Public Health Endangered by Deficient Use Models and Insufficient Applications

The general public is rarely impacted by poor choices in IT implementations. Unfortunately, the COVID-19 vaccination program has become an example of how not to implement important public-facing computer systems.

Recently, the mechanics of COVID-19 vaccine scheduling gave me a first-hand experience of what happens when the presumptions underlying applications software do not reflect the real-life situation.

I am, as Frankie Valli sang, a native New Yorker. For several reasons, including my familiarity with computers, I have become the point person responsible for arranging the COVID-19 vaccine-related logistics for my older relatives.

Some of these relatives no longer drive, others have mobility issues and need assistance. Many live in clusters of more than a single individual, often with a spouse, sometimes with another family member over 65, sometimes both. To get to one of the vaccination facilities, I must schedule and coordinate vehicle availability, driver availability, physician and other health provider appointments, and mobility assistance. It is a logistical exercise which typically requires at least a week's notice and considerable planning.

I have tried using three systems:

one belonging to an urgent care center affiliated with a major hospital network;
a major hospital network hotline; and
the New York State Department of Health.

The web site for the urgent care center only allowed reservations for individuals. There was no provision for multi-person appointments. The site required email and mobile phone numbers for notification when an appointment was available. The time scale of notification was fractions of a day, inadequate time to get to the location, even if one was waiting by the phone.

The Department of Health only allowed individual appointments for the present day. There was no provision for group appointments or appointments weeks in advance.

Calling the hotline of a major hospital network resulted in different challenges. The system was not set up to allow a common contact for multiple individuals. Email and mobile phone numbers were required for notification. The mobile phone was required for receiving SMS text messages. Many older individuals do not use SMS text messaging, and do not check their email frequently. Since I am the coordinator, my email and mobile phone number need to be used. I was warned that the system might misprocess entries with the same email and phone number.

The presumptions that everyone can be reached by email and text messaging are false presumptions for many seniors. Additionally, many professionals have personal assistants who keep their appointment book. The assistant is the person to contact when scheduling an appointment. It is common for one assistant to manage the schedule for several professionals.

These misperceptions affect more than family groups and professionals. The restrictions also effectively prevent organizations serving vulnerable populations (such as Senior Citizens' centers, religious institutions, fraternal and civic associations). which have access to group transportation, from arranging group vaccination events for those who are transportation-challenged, including seniors and the disabled. Many individuals in these categories are not otherwise able to travel safely to vaccination centers.

Such groups need to be able to make placeholder reservations weeks in advance; solicit participants; change reservations from blank to the individuals who wish to be vaccinated. Any issues concerning the appointment must go to the organization contact, not prospective vacinees.

We can and need to do better. The people affected by these misperceptions are often at high risk for COVID-19, and deserve far more consideration.

Much attention has been given to those living in congregate settings. What has not garnered a comparable level of concern is those seniors who still live independently in their homes, and need some degree of assistance from younger relatives, neighbors, aides, and other third parties. While not considered congregate living, these households often have multiple vulnerable members with complicated logistics, e.g. relatives to provide transportation, aides to assist with mobility.

It is tempting to blame the errors on the haste with which the COVID-19 reservation systems were implemented. The reality is that these errors are not limited to quickly developed COVID-19 reservation systems.

Online shopping is a sound strategy to minimize personal exposure. These applications were not implemented in haste – they existed long before COVID-19 appeared in humans.

In normal times, many senior citizens and disabled individuals experience great difficulty getting to and navigating grocery stores. Stores presume that the individual whose credit card was used to pay for the order will be picking up the order. However, there are many cases where the individual placing the order will not be present at the pickup. They may be unable to drive; they may have medical conditions which restrict their movement. A relative, neighbor, home health aide or other third party may be picking up the groceries. For that matter, a relative or neighbor who shops in person may be willing to pickup an order and drop it off. This is an excellent way to reduce exposure and it also saves substantial time.

However, none of the systems I have used for online grocery shopping for relatives has had a way to specify the name of such a third party. It would be a minor change, which would simplify the process significantly.

We must do better. The lives of our elders and others depend on it.

A postscript:

After posting this installment, I had an epiphany.

One cannot simply give lists of seniors to outside organizations. Doing so would be a major privacy violation.

However, all of the senior centers and other non-profits are known to the state, county, and/or municipalities. As are most, if not all, of seniors. It would be a straightforward operation to solicit the non-profits as to whether they want to be involved in an outreach program. The government could then send out a mailing to seniors identifying participating programs in their geographic area.

Admittedly not a perfect plan, but better than the present state of affairs.