The race to vaccinate over 300 million Americans against COVID-19 is a massive undertaking, the likes of which have never before been seen in the healthcare industry—or any others for that matter. The logistics of storage and distribution alone present a formidable challenge, not to mention managing patient follow-up, boosters, and tracking potential adverse effects.
Complicating matters, the wide range of settings in which vaccines are being distributed—at hospitals, doctor’s offices, pop-up clinics, and mass vaccination events—makes it extremely hard to keep accurate records of who’s had which vaccine by what manufacturer. Hiccups in the rollout, along with sporadic reports of negative reactions, have fueled skepticism and reluctance to get the vaccine in some populations.
EHR interoperability could provide a huge advantage in streamlining the vaccine distribution process, providing accurate records, and improving public confidence—and ultimately, herd immunity. Here are four ways interoperability can help us battle this deadly global pandemic.
1. Improved vaccine administration.
Most of the approved vaccines require an initial dose and then a booster several weeks later, which varies by manufacturer. As new virus variants emerge, there’s also talk of requiring annual boosters, such as the annual flu shot.
But with multiple doses required and a wide range of locations from which patients can receive the vaccine, scheduling appointments for the initial and subsequent dose is already proving to be a challenge. And expecting people to remember whether they received the Pfizer or Moderna shot is risky. If they show up at a different location to get the second dose and there’s no definitive record of the first injection, will they be protected if they get the “wrong” one? Right now, the CDC acknowledges that the two vaccines are not interchangeable and they don’t know whether getting two different vaccines will impact effectiveness. With considerable pushback on the idea of “vaccine passports,” and the fact that the vaccine card is an out-dated way of tracking immunization, there’s really no reliable way to keep track of who needs what shot and when.
While the CDC’s Vaccine Administration Management System (VAMS) was intended as a solution, it’s been fraught with technological failures, leaving many states on their own to find a better system, or with no system at all.
Interoperability would solve this problem by enabling coordination of immunization across healthcare organizations. Using standards-based interoperability, EHRs can share vaccine administration data with other organizations, help ensure second-dose compliance and provide a reliable record of each patients’ vaccination history, including the manufacturer. Interoperability would enable providers in any setting to manage supply/demand, ensure their location is ready to administer the shot when the patient arrives, and access up-to-date data that would enable them to confidently administer the right booster, and thus potentially improve patient—and herd—immunity substantially.
2. Provide better insight into vaccine effectiveness.
While it’s true that both vaccines have proven to have high efficacy in clinical trials, more data needs to be collected under real-world conditions in real-time. Despite promising reports, there is a need for more data, but gathering it is difficult because it has to come from public health data sources, which may have contradicting or incomplete information.
Interoperability would allow both insurers and providers to get real-time tracking on the in-situ effectiveness of each vaccine. As of right now, if a vaccinated patient later tests positive at a facility other than the one where they received the vaccine, it’s up to the patient to self-report this to the CDC. But with interoperability, if a vaccinated patient should later test positive for COVID-19, the shared data could reveal which vaccine they received, where, how far apart the doses were, and any other factors (such as confounding pre-existing conditions) that might help to identify patterns. And, we’d have more reliable insight into which populations might be most at risk for compromised effectiveness.
There’s also an opportunity to use the data that interoperability can surface to help educate the various distributors and administrators of the vaccine, to help them learn from one another based on real-time data. This could inform more effective member engagement, timing of patient engagement to promote compliance, and cultural differences that lead to compliance variability.
3. Identify side effects and adverse reactions.
The CDC’s v-safe smartphone app is designed to track patient side effects to the vaccine and offer reminders for the follow-up dose. But there are two significant shortfalls with this approach: 1) it’s completely voluntary, which means large swaths of vaccinated patients may be under-represented, and 2) it excludes populations without smartphone access, most notably the elderly, which are a high-priority population for vaccination.
Healthcare data interoperability would go a long way toward improving the accuracy and thoroughness of adverse reaction tracking. By either combining v-safe data with EHR data or using other post-vaccine data gathering techniques (e.g. phone calls to follow-up) alongside EHR data, providers can get a clearer picture of the impact of immunization side effects.
This can do two things:
1. Counteract the skepticism about vaccine risks with real, accurate results to help curb the rumors perpetuated by certain sectors of the press and the public. Rather than sensationalized anecdotal reports, we could hear empirical results.
2. Allow the application of AI capabilities to predict and identify which patient populations/demographics and pre-existing conditions are most at risk of adverse reactions and what kind.
With interoperability, providers can better inform patients about what to expect, advise them if there are any potential risks with vaccinating, and provide accurate, traceable data to support public health reporting.
4. Enabling faster interventions and building of the patient phenotype.
One of the biggest mysteries surrounding COVID-19 is the incredibly wide range of symptoms and severity between infected patients. Some experience mild, cold-like symptoms, and others report gastrointestinal upset or a rash. And far too many have suffered with severe, long-term and deadly illness. While we know that some patients with pre-existing conditions are more at risk for severe symptoms than others, there are also plenty of cases of those who should have had the worst but didn’t. Of course, this makes it extremely difficult to accurately predict risk and it fuels skepticism among the public.
Interoperability among EHRs would allow providers to have longitudinal medical records to better track and correlate symptoms and severity against patient demographics and pre-existing conditions. This would allow us to create a more robust patient phenotype on how the disease impacts specific populations. From there, interoperability can support more effective patient/provider interactions based on access to a fully-informed clinical profile, therefore enabling more personalized treatment that can help save lives. It can also help accurately identify patient populations that should be prioritized for vaccine administration.
COVID-19 has proven that our siloed healthcare data systems are woefully under-prepared for a widespread event. While there will no doubt be many lessons learned, and hopefully substantial improvements made once the acute crisis has been resolved, prioritizing interoperability should be a primary focus.
Using an API-based approach to enable shared access to vital population data can overcome data silos and proprietary, localized systems to give us a much clearer picture of public health and empower us to improve the healthcare data infrastructure.