HSG Honored for Development of Pre-Registration System for Covid-19 Vaccination and Community Vaccination Clinics
In partnership with a cross-sector group of organizations, HSG is proud to have been awarded the Erastus Corning Achievement Award for the development of a pre-registration system for the COVID-19 vaccination and community vaccination clinics.
HSG played a lead role in designing and managing this project, specifically building a cross-sector team of over 25 organizations to come together and deliver the COVID-19 vaccine in an equitable manner in the Capital District of New York.
“From the beginning, Albany County made vaccine equity a top priority, because we knew COVID-19 was having a disproportionate impact on communities of color and older residents. Our vaccination pre-registration system was indispensable in streamlining the vaccination process and it helped more than 45,000 people from Albany County alone receive regular information about vaccines near them,” said Albany County Executive Daniel P. McCoy. “There are too many people to thank for making this system a success and deserving of the Corning Award, but I do want to commend and thank our partners, Albany Mayor Kathy Sheehan, Alliance for Better Health and Juliette Price of Helgerson Solutions Group for leading these efforts.”
“It was an honor to serve the community of the Capital Region by leading this project,” said Juliette Price, Chief Solutions Officer at HSG. “The roll out of the COVID-19 vaccine in the winter of 2021 was undoubtedly one of the toughest challenges that our country has faced and one that I am proud to have participated in. We knew that if we worked together, placed equity at the center of our efforts, and designed a system to help residents access the vaccine in an efficient manner, lives would be saved and our wellbeing, economy, and recovery could begin. I want to thank all the partners who were involved in this effort—this was an extraordinary example of how cross-sector partnerships can solve problems that no single entity is capable of solving alone.
County Executive Dan McCoy & his team, Mayor Kathy Sheehan & her team, City of Cohoes, City of Watervliet, Mohawk Ambulance, Guilderland EMS, Colonie EMS, Marra’s Pharmacy, Capital Region Vaccine Network, Albany Housing Authority, Watervliet Housing Authority, Cohoes Housing Authority, Metro Baptist Church, Town of Knox, Damien Center, Care Design New York, Albany Public Library, Watervliet Senior Center, Capital District Latinos, United Way of the Greater Capital Region, Albany College of Pharmacy and Health Sciences, Guilderland School District and the North and South Colonie School Districts, and so many others—thank you for all that you did.”
Overview of the Pre-Registration System & Community Clinic Model
Emerging as an early holiday gift, the FDA approved the first emergency use authorization of a vaccine for the prevention of covid-19 in mid-December 2020, launching a historic and unprecedented effort to mobilize the vaccination of all eligible Americans as quickly as possible to mitigate the devastation that the covid-19 global pandemic inflicted. As approved vaccines became available to New Yorkers in early 2021, demand for the vaccine vastly overwhelmed supply, which was widely expected.
Until supply could meet demand, the vaccination effort entered a period of rationing, where only those who were most-resourced and able to navigate the system built to administer the vaccine were able to access appointments--a system that relied primarily on mass vaccination administration sites & complex online booking systems. This system was inequitable and disproportionately left out communities of color, low-income & working poor, the non-technically savvy, non-English speaking, people with hearing, vision, mobility, and other physical impairments.
Additionally, eligibility during the vaccine roll-out in New York shifted dramatically; beginning first by age and essential workers, then adding co-morbidities and additional professions, followed by age groups. Adding to the complexity was the “earmarking” of vaccines to specific populations, meaning specific vaccine providers were tasked with reaching specific populations, meaning appointments were not open to all eligible populations. Matching demand with supply with eligibility in the most efficient and effective manner became the challenge du jour.
In response to this environment, leaders in the Capital Region convened a collaborative aimed at infusing equity into the vaccination distribution effort, shifting burden off of residents & onto the delivery system, and providing a community-based approach to vaccination.
Over 50,000 Albany County residents used the infrastructure built through this effort, helping to bring Albany County to lead the Capital District’s rate of vaccination.
“Pre-Registration” to Manage Demand:
The first challenge the collaborative addressed was the problem that interested residents who were both interested in a vaccine and either eligible or not-yet-eligible had no place to register their interest in being vaccinated. The online scheduling systems available to make appointments had no other answer than “try again later” if no appointments were currently available. Shifting eligibility guidance also confused residents, who were forced to check back periodically to see if the eligibility guidelines had changed to include them.
To alleviate this, the collaborative built a public-facing website where residents were encouraged to “pre-register” for a vaccine. Users entered their contact information, demographic data, and eligibility-related information into the form and received a confirmation notice that they had successfully pre-registered for a vaccine and would be contacted when an opportunity became available to them. This tool built a virtual “line” for residents, which allowed them to feel seen and that they had “a place in line.” Users were periodically emailed to confirm that they were still “in line” even if they had not yet been offered an appointment opportunity.
