NSW Health’s vaccination booking system is broken

On 20 March 2020, Australia closed its international borders as case numbers of COVID-19 exploded around the globe. Fifteen months later, NSW Health has still not been able to deliver a robust booking system to support the state’s vaccination efforts, with the current mashup of hastily implemented technology riddled with problems.

As is also the case for other Australians, to attempt to book their vaccination, NSW residents start their digital journey at the HealthDirect website where they input some basic information into an online Vaccine Eligibility Checker.

In the days following the Prime Minister’s off the cuff decree that younger people previously excluded from receiving AstraZenica could now chance their arm and seek it out under the guidance of their GP, this service was updated to spruik this out-of-favour vaccine option. At a time where confusion and hesitancy reigns supreme, the phrasing on the introductory page of the site couldn’t be more unclear. And if you are aged over 60, you don’t even rate a mention despite being amongst the people most likely to have a bad experience if you come into contact with the coronavirus.

The website then asks for some basic information such as your age, which state or territory you live in, and whether you have previously had any COVID-19 vaccines. After reminding you that the smart people that comprise the Australian Technical Advisory Group on Immunisation (ATAGI) recommend the more effective, convenient, nascent international vaccine passport-compatible Pfizer option, HealthDirect then tries for a second time to flog you an AstraZenica vaccination.

A few more simple questions follow including whether you are eligible for Medicare. This may appear to be a strange question to ask as anyone currently in Australia is eligible for a free jab – just not at a GP clinic if you don’t have Medicare as it turns out.

So far so good, unless you are under the age of 40, in which case you will have needed to jump through a few more hoops to get to this stage. Having established your eligibility, HealthDirect now permits you entry into its Vaccine Clinic Finder. All going well you will be presented with a map and the option to plug in your postcode to see a list of healthcare facilities where vaccines are available.

Unfortunately the wheels fall off in the Premier State at this point, which is far from ideal at a time when most of NSW’s population is being forced into an increasingly restrictive lockdown, with greatly increased vaccination rates now viewed as the only way to get the show back on the road.

While HealthDirect is happy to display a long list of sites where it claims vaccines are available, in the author’s experience trying to book vaccinations for both himself and other family members over several weeks, clicking through to any of these options is an exercise in futility.

It is important to understand that each hospital has deployed their own appointment booking system, with HealthDirect simply acting as a centralised referral system. One could quibble about the design and length of the bookings forms patients are expected to navigate – all slightly different – which can take between 10-15 minutes to complete, but the biggest problem NSW residents are likely to face is getting to the end of this tedious data entry exercise, only to find that there are no available appointments, on any day in the future, at any time.

“Try another location,” you may say.

Great idea, however as each hospital has deployed its own IT solution to handle bookings, there is no way to transfer all the information you have diligently supplied to one hospital, to the next, or the next, or a GP clinic with a different booking system again, and certainly not to a GP clinic promoted by HealthDirect that only offers bookings by telephone.

While it wasn’t publicised with any fanfare and Pulse+IT has yet to find any evidence of a public tender process having taken place, we have been reliably informed that a state-wide solution is on the way for NSW Health hospitals that will hopefully resolve this particular issue, as well as some of the other glaring problems that have yet been ironed out.

As well as the booking forms being served up by the various hospitals in Sydney being bloated with unnecessary and often redundant questions, they are glitchy, and in some cases don’t allow the user to get to the end of the process no matter how hard they try.

Blue-coloured Medicare cards have a specific expiry day printed on the card (whereas the more typical green Medicare cards only have an expiry month) and are not accepted by the forms designed by some hospitals, but are by others.

Some fields that a particular hospital’s booking form considers to be mandatory can’t be clicked or typed into by the user, so again, it’s impossible to progress further, much less book an appointment. And if you are lucky enough to get to the end of the process and have managed to find an available date for your first vaccination, there’s no guarantee you will be able to select a date for your second, preventing you from booking anything all.

