Vaccines Management System for response to COVID-19

This document provides information on the decisions made around the procurement, development and deployment of the Vaccinations Management System to facilitate mass public access to an Appointment Booking Portal to support Covid vaccines delivery in Northern Ireland.

Background

1. Digital Health and Care Northern Ireland (DHCNI)

The DHCNI partnership sets the vision and strategy for Digital Transformation in Health and Social Care, directs and oversees the central budget for Digital investments and works in partnership with, and commissions projects and services from the Business Services Organisation which is the HSC’s shared services provider. DHCNI also aims to bring together the disparate Digital functions across the six Trusts: collaborating to develop a region wide strategy; facilitating shared leadership and decision making; setting policies and standards for the Trust teams to follow; and providing services and support.On taking up post in June 2019, the new Chief Digital Information Officer in the Department of Health, Dan West, reviewed the structures for delivery of digital services across the Department of Health and the HSC in Northern Ireland. This resulted in the formation of the Digital Health and Care Northern Ireland (DHCNI) partnership. It is led by the Department of Health and brought together the Health and Social Care Board’s eHealth and Care Directorate and the Public Health Agency’s Centre for Connected Health and Social Care.

2. Digital Co-ordination Cell

In April 2020, as part of the wider Departmental and HSC efforts to address the impact of the pandemic, the Department’s Chief Digital Information Officer (CDIO) convened a ”Digital Co-ordination Cell” (DCC) to oversee the Digital response to Covid-19 in Northern Ireland. The development of the StopCovidNI app was one of the products of the Cell.

1. 1. Purpose

The purpose of the DCC was to co-ordinate the digital support and enablement of the DoH & HSC response to prepare for the additional burden that Covid 19 was anticipated would place upon the system. Many of these were related to public health and operational considerations, however there was also a sub-set of the preparations that related to issues such as Data collation, storage and access (including governance) and use of appropriate technology. There were also a number of questions that required system-wide resolution and / or decision making as well as funding approvals at the overarching leadership level.

• 2. Objectives
• Understand, articulate, and where required, coordinate the Digital activities underway across the HSC.
• Identify duplication in the activities being undertaken or requested, bringing together the disparate parts of the system that are attempting to solve the same problem.
• Clarify expectations and define DHCNI strategy where required.
• Support DHCNI teams in provision of resources and authority; through coordination of funding and approvals, and directing the unblocking of issues.

1. 3. Reporting structure

The group reported to the Department of Health strategic decision making team, “Gold Command” and worked in close liaison with other operational Covid cells in the Department and with HSC organisations.

3. Digital interventions identified by the Digital Cell

Given that the Covid 19 pandemic was a rapidly developing and changing situation, the group identified a number of immediate priorities to help to cope with the impact on public health and the HSC. These included:

• enabling home working for DoH & HSC staff members
• the development of a Covid 19 web presence for healthcare advice
• the development of a telephone helpline
• development of a capability to carry out remote consultations

As the situation evolved and it became clear that further rapid innovative interventions would be needed to help lessen the impact of the virus, the group identified and commenced development of a number of other initiatives which were subsequently deployed. These included:

• The CovidCare App (symptom checker app providing immediate advice and links to trusted information on Covid 19).
• StopCovidNI (an app to alert users if they have been in close contact with other users who have tested positive for COVID-19).
• Digital Self Trace (an automated system to enhance the contact tracing process operated by the PHA telephone Contact Tracing Centre).
• Vaccinations Management System (digital processes to help manage the delivery of the Covid 19 vaccines).
• Data analytics platforms such as the Covid Dashboard (digital systems to assist in the analysis of data to produce information which could help the HSC and other public bodies to respond more effectively to the spread of the virus). 

4. Vaccination Management Booking System

1. 1. Introduction

When the development of VMS was first considered, consideration was given to the adoption of existing HSC systems such as Child Health and NIECR

However, there was a series of technical difficulties and in addition, the design and development work that would have been required to ensure existing systems would meet the capabilities required in booking, clinical workflow reporting and analytics was extensive.

1. 2. VMS Overview

The aim of the project was to accelerate safe return to the ‘new normal’ for Northern Ireland by delivering a fit for purpose digital Vaccine Management System (VMS) as soon as possible.

