The inside loop on the secret squirrel vaccine booking system

You may be wondering what the DoH's promised 'National Booking System' is. It's not that, for a start.

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UPDATE 3pm January 28: TMR has just got off the phone with the CEO of the Medical Software Industry Association, Emma Hossack, who has a lot of light to add to the following story.

We aren’t going to change the story because lots of elements of the story are still relevant to the overall picture and that the government is changing their story late in the game here, is probably a sign of the mayhem of trying to work out the logistics of COVID vaccination on the run. In summary, the indication by the DoH in their expression of interest for GPs document released last Saturday, in which the DoH said they would be providing a centralised National Booking System, is quite misleading – at least it’s a big misnomer.

According to Hossack, the DoH is not planning on a master centralised system at all, but is going to work on a principle of co-design with all the existing technology providers, primarily the booking engines, in order to extract enough information on where patients intend to get their vaccination so it can get distribution and logistics right.

Shorter: it’s not a new system patients will use to book through. It’s the government hooking into a number of large private enterprises and extracting appointment data in order to coordinate supply. That’s for GPs; with hospitals it’s less clear.

At this stage the major booking engines, which between them can access around 85% of all patients in the country, haven’t had this approach put to them in clear terms. Even this morning one of the major ones was admitting to TMR that it was in the dark but was hoping logic would prevail and the DoH would be using it in one form or another to help with GP vaccination logistics. Hossack says that the DoH never intended to build a big new centralised system and that the confusion so far has mostly been new year timing, and the general mayhem that is existing in getting everything organised for such a huge logistical exercise.

At its core, Hossack said the DoH would be asking the booking engines to create some sort of simple API that the DoH vaccine logistics crew could tap into to get a live, non patient identified feed of the numbers as they unfolded across the country. She said the DoH realised that a central system (with all the facets described in the article below) could never be built in time and would always have to rely on the suite of robust and existing software channels developed by both patient management system vendors and the booking engine vendors. So as far as GPs are concerned it looks like the booking engines will play a central part and none of the work which most have already started, to provide their practices with specific routines for screening, electronic consent, booking and re-booking, will go to waste.

As far as GPs are concerned, they can probably breathe some sigh of relief knowing that the booking engines should be developing protocols which will significantly streamline the vaccination process. That’s a very important priority for those GP practices which do decide to become vaccination hubs because nearly every GP clinic that does take on vaccinations will take them on at a net loss to their businesses in dollar terms. In marketing and branding terms, doing vaccinations might be a good idea. As one major Brisbane based clinic owner told TMR, “I’m going to lose about $10-20 per patient we vaccinate, but if I vaccinate enough, and they have a good experience with us, we as a clinic stand to acquire significant numbers of new patients. Even if I spend  $40 to $50 new per patient acquired, over time the business will benefit.”

One thing Hossack isn’t as clear about is how the so called National Booking System (which is a funny thing to call a distributed service that isn’t actually doing any booking itself but is actually going to be a collection of existing services all feeding non identified patient data back to a central logistics hub) is going to work in the hospital and hub system.

Unlike GPs, hospitals have no reach into the community through the booking engines, and their clinical systems of record are mega hospital centric behemoths wholly unsuited to a large scale vaccination booking and recording function.

The other problem for the commonwealth here of course is each state is its own fiefdom and they don’t tend to co-ordinate or talk on systems. As things stand there isn’t an easily identifiable system each could use which will do what the DoH is planning for GPs. A quick hack of the HealthDirect service that was established for COVID help information for patients early in the crisis has apparently been discussed. The other possibility is to tap into the booking engines and get them to handle hospital and hospital hub bookings (actually, that’s probably the bnest way to do it, as the booking engines would only need to add new hospital locations like they were new GP surgeries. If they did that, the national booking engines would have a complete picture of patient bookings and movements.

Other than this, for the time being each state health department will be looking at the problem likely from very different perspectives. It might be a good idea of the DoH to direct them all to use the booking engines as they’re base system for bookings, screening and getting pre visit consent electronically. If that happens the booking engines will take a big step up in terms of national digital architecture.  It will cost them but so far most are moving for their GP clients anyway.

Overall, there is still very real opportunity for the logistics of this rollout to get messy. If what Hossack is saying the DoH has decided on GPs is right then the whole show has been simplified by using existing well structured services and making simple API links to each of these for a central supply chain system. But how that extends to the hospital sector isn’t very well explained yet and has plenty of potential to get messy.

One other thing. The DoH has decided its Ok to pay GPs virtually nothing to vaccinate so it is gambling on GPs doing their civic duty and getting very organised. This might backfire big time if GPs decide on mass that the ROI is simply not there for them to vaccinate and the system is left with a giant hole that will need to be filled by the Hospital and private sector contractors.

Original story starts here:

Can the Department of Health really build a centralised booking system for GP COVID vaccinations within the next three weeks – or has it already built one?

That’s what it promised us all in last week’s release of expression of interest for GPs wanting to partake in the rollout.

Not that anyone actually understands yet what the DoH actually mean by a centralised government booking system for GP COVID vaccinations, as so far the only official words we have on the subject are:

• Participating GP clinics will receive “vaccine stock and access to a National Booking System”
• Said “National Booking System” will integrate with the major GP patient booking systems.

Three weeks?

OK, that feels ridiculous given that we’ve asked every major tech vendor how busy they are providing specifications and working on integrations, and none so far has a clue what the government actually wants or is doing. Our market leading GP patient management system Best Practice appears not even to have been contacted yet by the DoH, or any contractor working for it. Some of the major booking engines have had a chat to the DoH but they remain in the dark as to what the DoH actually is thinking or wants.

