As the nation prepares for a massive vaccination deployment, IT is the champion behind the scenes, ensuring that the process goes smoothly. Intermountain CIO Ryan Smith shares the challenges ahead, along with the solutions that will keep his organization on track.
How does a multi-hospital, multi-state healthcare delivery system coordinate COVID-19 vaccine administration from two different manufacturers, with two different dosing schedules, and adhere to priorities recommended by outside authorities, along with managing documentation, reporting, and billing?
At Intermountain Healthcare, along with many other hospitals and health systems across the nation, IT is playing a leading role behind the scenes, making sure all pieces of a very complex and essential process are properly executed.
"Healthcare systems like Intermountain have been administering vaccinations forever," says Ryan Smith, MBA, vice president and chief information officer, for the nonprofit 24-hospital Salt Lake City-based healthcare system. While administering the flu vaccine is relatively straightforward, he says, "there are a number of macro-level challenges around this new vaccine."
It's Complicated: COVID-19 Vaccine Presents Multiple Challenges
Among the COVID-19 vaccine challenges that Intermountain's IT team must address:
- Managing shipments from two different manufacturers with two different drugs.
- Both vaccines have dual dosage requirements with different dosing schedules. Besides coordinating different timelines, providers need to ensure that the second dose matches the brand of the first dose.
- Providing support to scale registration processes and workforce requirements to handle the massive number of patients.
- Ensuring vaccinations occur according to priorities recommended by outside authorities. "In the state of Utah," says Smith, "the Utah Department of Health … has been responsible for determining how many doses go to which healthcare systems and also is being fairly prescriptive about how many of those doses are for internal caregivers within these healthcare systems versus the percentage that ultimately go to patients."
- Handling billing. "Technically," says Smith, "these are separate encounters by the way that we look at it."
- Due to potential allergic reactions, some patients may need to receive a specific brand or be vaccinated in a specific setting.
- Addressing the need to coordinate vaccine administration in multiple states at multiple sites that employ different electronic health systems (EHR). "That does present additional challenges for integrated delivery systems like Intermountain Healthcare that have operations in more than one state," says Smith. "We do have operations in Idaho and Nevada as well. Both of those states are relatively newer acquisitions that still have different EHR technologies. We also have to work within those other state's guidelines and prescriptions in terms of how vaccines are administered and how many doses we get. There's a broad tracking mechanism for how that's occurring, but it does occur across multiple technologies for sure."
Vaccine Presents Opportunities for Disruptive Innovation
"There's a lot of coordination that needs to happen," says Ryan. With the challenge, he says, comes opportunity.
"We have a massive, innovative, digital-disruptive opportunity here," says Smith. "My recommendation for CEOs and other healthcare organizations is to embrace your IT organizations. Expect them to turn around [vaccine administration] solutions quickly and leverage their creative thinking [in the same way we] scaled virtual visits in the last 10 months and [implemented solutions] to meet testing needs. Technology is a huge foundational component of making that all possible."
The technology solutions that organizations like Intermountain launched in the early days of the pandemic, as well as other innovations that were underway before COVID-19 became a reality, may provide the foundation needed to meet vaccination demands.
"If you look back to the March‒April timeframe, things started out kind of slow, meaning everybody was still figuring out these processes," says Smith. "It quickly became apparent that technology was going to be a huge enabler from an innovation perspective to get exponentially more patients through the testing funnel. But that didn't happen overnight. It was weeks and months to get to the level where we are now."
He continues, "We're able to leverage some of that same innovative work and apply it to vaccination administration … which will really help us scale much more rapidly as doses become more readily available."
IT Solutions to Scale for a Massive Initiative
At Intermountain, IT is utilizing everything from the EHR to innovations launched at the beginning of the pandemic to prepare the health system to administer vaccines on a massive scale.
While Smith declined to discuss the costs involved in developing any new technologies, the ability to repurpose innovations that were in progress before COVID-19—or were created at the onset of the pandemic—has diminished the need to create new technologies now. "It feels like we're leveraging a lot of the infrastructure and tools that that came before," he says.
Among the highlights:
1. Maximizing EHR utilization. The Cerner EHR serves as the central IT component for coordinating patient vaccination activity. including the ability to facilitate registration, documentation, billing, and outreach processes for second dose administration.
2. Utilizing the employee health IT system. This system offers tracking capabilities to coordinate administration of vaccines to internal caregivers and other employees.
3. Creating analytic tools. Intermountain uses analytic tools that were developed internally or in concert with vendors for reporting, as well to meet specific needs, such as identification of higher risk patients.
4. Devising an interoperable interface with the state immunization registry. All healthcare organizations in Utah receive near real-time data feeds from the state's immunization registry. In recent weeks that interface has been extended to enable the registry to push information directly into Intermountain's EHR. "We don't have to go out and query their database like we've had to in the past," says Smith. "If we have a mutual patient across two different health organizations here in the state, whomever is treating that patient has real-time visibility of the vaccine information, which is really going to help us at a state level."
5. Employing tools developed early in the pandemic. One resource that was conceived by Intermountain long before COVID-19 became an issue is My Health+, an app launched in May, which serves as the health system's digital front door. The tool integrates with SelectHealth, Intermountain's health insurance company, and brings resources from across the healthcare experience into one place.
While the website and call centers offer ways to reach patients with important information, the app also offers the opportunity to conduct outreach, as well as direct them to appropriate resources.
"When we have scarce resources and lots of positive test results in the state and in the communities that we serve, there may not be the manpower to physically reach out and contact everybody," says Smith. The app has enabled people to sign up for testing and receive their results. He says it will play a role in communicating about vaccines as well.
Another resource that could play a key role is the ability to send patients QR codes electronically after they register for testing. The technology helps minimize contact and creates efficiencies during the testing process. I also could be helpful in vaccine administration, he says.
Intermountain is using a chatbot to reduce, by more than 30%, the influx of testing-related calls into its call center. The health system is now examining the use of a chatbot to assist in vaccination workflows.
"Things like this really propelled us into the digital future of healthcare in these last 10 months than what we've collectively been able to do as an industry … in the last five to 10 years," Smith says.
“Embrace your IT organizations. We have a massive, innovative, digital-disruptive opportunity here.”
Ryan Smith, MBA, vice president and CIO, Intermountain Healthcare
Mandy Roth is the innovations editor at HealthLeaders.
The process is complicated by distributions from two manufacturers whose drugs have different dosing schedules.
Scaling for such a massive initiative requires proper technology for registration, documentation, tracking, and billing.
Innovations developed during the early days of the pandemic are being repurposed to reduce costs.