Variety of systems deployed to track COVID vaccine data
April 30, 2021
Canada’s mass COVID-19 immunization program is centred on getting the right dose into the right arm at the right time. Those at the digital front lines of the vaccine rollout would add another critical ‘R’: the right information.
From e-booking and scheduling, to coordinating clinics and capturing pertinent data, to connecting to backend immunization registries, digital solutions are rapidly evolving to support the complex process of administering multiple vaccines in changing dose schedules to different groups of people based on eligibility.
The end goal? To make getting a vaccine as efficient as possible while collecting vital data down to the individual patient level, even if it means relying on a patchwork of systems due to the lack of a harmonized national platform.
“I think a window has opened with COVID,” said Cameron Bell, chief technology officer at CANImmunize, a company working to modernize Canada’s immunization system. “There’s always a flurry of activity at the moment of crisis and then things go back to the old ways. I hope we take this opportunity to actually bring in concrete changes.”
CANImmunize launched as a business in 2019, but its digital immunization work began eight years earlier when Bell partnered with Ottawa Hospital senior scientist and CANImmunize founder Dr. Kumanan Wilson to create an app to help Ontarians track their personal vaccinations.
At the start of the pandemic the company was working with Bruyère Hospital in Ottawa on a system to give employers the ability to manage mandatory staff vaccinations. Last fall, it quickly pivoted to tackle a different challenge.
The hospital was setting up its annual flu shot clinic and was looking to go paperless. Together with CANImmunize, it developed an end-to-end immunization clinic management system called Clinic Flow, a system that supports online booking, data capture, digital receipts and digital reminders, and also integrates directly to Panorama, a provincial immunization registry.
When COVID-19 vaccines began to arrive in Canada, the company partnered with Nova Scotia to advance the technology and it is now used to manage the vast majority of vaccinations in that province, as well as to support e-booking of vaccination appointments in Yukon.
Using Clinic Flow, Nova Scotia residents book their first and second dose appointments online, completing health screening and consent forms at the same time.
When they arrive at a clinic, an immunizer reviews their information on a tablet and decides whether they are eligible to proceed to vaccination. If not, the reason is documented.
The system also captures any adverse events noticed during the waiting period as well as the inventory lot number for each dose administered, a mandatory field that relies on standardized vaccine information from the Canadian Vaccine Catalogue published and maintained by CANImmunize.
“What Nova Scotia has done really well from the beginning is prioritize,” said Bell. “They are meticulous about correcting records that were entered incorrectly and they have extremely high standards with respect to the data going into the system.”
Dr. Wilson sees accuracy of immunization records as an important step in the journey towards a pan-Canadian digital system. CANImmunize is currently working with Nova Scotia, Ontario and B.C. to create permanent connections between Clinic Flow and immunization repositories, with the over-arching goal of allowing individuals to contribute data to their own immunization records.
The company is also working with the Canadian Vaccine Safety Network to facilitate adverse event reporting.
Newfoundland is another province benefitting from the trial run of a digital flu program last fall. Early on, the provincial government mounted an ambitious campaign to increase the number of flu vaccines administered from between 20 and 30 percent of the population to 85 percent.
That meant ensuring the province’s four regional health authorities had the resources required, and that information would be consistently tracked and reported on, and captured in one place.
After deciding to use the provincial electronic medical record (EMR) – called eDOCSNL and provided by Med Access – as the best application to manage community-based flu clinics, the province chose an e-booking system from Pomelo Health to alleviate the administrative challenge of managing such a large campaign.
“They anticipated hundreds of thousands of vaccines being carried out at public health sites and they simply didn’t have the administrative capacity to book and oversee a campaign of that magnitude, so they looked at an electronic solution,” said Fred Melindy, director of eDOCSNL at Newfoundland and Labrador Centre for Health Information (NLCHI).
Prior to rolling out the online solution, parts of the province with limited cellular and Wi-Fi were relying on “old school paper and pen with a calculator alongside to do tallies,” added Cindy Clarke, NLCHI director of eHealth Programs. The push to connect all regional health authorities on one system resulted in an extremely successful flu campaign that served as a testing ground for the far more complex COVID-19 vaccine rollout.
For COVID-19 immunization, each authority is using its own instance of the Pomelo Health e-booking platform and can customize the content based on where they are in the provincial rollout strategy.
When people click on the link to book, they are presented with appointment types and availability. After they book, they are sent reminders and can confirm their appointment, and all patient booking information is sent from Pomelo Health to the EMR.
Because it’s difficult to forecast which vaccine will be at a particular site when, only first dose appointments are booked online and second dose appointments are booked at point-of-care, yet all are coordinated in Pomelo Health, including call-in appointments.