Let’s give them six to eight weeks for a fighting chance and call things even here.

They still need to do a hell of a lot to make such an idea work.

I’ve contacted a few serious healthcare software tech heads and they all agreed that if you were doing all of this, probably six to eight months might be a better timeline.

It’s not like the DoH or the government has a stunning track record on building software that works, especially cloud based software, which such a system would surely need to be. Perhaps unfairly, all that comes to mind for me is Robodebt and the My Health Record.

One government related agency person has claimed that they “have seen” the system, which is intriguing. When asked what they’d seen this person said that they shouldn’t be talking about it. Apparently the whole thing is top secret.

But why would such an important piece of COVID infrastructure be so secretive?

Why would most of the major PMS and booking engine vendors be so out of the loop? Surely you wouldn’t rewrite an entire booking engine yourself and bypass well established and working infrastructure and marketing distribution channel to patients like this.

Conspiracy theories have started, one being that one of the major consulting firms is busy at work building it behind the scenes. Really? Without any due diligence or public scrutiny the DoH has handed a pivotal piece of COVID logistics over to an Accenture or PWC? That would be odd, even for the DoH.

The description so far of said booking system is so vague that you can’t guarantee that all of the following shopping list  would be part of the functionality. But if you were after a central booking system you’d probably want the following as a minimum:

• Integration with all the major booking engines who already have patient access and marketing in their hands. All these systems have current and ongoing patient users, integrations to all the major PMS systems and robust working booking software.
• Integration with the major PMS systems for direct access to the Australian Immunisation Register, for booking the second dose for continuity and logistics planning, access to the MHR and – well, it would just be good hygiene to have each patient in the normal base infrastructure for GPs, especially given it wouldn’t be that hard to do.
• Something that takes GP COVID bookings and talks to a central government logistics group who is distributing the vaccine so they know how much each GP needs and when
• Something that is able to send a patient who is booking a screening check and consent forms so screening is automated and a patient can pre-consent and get electronically signed up before they turn up to clog already busy GP surgeries, (Note: the government has chosen quite deliberately to pay GPs less for a COVID vaccination than the base A consult and insist all COVID vaccinations are bulk billed, so essentially, GPs can’t afford to do vaccinations anyway. Having to get consent on site would be ridiculous in terms of ROI for any GP.)
• Clinical notes, which can talk not only to a GP patient management system when GPs are vaccinating, but of course, which hospitals can use, and which would be cloud based and be able to talk back to a local GP.

A couple of other things you’d think the DoH would consider. Obviously the booking engines are important and you could go to just one of them and use that for your central system. But surely you’d go to the top three (HotDoc, HealthEngine and Appointuit) and build an API to each one because if you did that you’d have near national booking coverage for all GPs immediately. But we aren’t aware that any of the major booking engines are working with the DoH yet.

What does appear to be in train is that the major booking engines aren’t waiting for the DoH to ring. We understand that they are already working on COVID vaccination specific additions to their booking systems, which may include things like screening and consent forms. The logic for why they’d move early is obvious. Those GP practices that are actually thinking of loss leading their practice and doing their civic duty by setting up for COVID vaccinations are freaking out as to how they can do it and not lose too much money. Some of the smart ones have already stepped through with TMR the major stumbling blocks to success and ROI. And the biggest ones obviously are booking, screening and getting consent prior to arrival.

These practices are clients of the major booking engines. The major booking engines, who probably all want to work with the DoH, are moving anyway it seems. That might end up saving the DoH a lot of money if and when they do come knocking. But if the DoH don’t come knocking and have come up with some crazy external build it yourself idea, then the waste across the country might be horrendous.

An important DoH system consideration is that it  would need to be able to be tapped into by the states and their hospital and hospital hub clinics. That’s a whole set of new issues. What are hospitals and hubs going to use to record all these vaccinations, talk to the immunisation register and MHR, take reasonable clinical notes, and so on? It surely can’t be the hospital based EMRs which are mega systems designed in no way to manage an agile and massive logistical exercise like this. Ideally it would be a cloud based aggregated booking engine where feasibly, if a patient gets dose 1 at a GP they can if they get does 2 at a hospital and vice versa.

So what is going on here?

If there is a system and it works, why does it need to be secret from everyone? If it’s going to integrate with major systems why is it not actually integrated with them yet?

Who wrote the system if it exists, or who is writing it? How are they qualified to have written it and where’s the transparency on that contract or tender? How much is it costing?

Or, if it’s not written, but is due in three weeks, what brains trust came up with that timetable and plan, and is anyone going to tell the GP sector that “oh, sorry about that, we’re not actually going to be ready with a booking system when you’ve obviously gone to a lot of thought and trouble to meet our crazy timeline?”

Lots and lots of things are up in the air so far on the yet-to-be-revealed centralised government booking system for COVID vaccinations.

Our best guess: the announcement last Saturday was somewhere between a thought bubble and a brain fart by someone in the DoH who quite correctly asserted such a system would be needed, but possibly quite naively said one would be up and running in three weeks. There are many moving parts in the COVID crisis so errors are going to be made in timing, logistics and so on. Which is OK.

What probably isn’t OK is that the DoH has set GPs an almost impossible task to vaccinate and not lose money as things stand. Keeping them and the tech sector in the dark this long on a centre piece of infrastructure to make the whole thing work? That’s probably not going to be OK much longer.

Interesting  few weeks coming up in digital health land.