The challenge of vaccinating the most vulnerable

In December 2020, the FDA granted emergency use authorization for the first COVID-19 vaccine, initiating the largest inoculation effort in US history. But, three months later the rollout has not gone as smoothly as hoped – putting more stress on already overburdened health systems and providers.
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Vaccine rollout

As vaccines for COVID-19 make their way around the country, many health systems are facing an unexpected stressor. Priority patients are not always easy to contact, but vaccine doses don’t last forever – and many states are imposing strict penalties for those who waste their supplies.

Guidelines from the Centers for Disease Control (CDC) recommend using a tiered prioritization scheme to ensure equitable vaccine distribution. Those most in need – like frontline healthcare workers and residents in long-term care facilities – are top priority, followed by frontline essential workers and those aged 75 and over; people between 65 and 75 or those with underlying health conditions; and, finally, all individuals over the age of 16.

Between a rock and a hard place

However, with some states penalizing health systems that fail to administer all of their weekly allocated doses, vaccinators are often stuck between a rock and a hard place – trying, on one hand, to satisfy the state’s requirements to vaccinate as many as possible, while, on the other hand, striving to fulfill an ethical obligation to adhere to the eligibility requirements.

Healthcare systems are finding themselves in this predicament due to the fact that much of the onus to find and schedule vaccination appointments is falling on the individual patient – a process conducted primarily online. This often means high-priority elderly individuals who may be unfamiliar with online systems must navigate complex, confusing, and unreliable electronic registration and scheduling portals. If unassisted, these patients may be forced to schedule appointments for later dates or at distant locations as closer appointments are booked by those who are more tech-savvy. As a result, vaccines are not reaching critical populations and already limited supplies are going, at least in part, to non-priority patients first.

Harnessing data to identify priority patients

Providers and their health systems are naturally concerned about patients getting timely vaccinations. Thankfully, there are ways in which they may be able to play a more active role in the process.

Health systems have access to in-depth patient information within the electronic health record (EHR) and other databases (e.g. employee health records, practice management systems) which could be leveraged in a number of ways. Given that eligibility data may come from different sources (e.g., age and comorbidity could be contained within the EHR, but occupation could be in a hospital-wide employee database), data will need to be properly captured, aggregated, and normalized in alignment with eligibility criteria. This information, combined with clinical decision support, could easily identify high priority patients who can then be contacted to ensure they are scheduled and vaccinated.

Healthcare organizations also need a way to measure whether vulnerable patient populations have already been properly vaccinated. Patient-level data could be aggregated and visualized in facility- or system-wide dashboards to assess penetration and help identify target patient cohorts that may have been missed. This, combined with understanding why certain patients are not being vaccinated (e.g., vaccine hesitancy, counterindications, travel restrictions, etc.), could provide the basis for solutions aimed at increasing access and coverage.

State vaccination programs should partner with healthcare and hospital systems to ensure patients get vaccinated in a timely manner. Providers must be able to strike a balance between adhering to the state’s eligibility criteria and vaccinating as many people as possible. Engaging in the intentional, proactive use of aggregated and normalized patient data to quickly engage eligible patients can help resolve this quandary.

To learn how IMO is helping our healthcare partners to minimize the spread of COVID-19 and administer vaccines, click here.
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