A Deep Dive into the EHR COVID-19 Vaccine Administration Process

Clinicians at Truman Medical Centers and University Health in the Kansas City metro area administered the first doses of the COVID-19 vaccine in its area in early December and has since administered hundreds of vaccines.

In order to become one of the first 150 hospitals across the country to receive and successfully administer the vaccine, the health system had to optimize its EHR workflow to send its vaccine notifications to Missouri’s ShowMeVax reporting program. Furthermore, employees at the academic medical center worked with the CDC and the state to prepare a vaccination plan to hit the most recent guidelines.

While the hospital had the vaccination system set up in its workflow for other vaccinations, Heather Gleason, senior director IT applications at Truman Medical, wanted to ensure it kept the same workflows that it used for its everyday medication administration and electronic verification to maintain patient safety.

“We looked to Cerner as a partner because they had a playbook for mass vaccination that was previously utilized at a couple of test sites,” Gleason explained. “We wanted to integrate ‘smart technology’ to make sure that we can get people quickly in and out of the vaccination process.”

All of the vaccine components were in place in the workflow, but clinicians never used each part of the solution at the same time. As a result, Gleason and her team had to make an adjustment.

“First, we use the revenue cycle program to schedule the patients,” Gleason explained. “Then when the patient arrives for her appointment, she checks in at a kiosk application to give her name, date of birth, address, and answer a series of questions to properly identify herself and for reporting after the vaccine is administered.”

“We hadn't done it comprehensively all in one workflow,” she continued. “That was really the piece that we spent some time developing and building some new roles to automatically fire orders so that people aren't having to go in and enter orders as well as administering the vaccines.”

Although the steps were never put together on a single workflow before now, Gleason said the training process was nearly identical to typical clinician EHR use.

“Most of the clinicians are used to it in their current day, whether they're an outpatient nurse, a medical assistant, or an inpatient nurse that is coming over to help us vaccinate,” Gleason explained. “We have pharmacists that come over and help us vaccinate and they all are able to use their current tools that they're already used to, to administer the vaccine through the system.”

With any EHR system or vaccine rollout effort, patient matching is crucial to patient safety. Those in charge must analyze patient data to deploy an effective and accurate vaccination strategy. Providers must know if a patient has received a vaccination to allow for a coordinated rollout.

Accurate patient matching ensures the correct patient will get the correct vaccine and the patient will get two doses.

“Making sure we schedule the patient appropriately, check her in efficiently, and then having that vaccine order automatically so a pharmacist won’t have to go and put the order in before we can vaccinate,” Gleason continued.  

Next, the clinician prints an armband barcode label for the patient so the system recognizes the patient and can be verified. From there, the clinician utilizes EHR technology to scan the medication with the correct dosage.

“The big thing that we've been working on is the reporting aspect of it and making sure that we have a lot of scheduled appointments and being able to be predictive about what we believe our first and second vaccine counts look like for the next day,” Gleason said. “Then, we start to estimate what the schedule looks like for next week and the week after, so we are scheduling at least three weeks out for patients to return to get their shots.”

In an effort further optimize and streamline the process, Gleason, and the Cerner IP team are working together to eliminate the patient arm bands. However, it is not as easy as it sounds due to the talk of a vaccine card for those on a second dosage.

“Historically, you don't want to print patient information and we don't want to print armbands for patients to come in and get a vaccine,” she said. “But having a quick way to identify that patient with a barcode through a label, we think will continue to be a good option for us if we can continue to make it happen.”

“We've been doing paper consent processes because we have only been vaccinating workforce members and they need to have an occupational health record,” Gleason continued. “I think the big thing for us for when we start to vaccinate people in the community is we don't want paperwork in the community. They'll be doing electronic consents on iPads when they come in to register, so that we'll have that documented electronically.”

As the healthcare industry works its way through the vaccine priority list, Gleason and her team knows further optimization will need to occur to streamline the process.

“This is a developing process for us right now,” Gleason said. “As we start to talk about going outside the community and not just vaccinating first responders, but some of the other groups of the ‘1A’ that need to get vaccinated. We're looking to streamline some of our technology using some of that technology in different ways.”