Virginia could abandon vaccine scheduling software amid persistent problems

Virginia health officials might abandon PrepMod, a nearly $750,000 software system for scheduling, tracking and reporting COVID-19 vaccinations.

Dr. Danny Avula, the state’s vaccine coordinator, said PrepMod’s developers have been unable to fix recurring problems with the system, which have left it unworkable for many local health departments. State leaders have openly acknowledged those challenges since mid-February, when Avula announced they had given the company a deadline of Feb. 24 to address the issues.

As of Tuesday, no solution had been offered for the system, which the state began to unroll on Jan. 21.

One high-profile obstacle is PrepMod’s inability to create one-time registration links for users. As the Mercury reported in February, sign-ups can be used over and over again, creating a domino effect as links are circulated across text messages or social media. Multiple local health districts have been forced to cancel hundreds of appointments or turn people away after closed clinics for certain prioritized Virginians were inundated with ineligible sign-ups. 

“PrepMod has not been able to fix this — you may have seen the national headlines that other states are also moving away from it,” Avula said in an interview on Monday. The system was developed by a small, Maryland-based nonprofit and has since been sold to multiple states, including Massachusetts and Pennsylvania.

Avula said the developer, a subsidiary of the nonprofit Maryland Partnership for Prevention, hasn’t explained why it can’t provide a solution (the company did not respond to a request for comment on Tuesday). But WBUR in Boston reported that it spent two decades building and managing simple management systems for flu vaccinations in Maryland school districts before suddenly scaling up to COVID-19.

In late February, the company’s CEO was called to testify before state lawmakers in Massachusetts after several high-profile system failures, according to reporting by the Boston Herald. In a news briefing last week, Avula acknowledged that only about 40 percent of Virginia’s 35 local health districts are currently using the software.

“We are developing workarounds and testing those this week,” he said Monday. That includes a homegrown scheduling system — dubbed the Vaccine Appointment Scheduler Engine, or VASE — that’s been in development with the Virginia Department of Health for the last two weeks.

Avula said it’s still not certain if VASE will interact with parts of PrepMod or if the state will move away from the latter system altogether. One key benefit of PrepMod is its connectivity to the Virginia Immunization Information System, where the state registers COVID-19 vaccines. 

Data from VIIS is also transferred to the federal government, which uses the number of administered vaccines, in part, to determine Virginia’s future allotments. That makes connectivity especially critical, but Avula said it’s possible that the state could scrap PrepMod completely if its own system includes the necessary features.

“Depending on how all of that goes, I could see a pretty likely scenario where we depart altogether,” he said. 

It would be the third major shift since the start of Virginia’s vaccine rollout in mid-December. Like many states, Virginia also tried — and mostly abandoned — a software system distributed across the country by the U.S. Centers for Disease Control and Prevention. 

Called VAMS, it also created multiple challenges for local health departments. One of the biggest was its inability to create closed vaccine clinics that were only visible to those eligible for the events (teachers or seniors, for instance). In practice, this meant that anyone who logged into VAMS to book an appointment could view and register for clinics anywhere in the state, and sometimes even farther.

Cat Long, a spokesperson for the Richmond-Henrico Health District, said VAMS recently resolved that particular issue. That’s led her district to readopt the system after recognizing the ongoing challenges with PrepMod.

But other local health officials said PrepMod also has the advantage of being user-friendly, which made it more accessible to many of their residents.

“Getting a vaccine is already super stressful,” said Natalie Talis, the population health manager for the Alexandria Health Department. “People are super stressed about, ‘Am I eligible, where’s my place in line, am I gonna get a vaccine?’ And so from our perspective, scheduling should be the easiest part.”

Ongoing challenges with the available software systems, though, led the district to develop their own solution. Talis said an employee on loan from the city of Alexandria helped develop an internal scheduling platform that can send one-time registration links to users — eliminating many of the problems posed by VAMS and PrepMod. 

Other local health departments have also come up with workarounds on their own. Kathryn Goodman, a spokesperson for the Blue Ridge Health District, said officials there are using the entertainment booking platform Eventbrite to sign residents up for shots (some Florida counties have done the same). 

The system isn’t “ideal,” she said, largely because it creates extra work for already strained employees. Eventbrite can’t collect demographic and medical information for each patient, so health workers fill out the forms during clinics — slowing down the pace of vaccinations. The district still uses PrepMod for smaller events, and Goodman said it forces them to verify every single appointment the night before a clinic to ensure everyone who registered was eligible.

“This isn’t sustainable, necessarily, so we’re hoping the state is working on new programs that will make it even easier for us to do registration, scheduling and case management,” she said. The district had to stop using PrepMod for large-scale clinics in mid-February after another link was circulated widely through the community.

Goodman said it allowed hundreds of people who weren’t eligible for a dose to sign up for appointment slots — leaving none available for many residents over 65 who had been specifically targeted for the event. Hundreds more showed up after they couldn’t sign up online, forcing local officials to cancel appointments and turn people away.

“There were many, many people who were under 65 and did not qualify,” she said. “It led to long lines and a lot of confusion. I don’t want to blame the community — the issue is the software that has the faulty link-sharing feature.” 

“And we anticipate our vaccine supply is going to increase significantly in the coming weeks,” she added. “So we need to have a better software system in place so we can schedule thousands of people efficiently and accurately.”