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The crashes of online vaccine scheduling systems have become a sad symbol of how technology has hampered the nation’s Covid-19 vaccination campaign, leaving people unable to sign up or find out when and where they can get their shots.

But it doesn’t have to be that way. The technology and expertise to schedule people and line them up according to priority levels is widely available, health data experts said. It just needs to be implemented based on a set of best practices, so that people can be moved through the system efficiently.


“We have to rethink some of the existing strategies,” David Rhew, a physician and chief medical officer at Microsoft, said during the Consumer Electronics Show (CES) this week. “We need to make sure we’re not setting it up so that all these people come, all at once. We have to understand how to be able to organize this.”

But what does that system look like — and who’s responsible for getting it off the ground? During interviews with STAT, and in discussions at CES, where the vaccine distribution failures frequently came up, industry experts said an overhaul of the existing systems must be guided by the federal government, which they say should develop standards for scheduling vaccinations and tracking doses digitally as supplies increase in the months ahead.

On Thursday, President-elect Biden is scheduled to release new details on his plan for ramping up the vaccination campaign once he takes office next week. The transition to his administration offers an opportunity to hit the reset button on the lackluster efforts to date, and to incorporate better technologies, and the funding and command structure to support them in communities nationwide.


Several health information specialists said the federal government should make technology a core component of the vaccination campaign and take the lead on convening experts as soon as possible to devise quick solutions.

“What you need is national policy and guidelines that are setting the framework and template for how things get rolled out,” said Ashwini Zenooz, a physician and chief medical officer at Salesforce, a provider of cloud computing services.

Many of the largest technology companies — from Salesforce, to Apple, to Amazon — are already employing physicians and health technology experts to build these types of products. Inviting them to devise fixes to the existing underperforming systems is a simple and obvious step. But it’s one that has not been done during the vaccine rollout.

“There is no time to waste,” said Zenooz. “Big technology companies that have experience doing this need to sit at the table with federal health policy folks to say, ‘This is what we can offer.’”

That type of effort could help establish criteria for how scheduling sites should be set up, how to make them accessible and easy to use, and how to ensure they reach and remove barriers for marginalized populations.

Many of the online portals created to schedule vaccinations in health systems and cities are running into problems because they’re not backed up with enough computing power. Thousands of people are converging on these sites at once, causing servers to crash under the weight of the stampede.

The solution, health data experts said, is to tap into widely available cloud computing infrastructure that is lacking in hospitals and local health departments that don’t typically deal with such high traffic volumes. The same problem occurred earlier in the pandemic, when a sudden crush of telemedicine visits overwhelmed hospitals’ data systems.

“Your best bet would be to have an experienced tech company that’s using appropriate cloud-hosted technologies run a robust scheduling system,” said Ken Mandl, director of the computational health informatics program at Boston Children’s Hospital. “This would be a good opportunity to bring in some fully professionalized solutions.”

Those arrangements typically bring with them options to introduce more modern tools, such as chatbots that rely on artificial intelligence to answer questions about the vaccines, their availability, and local prioritization rules.

Rhew said Microsoft is developing a system with a chatbot to help address vaccine hesitancy. Once the questions are addressed, he said, users could be directed into a pre-registration process whereby they’re put into a database and receive emails to help them schedule appointments based on their place in line.

“That allows us to improve the workflow and throughput so we don’t overwhelm the clinics and hospitals,” he said.

Scheduling people to receive their first doses is only one part of the technology problem. States and local communities also must be able to track the available supply of multiple vaccines and match them with unvaccinated community members and those who are waiting for a second dose. They also need to be able to track crucial outcomes, such as whether vaccinated people, even if they don’t fall ill with Covid-19, can still transmit the virus.

It is an extremely complex undertaking that has already exposed several shortcomings in public health technology.

Every state in the nation has a vaccine registry to help track immunizations. But those systems lack the bandwidth to be able to support the unprecedented demand posed by a pandemic. They also lack the ability to communicate easily with other software systems, making it in some cases impossible to share data about vaccinated individuals and their health outcomes across different platforms.

Mandl said this problem is the consequence of a national health records infrastructure that is built around large hospitals, health systems, and registries that keep the data in their own silos, rather than giving control to individual patients whose data travels with them.

There is no easy way to fix that amid Covid-19, he said, but the solution might be to build a kind of digital wallet, or vaccination passport, that could be tied to individuals so their data can be kept secure and portable.

“Wouldn’t it be nice if there was a routine workflow that didn’t rely on some very specific, vendor-managed state-run registry to help make this happen,” he said. “Couldn’t this be a very lightweight set of transactions where we’re able to get a verified result and create an immunization report.”

On Thursday, a coalition of health and technology players — including Cerner, Epic, Microsoft, Oracle, and Salesforce — announced a new effort called the Vaccination Credential initiative with those needs in mind. The group is working to give the public digital access to their own vaccination records in a secure, interoperable format.

Apple has also built technology to allow individuals aggregate and store health records from multiple institutions to their smartphones, so these capabilities do exist. It’s just a matter of scaling them with federal leadership — and investment — that has been lacking for so long.

“Covid uncovers the weaknesses in our system,” Mandl said. “I think we do have the opportunity to both work on the rapidly stood-up systems now to address the need, but also to plan much more durable systems as we go forward.”