States Complain Federal Government Data System Delays Immunization Efforts

Tiberius was supposed to provide a bird’s eye view of where vaccines are at any given time and focus on bottlenecks and manufacturing shortages. Instead, state and local officials say it’s riddled with data gaps – the result of incomplete or erroneous reports from manufacturers, healthcare providers and others along the chain. supply.

Adriane Casalotti, head of government and public affairs at the National Association of County and City Health Officials, echoed Khaldun’s assessment, telling POLITICO she had heard similar assessments from its members .

“This comes almost a year after the biggest public health challenge we have ever faced – any delays or incomplete information has a real impact on their ability to actually do the job of getting vaccines up and running. do it in an efficient and predictable way, ”she said in an interview.

Officials said locating the necessary information can be akin to playing hide and seek, and some information – especially regarding vaccine transfers between vaccination sites – does not appear to show up at all. The other data does not appear until a certain delay has elapsed.

“When we see sites [that say they] don’t have doses, but the data shows there are doses out there, we believe transfers have taken place, ”Jared Moskowitz, Florida’s director of emergency management, said in an interview. Transfers “are supposed to be registered in the systems and Tiberius, but it’s a tedious process,” he said.

A source close to the project, speaking on condition of not being identified, acknowledged the problems but attributed them to a plethora of state data systems that were built for smaller-scale vaccination campaigns and often lack capacity. ability to track Covid response. .

HHS, in a statement, acknowledged issues with the usability of the system, saying it “is constantly working with jurisdictions to improve the user experience and develop new features to enhance the capabilities of the system.” The department assigns IT staff to the localities to resolve technical issues and training, and has made a help desk available.

The issues have also complicated the Biden administration’s efforts to get a full picture of vaccinations across the country and locate more than 20 million doses of the Covid-19 vaccine that the federal government has purchased and distributed to states but failed to. not yet recorded as administered to patients. The administration estimates that around 2 million unrecorded doses are due to delays in data reporting.

The problems are not entirely a surprise: Tiberius is as good as the data feeds provided to it. The technological infrastructure of public health has long been underfunded and unmaintained. And no previous vaccination campaign has required so much data to be reported on such a rapid basis.

“These systems were set up for the flu vaccine, mumps, rubella – they were not set up for a mass pandemic,” Moskowitz said.

There has also been confusion as Tiberius is being modified to meet new logistical challenges as more people are trained in its use. Source Familiar with the project said the number of users trained on the system had increased from 400 in November to 1,400 in January. All the while, systems have been updated in response to changing policy needs, such as prioritizing who gets the first hits.

“They’ve made a lot of changes or changes to it since we started using it. At least every week there have been changes, ”said Michael DeRemer, acting director of emergency preparedness and response in the Oklahoma Department of Health. DeRemer said his team members are largely fans of the system, but acknowledged that changes often require a learning curve.

Frontline health officials have anticipated some of the technological issues. A November Government Accountability Office report noted that the groups he interviewed wanted more information about the computer systems they would need to use and how the vaccines would be distributed, and needed more information. training to use new reporting tools.

Moskowitz of Florida said Tiberius has been keeping track of federal vaccine shipments – there are no widespread reports of trucks losing shipments – but “when it reaches the point of delivery, no plan, no resources , no transparency “.

Casalotti, of the National Association of County and City Health Officials, said based on feedback from its members that it can take a long time for beginners to find specific data, with information on the vaccine allocations confusedly split between three different tabs. DeRemer of Oklahoma said the setup – which buried information about the manufacturer contributing doses – was a slight annoyance, though surmountable.

Transfers are not the only concern of state and local authorities. They are also concerned about the data from the program that the federal government is running with pharmacies to vaccinate. most nursing homes and assisted living communities.

“An ongoing challenge is that [long-term care] program data is only updated in the Tiberius system twice a week, ”Michigan’s Khaldun said during the House monitoring hearing in prepared testimony Tuesday. “It makes it hard for us to know what’s going on on the pitch on any given day. “

Michigan isn’t the only state to describe data lags. A warning in late January on Tennessee’s coronavirus vaccine dashboard said data from the Tiberius federal pharmacy program is subject to delays of 48 to 72 hours, or more. This language has since been removed from the website.

According to a CVS spokesperson, the delay stemmed from a CDC request on the frequency of reporting. That has since changed to daily updates, which the spokesperson says CVS has done.

Health providers and state systems are responsible for most of the data tracking after the federal government ships vaccines to states. Tiberius can only record vaccine use after the doses have actually been administered and the information is recorded and sent to the federal government. It may take days.

Those familiar with the initiative say the data lags have been significantly reduced, and DeRemer of Oklahoma said it rarely takes more than 24 hours to get immunization data from long-term care facilities.

Another concern is whether all of the long-term data reported by different parts of the system matches. Courtney Phillips, secretary of the Louisiana Department of Health, said Tuesday that the total number of vaccines administered by the Centers for Disease Control and Prevention exceeds what appears in Tiberius or other databases.

Other states have a more favorable opinion of the system. Karen Landers, an official with the Alabama Department of Public Health, said her team was quite happy with the process. And the Ohio Department of Public Health said in a statement the system had “minor problems” at first, but improved.

Ultimately, however, the campaign places high demands on vendors. There are anecdotal reports that some clinics have as many volunteers for data entry as clinical staff. But some officials suspect vendors are simply not releasing data in a timely manner amid the tension of the Covid-19 response.

The federal government had initially sought to require providers to send data on their immunizations to the state within 24 hours. But last year, the CDC relaxed that time limit to less than 72 hours.

In communication with states obtained by POLITICO, the agency wrote that it had heard “some anecdotal concerns” about the inability to meet the one-day turnaround time, advising states to ask affected suppliers to submit their data “as soon as possible and no longer than 72 hours” after vaccinations. The CDC did not respond to a request for comment.

Several state officials told POLITICO they had not received any new requests from the Biden administration on how to document their vaccine supply.

In Alabama, some providers have difficulty entering their vaccines into their public system, requiring it to take an extra day or more for these vaccines to be counted as administered.

“When you have multiple systems here, you’re going to run into issues that maybe don’t really reflect the hard work going on,” said Landers, deputy public health official in the public health department.

A spokesperson for the Oregon Department of Health noted that Tiberius had “regular data delays and system changes,” but said all public health systems were strained in some way. another one.

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