All-hands efforts to marshal vaccine data

Vaccinating about 330 million U.S. residents against COVID-19 depends on the exchange of health information, and public- and private-sector organizations are working on technology to facilitate it.

The Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) announced Jan. 19 that it had awarded $20 million in CARES Act funding to projects that support health information exchanges (HIEs) and immunization information systems (IISs). The move supplements a September 2020 award through the new Strengthening the Technical Advancement and Readiness of Public Health Agencies via Health Information Exchange (STAR HIE) program that tapped five HIEs to receive a total of $2.5 million in CARES Act funds.

This supplement provides additional funding to four of those five and adds support for 17 new recipients.

“Through collaboration with HIEs, public health agencies should be able to better track and identify patients who have yet to receive their second dose of a COVID-19 vaccine and/or better identify patients who may be high-risk and have not yet gotten a shot,” Peter Ashkenaz, an ONC spokesperson, wrote in an email to GCN. “This supplement will also improve the methods used for tracking and supporting COVID-19 vaccination administration.”

To bolster that support, on Jan. 15 ONC awarded the Immunization Data Exchange, Advancement and Sharing (IDEAS) grant to the Association of State and Territorial Health Officials to expand immunization data sharing among IISs and HIEs in up to 40 states. This work will be conducted in coordination with STAR HIE, which includes 22 HIEs, and a COVID dashboarding project that is in development.

How the specific exchanges will work will vary based on each state’s health IT systems and infrastructure, but the goal is to integrate all IIS data with other sources to aid in COVID response, Ashkenaz said. IISs, or immunization registries, typically don’t have demographic and comorbidity data, while HIEs do. There are 63 IISs and about 100 HIEs nationwide.

All three initiatives -- the IDEAS grants, STAR HIE and the dashboard -- will build on previous work on HIEs, which are typically considered trusted third parties that partner with otherwise-competitive health care entities, he added.

“The exchange of data between HIEs and IISs helps to make best use of information inherently available in many HIEs,” Ashkenaz said. “With all of these efforts, we also aim to specifically improve the HIE services available to support communities disproportionately impacted by COVID-19. This is intended to build the capacity of health care providers who care for vulnerable or at-risk populations and communities that have been disproportionately impacted by the COVID-19 pandemic.”

Another objective of the STAR HIE program is to make public health agencies more capable of responding to events, including pandemics, in the future.

California’s vaccine management

While ONC continues work on its effort at the federal level, states continue to handle the bulk of vaccine management. On Jan. 25, California launched My Turn, a new system residents can use to learn when they are eligible to be vaccinated, make an appointment and receive notifications by text or email about when they can schedule a time to get their second dose. My Turn also tracks vaccination data and lets providers share data on vaccines received and administered.

The state worked with Accenture, Salesforce and Skedulo, a software-as-a-service, high-capacity scheduling solution provider, on the system. It is being pilot-tested in Los Angeles and San Diego counties, and will be available statewide in early February.

To use My Turn, residents who are 65 and older in those counties go to MyTurn.ca.gov and answer qualification questions. If they qualify, the site identifies local testing sites and open time slots. Residents choose one and receive a QR code by text or email that they use to check in for their appointment.

“A big part of the overall solution is inventory management, knowing which one of the vaccines is administered,” said Miles Kelly, executive vice president of Skedulo. “Each one of those vials is captured with barcodes, and there’s a tremendous amount of accuracy and backend management on the inventories themselves,” he said. “That inventory, the tracking of that, the security of that information -- that’s all part of the solution that we’ve built.”

CDC’s v-safe

The Centers for Disease Control and Prevention is rolling out a different kind of vaccine tracking with its v-safe after-vaccination health checker. It’s a smartphone-based tool that uses text messages and web surveys to check in with people after their first dose of a COVID-19 vaccine. It also reminds users to get their second dose. CDC benefits by learning quickly about common side effects vaccine recipients experience.

Oracle is collecting, managing and housing v-safe data on a secure server, according to a Nov. 19, 2020, CDC document on the surveillance tool. The company is providing IT support, and all vaccination data will be stored, processed and transmitted according to Federal Information Security Modernization Act requirements and based on National Institute of Standards and Technology standards.

“Data will be housed in Oracle Cloud Infrastructure (OCI) U.S. Government Cloud tenancy; the OCI U.S. government tenancy is Federal Risk and Authorization Management Program (FEDRAMP) approved,” according to the document.

Every person who is about to get the vaccine has the option to interact with v-safe, said Dan Stroman, senior director of public sector at CloudCheckr, a cloud management solution that is also part of v-safe. CloudCheckr is helping track the spend so that costs can be allocated appropriately into CDC and in security management.

Personally identifiable information “is the most sensitive security aspect of government/citizen interaction,” Stroman said. “V-safe has been a very good example of proper and secure use of the cloud and secure management of PII in the cloud exclusively.”

Questions about the tool’s security have been raised, but CDC maintains that “personal information in v-safe is protected so that it stays confidential and private.”

To use it, vaccine takers need a smartphone with a touchscreen that can receive texts. Those without a smartphone can submit reports of adverse side effects to the Vaccine Adverse Event Reporting System, run by CDC and the Food and Drug Administration.