Full Title or Meme
This is an examination of the actual experience of COVID Vaccination and how well-meaning effort collide to create mass confusion.
The COVID Vaccination experience as the US comes out of the first phase of the pandemic and begins to deal with vaccination.
Current Use Cases
Pre-scheduled at a Pharmacy
I got a shot 2021-02-11. Here is the way I see it today. At the end I will explain why this is broken. I called (more that once) to sked a shot. I finally got on the calendar. At that point a record was made of my name and birth date. I went it to get the shot, my data was validated, the pharmacy checked my insurance card to ensure they would be paid and i was given a shot. My record was updated at that time and a label was printed out that was (in effect) a shot cred. They peeled off the print out on sticky tag an applied that to a CDC Covid-19 Card form MLS 319813_r This is the credential I could put in my wallet, but it is not the medical record. The medical record should be in the lab, the paper card is the credential. I went home i tried to avail myself of the 21st Century Cures act to download my health data. It turns out that since it was a pharmacy administering my shot, the standard pharmacy proof-of-presence was a prescription number. Since i had never been to that particular pharmacy before, i could not authenticate myself and so could not get a digital record of my shot.
So what is the problem? The medical record existed, but no method to authenticate me to the record was available. The paper form will (with any luck) be sent to the CDC which might, at some future date, actually record the event but under some privacy-enforcing de-identification code. One needs to wonder if privacy and public health will ever be able to talk to each other.
Virginia No Data in Advance
I got my first shot ind week ending 2021-02-12 in VA. The scheduling process uses my name and birthday as identification. When the shot was given, I was expecting something like that describe above, meaning, there should be a record of me (name and birthday) being given the shot. Instead, the nurse hand wrote the card and collected my consent form. I asked her how would the health department know that I (name and birthday) had the shot, she said someone will enter the info according to the consent form. In my case, my card (hand written, no digital record) is the cred. The information on the consent form will become the medical record. These 2 items are disconnected. With some luck, someone can read my handwriting on the consent form and enter into the system my name and birthday correctly. Net, net, the current system totally depends on the white card as the source of truth. I am not confident that we can find a reliable downstream data source.
Stuck in a Snowstorm in Oregon
CNN reported that Josephine County Public Health workers were returning from a mass vaccination clinic at Illinois Valley High School in Cave Junction when about 20 members of the group got stranded in a snowstorm at Hayes Hill. They had with them six leftover doses of the vaccine. To keep those doses from going unused before expiring, the workers went from car to car to offer people the chance to get a shot. An ambulance was waiting nearby in case any recipients had an adverse reaction. All six doses were administered to the waylaid motorists, including a sheriff's office employee who had intended to be at the earlier mass vaccination event but got stuck in the snow.
COVID 19 processing experience at the VA
- Received an announcement that govern shots were available at the local Veterans Administration hospital.
- Called to make an appointment, provided my name and last 4 of social # Verifying I was a veteran and had a record. (My identity was validated last October via my PII, SS#, DL and DD214)
- Arrived at designated time with 40+ in line ahead of me but having an appointment, the nurse had a master appointment schedule, I was taken to the head of the line which was a covered area outdoors.
- Was escorted into a registration station, provided my name, last 4 of social and driver’s license; I was being activated in the VA COVID registry system as receiving my first shot.
- Was then escorted to a prep area where I was informed about the shot, adverse effects and asked me questions about allergic reactions, med and foods. I was given a blank CDC COVID shot record card/credential and told to fill in the top line with my demographic info, PII; the roaming nurse verified such. At that time I was told my follow-up shot date and told to write it on the card and to write it on the information sheet they gave each person.
- After about 10 minutes was escorted into a screened in nurse injection station with CDC card in hand which was reviewed and updated by nurse with manufacture, med, lot number and his initials, all of which was entered into the computer at that time before being given a green light to go to a 15 minute rest area before being released.
- Checked Electronic Health Record over a week later, the COVID Vaccination data was there, but I could not get an HL7 FHIR download of my data.
n.b. The VA has a new EHR system, but it is (in 2021-01-01) only deployed to Spokane WA hospital.