The Louisville Metro Department of Public Health and Wellness distributes vaccines fast and efficiently with the cloud.

 

“Our first local COVID-19 case tested positive on March 8th, 2020, and it quickly became an all hands on deck effort ever since,” said Dr. SarahBeth Hartlage, Medical Director for the Louisville Metro Department of Public Health and Wellness (LMPHW). “We have led a number of different response efforts throughout the past year; education about mask wearing and social distancing, contact tracing, disease investigation, a PR campaign to combat the COVID fatigue, and more. And, as you might imagine, we also kept close tabs on the vaccine development throughout the course of the pandemic.”

LMPHW’s mission is to achieve healthy equity and improve the health and wellbeing of all Louisville residents and visitors. On an ordinary day, this includes activities like operating WIC clinics, serving people with substance use disorder through their syringe services program, conducting health and safety inspections of restaurants, hotels, tattoo and body art studios, and more.

In these extraordinary times, however, such mission-critical efforts have taken on a new meaning with respect to COVID-19 and resulting vaccination strategies. The team did have some experience with mass vaccinations and some high-level plans in place after influenza H1N1 back in 2009, as well as a hepatitis A outbreak about five years ago. “But we didn't really know what the COVID-19 allocation process was going to look like nor how many vaccines we were going to be receiving until around December. We just knew we had to be ready to move fast as soon as COVID-19 vaccines were available,” said Dr. Hartlage.

COVID-19 continues to be a crisis of speed.

At the time of publication and roughly one year after the governor declared a state emergency, COVID-19-related deaths ranked third in causes of death across Kentucky. So when the COVID-19 vaccination became available, the governor issued a goal of administering 90% of all vaccines within seven days of their arrival in the Commonwealth – fairly and equitably.

This direction had an especially large impact on the LMPHW team. Louisville-Jefferson County is among the largest metro region in Kentucky, with a population over 617,000 that accounts for almost 14% of the state’s total population. Of those 617,000+, roughly 35% identify as a racial minority1, putting extra emphasis on the need to navigate the nuance and complexity that is required of an equitable approach: identifying vaccination sites that are accessible to underserved communities, addressing language barriers, taking the time (a luxury no one has right now) to understand community-specific concerns, and more.

 

LMPHW joined us on Leading Through Change

Leading Through Change is an online learning series that explores the topics, challenges, and stories that have come from navigating COVID-19. Dr. SaraBeth Hartlage joined us to share her team’s experience in standing up one of the country’s many vaccination sites, and what it means to keep the city safe during this crisis.

“If I had 785,000 doses, I would give one to every Louisvillian tomorrow. But that just isn’t the reality right now. So we have to balance these different sometimes competing needs in order to prevent severe disease or death: tier 1-A vaccinations, where we placed a particular emphasis on our long-term care residents who bear a significant portion of the death burden from this disease. We then focused on limiting community spread, so [we focused on] some of our critical infrastructure workers, manufacturing, or those in marginalized communities who are not able to isolate or quarantine or socially distance,” said Dr. Hartlage.

To manage both the workload and the complexity, LMPHW expanded the workforce, hiring an estimated 30% more full-time employees, signing on a number of contractors, and welcoming several volunteers. “So our teams were staffed and our processes were clear, which means next our systems needed to be prepared,” said Dr. Hartlage.

Introducing LouVax, a cloud-based vaccine management system.

LMPHW worked with technology partner Sense Corp to launch LouVax, a comprehensive vaccine scheduling and management system built on the FedRAMP-authorized Salesforce Government Cloud. It gives Louisville Metro residents an online, contactless way to register themselves to receive a vaccine at LMPHW’s drive-thru vaccination clinic, and include the plethora of basic information the team needs to prioritize distribution. Here’s how it works:

Registration
To register for their vaccination appointment, Louisville Metro residents are invited to create a profile in its vaccination portal via Experience Cloud. Here, the resident is guided through a series of steps to capture basic information such as date of birth, health screenings, and so on. That information is then recorded in a profile-like setting in Health Cloud, creating a 360-degree view of the resident which LMPHW can use to determine vaccine administration. “As a result, LouVax can account for occupation risks and preexisting conditions that may affect the vaccination process,” said Jimmy Schatte, Sense Corp SVP, Public Sector.

Notification
Once a resident is deemed eligible to receive the vaccine, LMPHW notifies via email using Marketing Cloud, which includes next steps for scheduling their vaccination.

Day of
When residents arrives at their appointment, they have the option to check in via a QR code on their mobile device which pulls up the information they input in Experience Cloud/Health Cloud. Onsite staff review the resident’s history before, log the vaccination event in the same profile, and schedule the resident’s follow-up appointment to receive their second dose within the appropriate timeframe using Field Service Lightning. “By applying a simple architecture to complex workflows, LouVax helps streamline the efforts of nurses and clinical staff as they facilitate vaccinations,” said Schatte.

Reporting and compliance
MuleSoft APIs were added to interface with the state’s immunization registry and health information exchange, enabling LMPHW to complete reporting requirements within 24 hours. “When we did this on paper, we actually had a staff of 30 people working in an office building downtown doing nothing but manual data entry to get everything in the registry,” said Dr. Hartlage. Salesforce Shield was added to help LMPHW compliance with applicable privacy laws like HIPAA.

“Our previous experience with mass vaccination had taught us that while the injection itself is the most highly visible portion of the operation, in many ways, that's the easy part. It’s the other parts of the operation that are not as visible – managing patient scheduling, inventory, and documentation – that can make or break everything,” said Dr. Hartlage. “Our cloud-based strategy empowers us to move through these steps quickly and efficiently.“

Early results are setting the stage for lasting impact.

Quickly and efficiently, indeed: LouVax system went live in just four weeks, the drive-thru clinic was stood up in just eight days, “and updates are pushed live out of UAT even faster because we configured it out-of-the-box instead of custom-building a solution,” said Schatte. “Anytime LMPHW needs to make a change to the system – say, taking in new or different information for a given priority group – those updates are pushed throughout the system automatically. No manual updates required. This enables the LMPHW team to adjust to any changes in guidance, and adapt workflows as they move from vaccinating one priority group the next, automatically.”
 

Best practices checklist

LMPHW shares five best practices from its experience with LouVax.

At the time of publication, LMPHW had administered over 50,000 vaccinations, 16,000 of which were for educators. The team is moving as much as 138% of the state’s allocation per week (well over the governor’s 90% goal), and averaging 200 passenger vehicles per hour at its largest drive-thru clinic.

“At its core, government really does specialize in organizing and distributing resources on a large scale, serving as a conduit for innovation,” said Dr. Hartlage, “and the pandemic has really highlighted what talented, passionate people can achieve even in a short time when they have access to the right resources.”

 

 

 

 

https://www.census.gov/quickfacts/fact/table/bowlinggreencitykentucky,lexingtonfayettekentucky,louisvillejeffersoncountybalancekentucky,KY,US/PST045219

 

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