But problems with vaccination sites have an additional sense of urgency because health officials are trying to vaccinate as many people as possible, as quickly as possible. On Thursday, President Joe Biden said his government would send technical teams to help states improve their websites. He also said that the federal government would open a website on May 1 that would allow Americans to find out where the vaccine is available. Many state officials have switched software vendors, only to see little or no improvement. In California, technological accidents have allowed ineligible people to make commitments. Massachusetts residents were blocked by blocked websites. Some North Carolina residents are avoiding online registrations altogether, instead of getting involved in a free vaccine for everyone. PrepMod is being used by 28 states and localities, after many states rejected the $ 44 million VAMS tool developed by Deloitte. Salesforce and Microsoft developed vaccine software, too, with their customers equally frustrated. Smaller tech companies have also launched their own scheduling tools. “It’s like a patchwork quilt,” said Morrison, who decided after the PrepMod test failed that his county would try something else. “Some of these systems have strengths, but they all also have weaknesses.” Other health officials defended the naming systems, and the developers behind the software said complaints about their products were overblown. Tiffany Tate, creator of PrepMod and executive director of the Maryland Partnership for Prevention, said that criticism of her system stemmed in large part from health professionals’ lack of knowledge about how to use it or the changing needs of states. “The pandemic is evolving and we have 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 smaller groups in the early stages of launching vaccines in the states, so the company was “responding quickly to meet their changing needs” and was updating the system to handle a larger load. Health experts say several factors have complicated the software’s implementation. In some cases, developers have condensed work that would normally take years to weeks, leading to failures. In addition, the different approaches to determining eligibility in dozens of locations using the software have made it difficult to develop a unique approach for everyone. 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 do not support scheduling appointments, but they do allow people to access databases to find available vaccines or enter waiting lists. Often, systems cannot communicate with each other. “You are basically building and testing real-time data systems, while millions of people are trying to find vaccines,” said Claire Hannan, executive director of the Immunization Managers Association, which defends state health departments. Microsoft, which sold vaccine software to several states and Washington, DC, frustrated New Jersey with its system, and in late February, after days of website failures in the nation’s capital, the company admitted it had “fallen short”. Microsoft said in a statement that it was “focused on helping governments manage their COVID-19 vaccination programs as quickly, safely and efficiently as possible”. PrepMod’s problems have led to delays in launching vaccines in places like Washington state and Pennsylvania. When the vaccine naming site in Massachusetts went down for several hours after an increase in demand, PrepMod took responsibility and apologized. Andrew Therriault, a Boston data scientist, said he was “surprised” by the extent of PrepMod’s shortcomings. One problem he discovered was that the system did not reserve an available time while people filled in their information, so that they could be expelled at any time if someone else arrived before that specific time. “I try to imagine someone doing this who is not so tech savvy – it basically means that they don’t have a chance to compete,” said Therriault. Some of the subscription software has also caused major headaches by not allowing exclusive registration links that expire after a single use. The reusable links have prevented vaccination efforts in places like California, where healthcare departments are using PrepMod and a system powered by Salesforce, MyTurn. In some cases, health officials aiming to reach black and Latino communities that had low vaccination rates issued MyTurn naming codes for those groups that ended up being widely shared, including among the wealthiest white communities. Since the codes did not expire after a single use, these people could use them to get vaccinated before their turn came. Tate of PrepMod said health professionals and others who shared the links improperly were to blame. “This is not a problem with our system. This is 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 California health department spokesman, said MyTurn also added exclusive links. UC San Diego Health, which operates a drive-thru mass vaccination site, is using its existing software instead of MyTurn because the two systems are incompatible, said Dr. Christopher Longhurst, chief information officer at UC San Diego Health. Otherwise, those arriving for a second scheduled dose in the hospital system would have to be separated from those scheduled on MyTurn, he said. “We would have to exhaust all of our second doses on some tracks while using new software on others,” he said. “It would be incredibly inefficient”. This week, the MyTurn system offered more consultations than it should at a vaccination site in San Diego run by Scripps Health, forcing the site to close for several days because it ran out of doses. “The MyTurn system is fraught with problems,” said Dr. Ghazala Sharieff, chief medical officer at Scripps. “These challenges are adding another layer of unnecessary stress to our team.” Health officials said reliance on imperfect tools by outside companies underscored the need to invest in technology for public health departments, many of whom still use paper and fax machines to keep records. The state records that monitor residents’ vaccination 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 for it, she said, and they would need more money and time to prepare. Some regions have chosen to avoid the technology altogether. In Johnston County, North Carolina, southeast of Raleigh, the Department of Health decided that it would be very difficult for staff to manage online appointments, so vaccines come first, they are served first. The policy has been effective, said Lu Hickey, a spokesman for the Ministry of Health, but it means that the county – which also does not require personal identification – does not know whether people are being vaccinated in the proper order and has to rely on the system tribute . In Richmond, Morrison said employees are looking for solutions and even thinking about trying VAMS again. “We are working together at the local level through a lot of manual effort and alternative solutions that we have implemented to put on band-aids,” she said. This article was originally published in The New York Times. © 2021 The New York Times Company