Launched publicly by County Executive Dan McCoy in early February, over 45,000 county residents successfully pre-registered on the site.
Managing Pre-Registration Data:
The intent of the pre-registration tool was to connect residents to vaccination opportunities as quickly as possible, necessitating that the data we collected be organized and stored in a secure, highly flexible environment so that lists of eligible residents could be generated for vaccination providers who could then invite eligible residents for an appointment. As eligibility criteria shifted, the data was able to quickly meet the demand of the vaccination program.
As the collaborative worked with a number of large and small vaccinator partners, it became important for providers to have access to the database to be able to fill their appointments. Some partners wanted the collaborative to do the outreach to residents and other partners wanted to do the outreach themselves. This distributive model where vaccinators had direct access to the database allowed for maximum flexibility and for residents to be offered appointments from multiple providers and choose which opportunity was right for them.
As the pre-registration database grew, the challenge of record management also grew. Working with the local regional health information organization, the database became informed by New York State’s Immunization Information System (NYSIIS) so that pre-registrants who were successfully vaccinated were marked as such and were no longer reached out to for appointment opportunities. This cleaning process was on a 24-hour schedule, ensuring that our outreach was highly targeted.
Outreach to Eligible Residents:
For those residents who pre-registered, communicating with them in a regular and action-oriented manner was the goal. When a resident pre-registered, they were sent a confirmation email that instructed them they had successfully pre-registered and that no further action was needed on their behalf, and they would receive an email or text message with vaccination opportunities when one became available to them.
Working with a broad range of vaccine delivery partners--Albany County Department of Health, FEMA, Albany College of Pharmacy and Health Sciences, Marra’s Pharmacy, Lincoln Pharmacy, Mohawk Ambulance, Guilderland EMS, Colonie EMS, and others--pre-registrants received emails and text messages that connected them to clinic opportunities that matched their eligibility. Roughly 93,000 thousand messages were sent to connect pre-registrants to vaccines.
Of all the modes of communication attempted, text messaging yielded the highest results in terms of appointment booking. These texts clearly communicated the date, time, and location of a clinic and contained a booking link for users to click if the appointment was convenient for them. This allowed for the text to immediately drive traffic to the appointment system, instead of asking for users to search around for the correct place to make an appointment.
As time went on, optimizing messages yielded insights into what works best: verbiage, timing of the messages (early mornings, early afternoons had highest impact) and use of emojis and spacing (ensuring the first line appears in the recipients text inbox) had large impacts on conversion rates. Personalizing the messages with the person’s first name or initial seemed to impact the conversion rate most highly.
Given the collaborative’s focus on infusing equity into the vaccination delivery process, communication was prioritized to pre-registrants who lived in zip codes identified by the CDC as being high on the Social Vulnerability Index. These registrants were given first access to clinic appointment slots. Next, priority was given to residents who lived most closely geographically to the clinic location and then progressively the messages would reach wider target radius as appointments remained unbooked. This ensured that clinics (specifically pop-up clinics) were filled with residents within close proximity to the site, which we know to be a significant predictor of showing up vs. no-show or same-day cancellations.
A very small number of residents pre-registered using a landline phone as their only contact information. To ensure that these individuals were not left behind, care management staff & volunteers called these individuals directly to book appointments at clinics. Ultimately, this group was extremely difficult to reach and manual calling was a resource-intensive activity that yielded low returns. Additional exploration of what can be done to reach those who do not have mobile phones should be explored in future efforts.
Organizing & Managing Community Pop-Up Clinics & Building Provider Capacity:
In order to best serve residents, it was deemed critical that community-based pop-up clinics be established to bring vaccine appointments directly into neighborhoods, meeting residents where they live, work, and play. Working together with a group of non-traditional providers such as EMS agencies and pharmacists, nearly 50 pop-up clinics were held in the county, representing nearly 9,500 vaccinations.
Beginning in early February, these pop-up clinics were held in public housing buildings, public libraries, senior centers, churches, legion halls, congregate living settings, rural town halls, fire stations, local schools, cultural centers--locations central to where people lived or worked and those that could provide a trusted place for residents to become vaccinated. The locations of these clinics were driven by the data being produced by the pre-registration system--where demand grew, clinics would be organized in order to serve the population who was pre-registering.
These clinics were much smaller than the mass vaccination sites, handling anywhere from 75-800 vaccines per clinic, meaning there were no more than 25-30 individuals being vaccinated at one time, providing comfort and peace of mind for those who did not want to attend a large mass vaccination event.
Some clinics were tailored to meet the needs of specific populations, such as a series designed to serve the intellectually/developmentally disabled (I/DD). Special attention was paid to designing a site that would be appropriate for the sensory needs of this population--lower lighting, quiet spaces, and additional staff who understand the I/DD population and the supports needed.