The VMS was required to create a digital vaccine appointment booking capability initially for vaccinators and health and care professionals and subsequently the citizens of NI. The solution was also required to have the capability of capturing an agreed set of data points for reporting purposes which would be likely to attract high levels of political and media scrutiny.

A core team was established to undertake:

• Delivery of a digital vaccine appointment booking capability to support the vaccinating of: vaccinators, the wider NI health, social care and associated clinical professionals across the public and private sectors, and the citizens of NI across care settings (GP, Hospital, Community etc.);
• Mobilisation, commissioning and management of a network of VMS supplier expertise across Northern Ireland to collaboratively develop the minimum viable product (MVP)[1];
• Engagement with local delivery teams to co-ordinate VMS development, infrastructure, technology and data requirements;
• Providing the data which enables reporting on VMS progress, impacts and readiness to the Chief Medical Officer (CMO) and policy makers in the Northern Ireland Executive;
• Provision of initial guidance and support on how to use the VMS to HSCNI staff and other approved users and
• Consideration of the development needs of the product for the further iteration and development of the MVP from an initial tactical solution to a strategic solution with potential to become the long-term solution for vaccine management.

1. 3. Objectives

Towards the end of October 2020, DHCNI was requested to develop, at pace, appropriate digital supports to the administration of the vaccination programme. The programme was to commence as quickly as possible and the first vaccinations were administered on the 8th December 2020.  The required digital supports therefore needed to be developed and deployed rapidly and in a manner sufficiently flexible to meet the changing needs and priorities of the vaccination programme.

The primary objective of the VMS was the development of a set of products which would be integral to the success of delivering the vaccine to healthcare professionals and the citizens of Northern Ireland efficiently and effectively. Other supporting objectives included the need:

• To accommodate the needs of different patient cohorts and workflows across various delivery partners (Trusts, GPs and other independent contractors);
• To standardise the approach to data capture;
• To automate and standardise processes where possible;
• To reduce dependency on paper and manual process (and in doing so reduce chances for manual error and improve data quality);
• To promote the capture of electronic data in real time;
• To provide a holistic view of the progress of the vaccination programme across the region and
• To produce timely reports and enable data analytics to inform policy and decisions.

The development of capacity and capability to undertake complex analytics on vaccination data alongside other data points is the subject of a separate application.

Policy has yet to be developed which would require citizens to evidence that they have a level of immunisation against coronavirus through having received a COVID-19 vaccination.  The development of digital solutions to support such a policy (sometimes referred to as ‘vaccination passports’) is not currently with the scope of this application.

5. Procurement decisions

Given the impact of the pandemic on all aspects of society, the pace at which public health interventions could be deployed meant that the procurement approach needed to be open, collaborative, flexible, agile and rapid.  Decisions, information and designs needed to pass between the top-tier of management to the delivery teams quickly and the ‘traditional’ commissioning and delivery paradigm was not appropriate. During the “Discovery process” [2]a number of the priorities were identified on the effective deployment of a VMS. These included:

• Timescale 
• HSC confidence in being able to deliver clinical workflow requirements
• Integration with GP systems
• Necessity for reporting

The context for VMS design decision making was a highly compressed timeframe and an urgency to rapidly develop a system that could support immediate vaccine roll out to the most vulnerable citizens. VMS planning and design started with a view to deploying vaccine teams to the Care Home community before Christmas 2020.

The VMS is necessary to:

• Improve the "as is"/current approach within Northern Ireland of annotating paper print-outs for call/recall and keying these manually into systems following each vaccination clinic, as well as manually sending letters to GPs;
• Reduce/negate the clinical and information governance risks associated with the "as is"/ current approach e.g. reduce physical printing and transport of paper documents containing patient data; remove the ability of these documents/data being viewable by patients or staff in clinical or back office settings;
• Ensure provider organisations meet obligations regarding patient confidentiality;
• Improve the accuracy of clinical data recording e.g. automated HCN look up and thus reducing data error;
• Make available more easily and securely, clinical data to health and care staff involved in the patient's care pathway;
• Provide standardised clinical management and workflow working in all vaccination settings, supported by a software solution and
• Provide structured data relating to the vaccination of patients to be included into regional datasets for improved reporting purposes.

