Vaccine to Vaccination

What have we learned thus far (from the current and previous pandemics and vaccines) that will prepare us for the COVID-19 vaccine?

Seth Hartman: One thing we have become experts at through this pandemic is the ability to quickly assemble teams that can put loosely defined plans into action.  At the beginning of the pandemic, we were quickly changing our practices on PPE guidance based on updated information, and quickly changing our clinical practices as a result of new data.  We learned through this process that we must have a top down and bottom-up communication structure so that we could disseminate new information quickly and react to issues rapidly that arise as we continued to learn new ways to care for our staff and patients.  As we prepare for the vaccine, we are relying on this structure to help us understand how to identify the populations that fit within the CDC criteria for vaccination as well as create the physical structures in the health center and communities of need to ensure we can get the vaccine to all those who wish to receive it, ensuring that our community in Central, South and Southwest Chicago does not go without access.

What plans, policies, best practices have you had to add or update as you prepare for the distribution and administration of the vaccine?

Seth Hartman:  Largely our plans, policies, and best practices surrounding patient care and immunizations have served us well in outlining how we care for staff and patients.  The prioritization schema from the CDC is one area that we are referencing to ensure that our vaccine administration clinics ensure the appropriate patients receive the vaccine on schedule, but otherwise most areas have stayed the same.  Our standard operating procedures surrounding the deployment of the vaccine are certainly a new development, with cold chain monitoring, reconstitution timing, and administration schedules matching the thawed vaccine, but this was to be expected with such new therapies. 

What role has the informatics team played in co-designing the vaccine preparedness policies and procedures? 

Seth Hartman: The pharmacy informatics team has been a part of these discussions from day one.  Our responsibility is to ensure that we have appropriate workflows surrounding the deployment of the vaccine to our clinical areas, inventory management consistent with CDPH and federal requirements, clinical information available to practitioners at the point of ordering, verifying, dispensing, administering, and monitoring the vaccine, and appropriate reporting to our state and federal bodies.  Policies, procedures, and system build reflect this level of information which is sourced from committees at which pharmacy informatics are accountable for this level of detail.

Technology plays a significant role in the vaccine distribution and administration process. Can you elaborate on how technology is being used in the distribution, administration, tracking, reporting, and surveillance

Seth Hartman: We are using a straightforward process to track the vaccine with the Illinois based ICARE system.  This system received information regarding all administrations of the vaccine and is updated nightly.  These updates deduct from our virtual inventory in the VTrckS and Vaccine Finder systems so that CDPH is able to reallocate more vaccines as it is available and our inventories run low.  Reporting has been configured and made available to ensure accurate matching of this data on a daily basis to see that both systems remain intact.  Patient scheduling will indicate need at different sites and is based on algorithms based on priorities set by the CDC.  We are using our patient portal for phase 1 to alert employees for their eligibility to schedule their first visit and will work with them after successful administration to schedule their second visit at the appropriate time window.  Each recipient of the vaccine will be provided information on the V-SAFE system and how to set up enrollment on their mobile device for surveillance.

How will institutions track the administration of the two doses required for the vaccine?

Seth Hartman: We will use a tool in our EHR for tracking of vaccine administrations common to practice today to account for a primary vaccination and a secondary vaccination that can be managed and reported on with patient registries within the framework of our EHR.

Have you had to train additional staff to meet the increased demand in workload?

Seth Hartman: Yes, we are working on getting every available vaccinator trained across multiple specialties to ensure we have enough staff to provide vaccinations to all of our staff and patients throughout our system.

What outcome metrics can we use to measure the success of the campaigns and initiatives?

Seth Hartman: I think easily we can measure the proportion of employees indicating a preference for vaccination compared to those who receive it.  We can measure the proportion of patients vaccinated within different geographic regions, and demand based on site to prioritize resource allocation for vaccinators.  We can measure cancelled or unarrived appointments and track barriers to vaccination to help set up programs to ensure patients can access the care they desire, and many other areas.  We are quite lucky to be very data rich in healthcare these days with access to track and report on many, many metrics.

As information quickly changes, the IT systems must be updated to reflect these new changes. What strategies have you used to ensure that your systems continue to provide the most accurate and timely information to avoid misinformation?

Seth Hartman: As new information becomes available my team has the ability to input clinical data into the EHR rapidly, both by ensuring the availability of the team, and with support from our IT partners in ensuring that our data transmission pathways across EHR environments are available for us to use for this rapidly developing and quickly changing information 24/7/365.

Do you believe we have or are setting up the infrastructure to provide equitable access?

Seth Hartman: Yes, that is a primary concern at the University of Chicago.  We first must follow the CDC guidelines and secondary to that we are working hard and have registered vaccination sites to ensure access in our most vulnerable communities and populations.  While there is much remaining to develop in terms of our overall mass vaccination strategy for Chicago, one central tenet to all discussions of care at UChicago Medicine is how we equitably distribute resources to the community we serve to ensure access to care is both at the Forefront of Medicine and within reach of everyone in the community.

How do we build trust and engage the necessary stakeholders to ensure the success of the initiatives?

Seth Hartman: We must rely on our scientific community to continue to provide clarity on the matters at hand and to ensure that this information is available and shared widely through our clinical and political partners.  Information scarcity, and misleading data/reporting are a threat to the success of this campaign and must continue to be challenged by the sharing of solidly backed, scientific data.

For our last question, what advice would you provide public health institutions and health systems as they prepare for the vaccine?

Seth Hartman: Focus on creating structures for good information flow at your institutions, both top down and bottom up.  Work to ensure you have resources freed of other work that can wait, to ensure you have the flexibility to pivot quickly as new information is released.  Begin your communication processes now, both for internal stakeholders as well as external.  Identify any areas of staff that you have that can be allocated to vaccine administration, I expect this to ramp up quickly once it begins and it will be critical to have a group of staff you can deploy rapidly to meet demand.