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Situation

In the next 2-6 months, health systems, governments, and organizations around the world are going to face the biggest vaccination campaign in human history. There will be operational uncertainty and urgent needs for patient prioritization, care documentation, and follow-up. A COVID Vaccine Program Toolkit could be rapidly distributed and added to implementations using OpenMRS’ new microfrontend framework. 

Background

    • In 2021, we will see the biggest vaccination campaign in human history. COVID-19 Vaccination programs are anticipated to start rolling out as soon as December 2020 and early 2021. 
    • COVID Vaccination Campaigns will be unlike any global immunization campaign we’ve seen before. Here’s why:
      • (1) Universal Urgency. The need for such a vaccine is so urgent, world-wide, and interconnected with the economies of entire nation-states.
      • (2) Implementation Uncertainty. The exact vaccination program used will likely take many different forms, because there are so many different types of vaccines currently under development. This means there are still many unknown variables, such as whether a cold chain will be required, the dose regimen/timing, and screening protocols (see the current landscape of COVID-19 candidate vaccines). 
      • (3) Immediate Need to Prioritize and Follow-Up. Because of the massive impact of COVID concerns on daily life, one can expect the demand for COVID vaccines to be much higher than the available supply, to a degree we haven’t seen with other immunizations. This means public health programs will have to develop protocols and processes to identify patients most in-need of the vaccine, and to follow up with these patients - especially since at least 33 of the 44 vaccine candidates in clinical evaluation of the current vaccine candidates require a subsequent dose.
    • Community Health Workers will likely be a back-bone of vaccine delivery, especially where local hospitals or outpatient clinics are either understaffed or overwhelmed by COVID cases, or no longer seeing many patients due to the public fear of being exposed to COVID in a healthcare setting. Community Health Workers will likely have to take the vaccine into communities more directly, away from traditional clinic settings. 
    • This is an opportunity to leverage new plug-and-play frontend work in OpenMRS. A lightweight COVID Vaccine Delivery Tools can be implemented with the new microfrontend architecture, making it easier for implementers to both experiment with the functionality and to explore the new microfrontend architecture approach. Because these microfrontends use the OpenMRS core platform and REST and FHIR2 APIs, the tools won’t disrupt implementers current production system the way a new module would be. 
      • Many of the requirements below overlap with upcoming priority work around Patient Lists, Offline Mode, and Integration/Interoperability with Health Information Systems for reporting and public health monitoring.

Use Cases: Personas and User Stories

Health Centre Coordinator

  • List of Eligible/Priority Patients: I need to know which patients are eligible or a priority candidate for a vaccine (e.g. older, multiple comorbidities so at higher risk of severe illness/death), and who have not received it yet, so that our staff (especially Community Health Workers) can contact these patients and arrange to see them. 
  • List of Recipients: I need to know which patients have received the vaccine, so I can report on our metrics, and so that they can receive follow-up as needed (e.g. if a subsequent dose is required in 2 weeks; if a research program is monitoring patients for side effects)
  • Changing Criteria: I need to update the eligibility criteria for a vaccine as the guidelines change (probably every ~4 weeks).

Community Health Worker

  • List of Eligible/Priority Patients: I need to see a list of patients who need the vaccine, so that I can prioritize which households to visit and which patients to immunize first.
  • Record Giving a Dose: I need to record that I’ve administered a dose, so that there is a record of what kind of vaccine the patient received, how much, when, whether a follow-up dose is also required, and when.
    • Likely requires offline fx.
  • Upload Data: I need to upload the information I've collected (e.g. doses administered, to which patients) to my local health centre's or hospital's information system.

Clinician (Physician or Nurse)

    • Review History: I need to see the patient’s vaccination history so that prior vaccines, including COVID, are clearly visible, and I can understand what the patient may or may not be currently protected against. 
    • Record a Patient-Reported dose: I need to record that the patient states they have previously received a dose, so that there is a record of what kind of vaccine the patient received, how much, when, whether a follow-up dose is also required, and when.
    • Record Giving a Dose: I need to record that I’ve administered a dose, so that there is a record of what kind of vaccine the patient received, how much, when, whether a follow-up dose is also required, and when.
    • Follow-up form: I need to record a subsequent dose or a follow-up visit with the patient where I assess their reaction to the vaccine, and record my findings, so that there is a record of patients who have had a reaction.
    • Eligibility Alert: (MVP+) I need to know whether my patient is eligible for the vaccine
    • Follow-up Alert: (MVP+) I need to know if my patient is due for a subsequent dose of the vaccine
    • See a Community-Administered Doses: I need to see that the patient received a vaccination at home or in their village, what kind, and when, so that I understand what care the patient has already received and don’t duplicate a dose or miss an opportunity to provide a follow-up injection.
      • Integration with CHW tools that'll be used to record this? eg MedicMobile, CommCare?

Technician Implementing OpenMRS

  • Concepts for covid vaccines
  • Follow-up form template

Regional Health Officer, in the regional coordination centre

  • Data formats we need to support… ADX? 
  • I need to know who has ...

Other Requirements

  • Requirement: Needs to be backwards compatible with 2.3 platform, ideally on 2.4. With FHIR2 module and SPA mod/other packaging that puts in the vaccine front end.


Questions for Organizations Planning to Distribute COVID Vaccines

  1. What’s the first use case you expect you’ll need to be able to handle?
  2. What documentation are you expecting to have to do for COVID vaccinations? What was it like in other cases, such as Ebola?
  3. What reporting are you expecting to have to do for COVID vaccinations?
  4. What systems or data formats are you being asked to support for reporting purposes? What systems should we be thinking about a strategic integration with ahead of time? (e.g. DHIS2, OpenSRP, OpenLMIS, SORMAS)


To Do To Further Develop This Page

Gather Comparison Screenshots from:

CHW systems

EMR systems

Analysis Systems

(Logistics Systems?)

Look at examples from other global vaccination campaigns - Ebola?

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