By Minakshi Tikoo
Yesterday, I went to get my booster shot at NYC’s City Point vaccine hub in Brooklyn. This time I remembered to take my two vaccine cards, as I did not want to collect a third paper card as proof of my vaccination. I cannot fathom why I have a paper-vaccine card. This is after spending billions of tax dollars to improve technology infrastructure in health care. We are in the digital age, but healthcare continues to use technology with workarounds and increased inefficiencies. We are ready for a digital transformation in healthcare in the true sense of the word.
I was surprised and disappointed that the process for identifying me was more inefficient than a year ago when we were just rolling out the vaccine hubs. How is it that a year later with already having received two doses of the vaccine and an Excelsior pass I was still required to type out my first name, last name, DOB, and other demographic identifiers at least five times if not more. The process went like this, I went on to the vaccine finder site, identified the hub and selected a time for getting the vaccine. Then I entered a whole bunch of information about myself repeatedly, I guess they want to be sure that I can type my name or want to increase the probability of mistyping my identifiers. After I completed the webform, I received a QR code and confirmation of my appointment via email, which was never used. Why are we generating a QR code then? After I finished the NYC web form, I was asked to complete a NY state COVID-19 vaccine form, which no one even checked, even though I was told I needed to bring it with me to the appointment.
Once I arrived at the hub, no one scanned the QR code and everything was hand-entered by the person into their iPad, at least this time I did not have to type anything. I interacted with 5 individuals before I got to the vaccine line, there were 10 people in line, with two lines running in parallel for people getting the Moderna shot, I assumed the rule was that alternate people would be send to the vaccine station to keep the lines short, but for some reason the line person could not keep this alternate principle straight. And there were three people directing people from the lines to the vaccine stations.
Once at the station, I was asked for my ID again, and asked even more personal questions out loud, so that everyone could know if I was immune comprised, had AIDS or cancer. I assume the process of five people checking and rechecking my information was insufficient to establish my identity. Then the nurse administering the vaccine filled out information on a paper form even though she had an iPad! Also, another monitor had a clip board and was carrying the vaccine vial around from station to station. Now, why we have moved from each nurse having access to a vial, to one person carrying the vax vial around, is perplexing to me. I can understand that workflow when the throughput is low and they do not want to waste the vax, but when lines are long, the vaccine hub leader should be able to make effective and efficient workflow decisions. The ratio of staff to people being vaccinated is insane and people are just sitting/standing around without increasing the efficiency of the administration process or improving the person experience. It was very disappointing to see inefficient workflows after we have had a year of experience under our belt.
In the end, it is still unclear why our registration systems to identify people accurately are worse than before. Having an enterprise master person identification system that bought data together from the existing systems like the immunization registry, NYC ID, and DMV could have helped serve people better rather than asking people to keep filling web forms with identifying information that do not seem to integrate with other backend systems. This is a recipe for deliberately creating duplicate records resulting in reporting errors and inability as public health agents to accurately count who is vaccinated and who is not, without passing the burden of ownership of keeping track of CDC paper cards and vaccine data accurate in government systems onto the citizens.
Also, why what we produce as a vaccine proof is a small paper card is mind boggling, why the government thought that having each state and territory create a digital vaccine pass was better than a CDC vaccine pass is baffling, given that all immunization registries are required by law to submit data to CDC. This is where being driven by politics and political affiliations got in the way of putting competent leaders in charge of mobilizing a logical vaccine delivery strategy. Too many resources being directed at states creates and contributes to ineffective, inefficient, and wasteful systems as money is of no consequence, the more you waste the more you get. CDC could have created these systems while we were waiting for the vaccine to be developed, and then the states would have the opportunity to decide whether they wanted to leverage the CDC system or spend millions of public funds creating parallel redundant systems. In some states, the cities are in competition with the state, as in the case of NYC, the state created a perfectly reasonable and easy to use NY Excelsior COVID pass, but NYC still thought they should create their own COVID-19 pass. I write this piece not as critic, but as an average citizen that finds it difficult to understand why with so many resources at our disposal we continue to create and deliver urgent public services using the worst technology solutions at tremendous cost when we have mature and innovative technologies available in this space that can accurately identify people across systems.
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