It should be noted that the VMS includes an appointment management/clinic scheduling functionality and a clinical recording tool. The VMS supports near time analytics of COVID 19 vaccination data through a separate but connected data analytics platform. 

1. 1. VMS Development Drivers and Decision Making

A development of this nature required the DHCNI team to design the VMS tactically using rapid, agile techniques covering selection, design, build and implementation. Linear, lengthy requirement capture, investment and procurement processes would not have delivered the outcomes in the time available to meet public expectations. The urgency and speed needed to set up a VMS required DHCNI to adopt the fastest route to a workable solution using existing relationships within the DHCNI/BSO eco-system. Given the lessons learnt and success of the Track and Trace capability, DHCNI expanded the design brief with Kainos to incorporate the tactical VMS into their existing Customer Relationship Management (CRM) capability. 

The tactical VMS started deployment across NI from late December and was only considered a short-term solution until a more scalable, strategic capability could be designed and developed. The initial VMS was achieved in only 10 days and was based on a proven Commercial Off-The Shelf (COTS) medical booking system purchased via the G-Cloud 12 Procurement Framework Agreement. The tactical VMS was developed by APTVision, a G-Cloud approved medical systems supplier. It was decided that vaccinations recorded by General Practices would not be recorded^[3] in the tactical APTVision element of the VMS but could be copied to the Data Model contained within the Kainos Dynamics Analytic Platform instance which forms part of the strategic VMS solution. 

6. Supplier Interactions December 2020 - January 2021

Shortly before Christmas and early in the New Year, after the VMS development had been started, DHCNI invited several suppliers (TotalMobile, Civica and Microsoft) to demonstrate their services to the VMS team and showcase what their offerings were capable of. The VMS team (supported by independent IT research company Gartner) quickly concluded that two of the offerings (TotalMobile and Microsoft) were not able to meet the most urgent VMS requirements. The TotalMobile proposition, whilst comprehensive, was aimed at pure field operations rather than a more limited, short-term rollout to care homes across the region. This was not what was required at the time.  The Microsoft proposition, received via the Kainos development team, was a re-configuration of their Dynamics application designed to support vaccine roll outs. This solution mirrored a move by several global enterprise application suppliers observed by Gartner analysts as keen to address the pandemic situation.  After discussions with Kainos and Gartner it was concluded that it would take longer and cost more to deploy than the deployed APTVision pilot which was already in operation.  Therefore, NI’s vaccine outcomes could not be accelerated nor improved by stopping the APTVision / Kainos developments and switching to the alternatives.

The third proposition by Civica, another existing DHCNI supplier, had merit but would not have been available in time to support care home vaccination time frames.  All suppliers were advised to remain in touch and the VMS team would engage via procurement channels should an opportunity for additional functionality materialise.

7. Assessing Value for Money in a Pandemic Use Case

As stated earlier, the urgency and level of demand to set up a vaccine management capability was unprecedented. This scenario required DHCNI and the VMS programme team to rapidly design and deploy system which did not exist at that time, against a backdrop of unpredictable clinical conditions, continuously changing technical requirements all within an ecosystem which is not designed to work at such speed.

With a focus on delivering a vaccine as quickly as possible to save lives, the VMS team commissioned the help of Gartner[4], the world’s largest independent IT research company. Gartner had previously worked with DHCNI to conduct value assurance of the EPIC EPR system procurement in early 2020.  DHCNI, the VMS team and Gartner worked in collaboration with the existing COVID programme teams (Track and Trace, Kainos, BSO) to assess and review the VMS options. Gartner reviewed the ability of the vaccine management supplier landscape both regionally and globally as well as providing guidance on the best ways to deliver pandemic solutions at speed.