As an additional validation step, NLCHI developed a separate pre-registration system in-house. It is used to prioritize groups being targeted for specific phases of the vaccination campaign, and to help plan where clinics should be located and how they should be staffed. All three systems – the pre-registration app, e-booking and the EMR – are connected, making it possible to effectively plan capacity and workload at each clinic so resources can be assigned accordingly.
“A large part of the decision to use Med Access for documenting immunizations and collecting data was the integration link with self-booking,” said Melindy. “It’s really made it possible to do a more correctly resourced and more efficiently rolled out immunization campaign than we’ve ever had the capacity to do here in the province.”
“Going this route really streamlined the province despite our geographic and regional differences,” added Clarke. “Having one provincial solution helped bring everyone together, using the same process with the same tools, and actually generating the same type of data and reports. That is a big bonus.”
In Ontario, each public health unit is developing a vaccine plan tailored to their own community’s needs, but all vaccinations are documented in the provincial COVID-19 immunization registry called COVAX. One company that quickly pivoted to help Ontario hospitals and public health units to automate their vaccine clinic workflow is Verto Health.
The company’s digital twin platform is designed to automate care pathways and prior to the pandemic, it was focused primarily on helping cancer and chronic disease patients to track their journeys through the healthcare system. Its new vaccination solution for COVID-19 allows patients to self-schedule and manage their appointments online, handles patient consent and eligibility, and streamlines vaccination workflow at clinics.
“E-booking solves just one part of the problem,” said Verto Health founder and CEO Michael Millar. “The real advantage is in optimizing the flow of patients as they move through the vaccination centres and making sure we don’t lose track of them for second dose follow up.”
The Verto Health platform enables eligible people to book, cancel or reschedule appointments online, with either SMS or email confirmation the day of the appointment as well as a cancellation link. A dashboard based on the Kanban workflow management methodology is provided to hospitals and public health units so they can coordinate distribution of vaccines across a region, and to immunizers at clinics so they can see at a glance who is scheduled for the day.
One advantage of the digital twin technology is the ability to easily integrate to other systems – like the province’s COVAX registry – and to react swiftly to policy changes. If the dosing schedule changes, for example, second dose appointments can be automatically adjusted to the next available date.
Women’s College Hospital (WCH) in Toronto was an early user of Verto Health’s platform. When it launched its initial community clinic in late January, community partners were manually scheduling appointments for high priority healthcare workers for the first three days before transition to e-booking.
“We were able to register them in the provincial COVAX system once they arrived, but it was incredibly time consuming and very inefficient and took a lot of human resources,” said WCH CIO Drew Wesley. “The team responsible for scheduling had a very loud cheer when the Verto Health application was up and running,” he added.
WCH has since partnered with other hospital clinics in the Mid-West Toronto Ontario Health Team to coordinate vaccinations through vaccine.to.ca, a site implemented by Verto Health to serve as a digital front door to Toronto hospital vaccine clinics. When patients book appointments, the data is imported directed into COVAX so that when clinics open, people are already pre-registered in the system.
“The Verto Health platform is not only helping us manage very well the appointment booking portion of clinic operations, but also helping us understand the flow of individuals who are coming to our clinic. That’s the digital path,” said Wesley. The ability to track people also means less vaccine wastage due to no shows.
At the backend, COVAX is helping to manage inventory by recording the type of vaccine given down to lot number with very detailed reconciliation taking place, he added. Though the system itself is not an “intensive data source,” said Wesley, it is quickly evolving. “There are a lot of moving pieces happening at a very rapid pace, but we have good technology partners working together to try and help us better manage the process.”
Collaboration is the driving force behind Project ABC, a Digital Technology Supercluster project under way in B.C. led by Cambian Business Services Inc. ABC is short for authorization, booking and coordination of widespread testing and immunizations. The project collaborators – including LifeLabs, IBM Canada, WELL Health, Tickit Health, Providence Health Care and Simon Fraser University – are working to integrate systems and provide automated vaccination tools, including QR codes, to remove bottlenecks in mass immunizations.
“A lot of the things we focused on were about how we could support better public health for Canadians,” said Cambian CEO Bruce Forde, noting that much of the infrastructure that Project ABC came up with builds out from the Panorama immunization repository.
Rather than relying on client registries or medical IDs to identify people within each phase of the vaccine rollout, the Project ABC approach enables people to register for themselves. Pending approval by the B.C. government, it is expected to be implemented this year. “Fundamentally, the technology we’ve got for doing the authorizing is based on a patient-reported model,” explained Forde. “You register and say your age, demographics, conditions; we could go and verify that and audit it, but at a time when it’s busy and everyone is trying to figure out what’s going on, it’s the honour system.” The Project ABC booking system, which is integrated to Panorama, works behind the scenes as non-branded OEM software to enable people to choose a convenient vaccination site from a list and pick a date and time.