Gartner also provided commercial support and advice to the VMS Commercial lead and DHCNI during negotiations and contract reviews. All parties, including both Kainos and APTVision as well as Gartner, commenced work on the VMS. All parties worked in good faith during December and early January based on the assumption contracts would be agreed by DHCNI using the G-Cloud framework. Use of the G-Cloud framework meant government agreed rates were already approved, however the actual hours of effort undertaken by the suppliers exceeded the agreed working hours in G-Cloud 12, in effect equating to a discounted rate. Gartner reviewed the additional work proposed by Kainos and APTVision and compared them to the market ‘basket rate’ for developers in the UK/Republic of Ireland region.

The VMS commercial leads considered 2 factors when assessing value for money (VFM). The first was that DHCNI procured Kainos, APTVision and Gartner on G-Cloud -12. Day rates are already agreed upfront as part of this framework agreement and further discounts are not allowed under the T&Cs of G-Cloud. The second factor is that all suppliers undertook work at risk for several weeks. The VMS team observed that all three suppliers worked longer hours and over weekends than their agreed rates permit. In effect this additional effort has given DHCNI a de-facto discount.

With those factors in mind the commercial leads concluded that the rates offered by Kainos and Gartner were all G-Cloud rates. Compared to developer market rates these are at the upper end of the market basket figures[5] but within an acceptable range given their corporate risks, lack of contract cover and extended hours of working. The rates charged by APTVision were even better value given their resources had been operating at the limit of their capacity. Furthermore, their complete flexibility to deliver in an uncertain and rapidly changing environment and offer new functionality has demonstrated their value add to the VMS roll out. Likewise, the Garter team, whose role is assurance, commercial and transformation support have been equally flexible, operating long hours well outside their agreed statement of work to provide the VMS team with a wide range of expertise, market analysis and development skills.

8. Next Steps Qtr1 2021

Moving forward, it was decided that the strategic VMS solution would be a combination of the APTVision booking platform, and a Microsoft Dynamics CRM solution deployed on Belfast Trust’s existing infrastructure. This would contain a central vaccine database and analytics capability for population COVID health management support and analysis.

From the week beginning the 8 Feb 2021, the VMS would morph combining the booking and scheduling engine developed by APTVision with the enterprise scale database and analytics capability built by Kainos on the Belfast Trust Microsoft Azure environment. In addition, the VMS team had the time to work with Big Motive and key stakeholder groups such as the GP community and Health Trust leads to develop a custom workflow better suited to their clinical delivery needs.

Rationale for this merger was the need for a sustainable, in-house vaccine management capability that is woven into the DoH ITS fabric and can be supported using existing service management processes and capability long term. The APTVision aspect of the VMS was only ever considered a short-term solution. The strategic VMS needs to be a point of care, digital vaccination management and data recording tool. To that end DHCNI wants to establish a standardised, regional approach to the recording of vaccination data and a regional dataset for national, regional, and local reporting.

The scope and requirements of the VMS continually evolve^[6] but the current tactical solution has met the current vaccine cohort delivery requirements to February 2021^[7]. As vaccinations move to the wider population and grow to accommodate both Trusts and GP practices, DHCNI need to ensure the VMS is sustainable long term, supportable and able to respond to emergent clinical needs in a controlled, financially predictable way. It is to be decided if, in time, it will also be used to support the delivery of the annual seasonal flu vaccination programme from 2021, and potentially other programmes, such as pneumococcal, shingles and travel vaccines.

Breakdown of costs by commercial partners

NOTE: There were no advertising or promotion costs in relation to the Vaccinations Booking Portal

[1] MVP is a version of a product with just enough features to be usable by early customers who can then provide feedback for future product development. 

[2] The discovery process in product development involves activities required to determine if and why a product should be developed. Carrying out this work makes it more likely to create a product users actually want and need.

[4] Gartner is a global research and advisory firm providing information, advice, and tools for leaders in IT, finance, HR, customer service and support, communications, legal and compliance, marketing, sales, and supply chain functions. Gartner differ from other advisory firms in that they have no affiliation with any IT or technology supplier nor do they code, build or implement IT systems. Gartner’s advice follows Gartner’s Principles of Independence and Objectivity overseen by an Ombudsman. https://www.gartner.com/en/about/ombuds

[5] Benchmark extracts for developers supplied separately.

[6] For example vaccine certificates, portals for SAR

[7] As at 8 Feb 2021