For the times we are living in, vaccination booking systems should be viewed as essential public health infrastructure and managed accordingly. While sources from NSW Health report having pulled together the current system in what they call "record time" – I assume compared to the IT systems they rolled out during the Spanish Flu of 1918 – Pulse+IT contends that jurisdictions have had well over a year to get ready for the arrival of vaccinations and what NSW Health has delivered is broken and underwhelming.

But are there any green shoots? Perhaps. In recent days HealthDirect has added the ability to sort available appointments by “Earliest Available” as well as proximity to your postcode, so some attempts at improving the platform are clearly underway. Unfortunately even with this new filter, extensive searching over several hours across a number of days this week, the author was still unable to find a suitable location in Eastern Sydney - the starting point for the current outbreak - with any available appointments.

Coincidentally, in our poll last week, we asked: Have you had a good experience booking your COVID vaccination? Most readers are positive about their experience: 80 per cent said yes, just 20 per cent saying no. Perhaps they skipped the IT and picked up the phone?

We’ll take a look at Tasmania’s situation next week. In the meantime, our poll question this week is:

If you have had a COVID-19 vaccination, was it administered in a hospital?

Vote here and feel free to leave your comments below.

Comments  

0 # QLD Health staffer 2021-07-12 09:05
"Perhaps they skipped the IT and picked up the phone?" Or perhaps most responses came from QLD'rs, which has shown that when it comes to the big things then a coordinated State wide response is a considerably better approach? The NSW model of Health shows the inherent weakness of such thinking when the big issues hit.
0 # Simon James 2021-07-12 09:41
This may be the case but let's not pretend QLD Health always get it right when it comes to their IT projects.

Comments from our most recent poll launched on 9 July suggest the majority of our readers received their vaccinations outside of hospitals (e.g. at general practices and federally funded vaccination clinics), where booking is a much easier process as the HealthDirect site can tell you whether the clinic has available appointments before you waste any time filling out a lengthy NSW Health form, only to be told there are zero doses available. As practices have existing relationships with their patients, they are also able to be more proactive in rounding up their patients as and when they have vaccine supply, shifting the burden away from the consumer.

Many Pulse+IT readers work for healthcare organisations that were prioritised in the vaccination rollout, and as these folks did not have to jump through the same hoops as the general public, I'm sure this contributed to the favorable experience many reported in the poll.
+1 # Robert Dashwood 2021-07-12 15:57
Seems to be in conflict with this article from eHealth NSW?
https://www.ehealth.nsw.gov.au/features/mass-vaccination
Would love to have a round-up of all the solutions in each state/district.
+1 # Simon James 2021-07-13 14:26
Hi Robert, if NSW Health's own media department won't write nice things about them, who will :) Ultimately if what is currently deployed was so fantastic, it wouldn't be getting ripped out and replaced.

At the end of the day the technology isn't the problem in isolation, it's how it has been implemented by NSW Health and their suppliers, and how it relates to the available supply of vaccines and the capacity of the healthcare workers to deliver on what is being offered via the HealthDirect site.

Yesterday for example -- months after it commenced operation -- the NSW Health flagship mass vaccination centre at Homebush had people lining up in the evening, outside, for almost two hours after their allotted appointment time. Today you won't see anything about that in the headline stats (https://www.nsw.gov.au/covid-19/find-the-facts-about-covid-19) and it's not obvious to me that such basic performance metrics are even being tracked.
0 # Simon James 2021-07-16 16:34
In the week following this editorial Pulse+IT received over 135 comments via the poll in an optional comments section. Respondents were asked to comment on their experience getting vaccinated. Some of the more substantive comments are included (unedited) below:

- I did it in QLD and the Microsoft solution is not good as it would not allow me to register first time and then they emailed me 24hrs later saying they had dropped the registration key and sent me an new one. The solution then shows hospitals that are close by, but when you select them they say the stock is not there. Why not show only hospitals that have stock!!!

- On arriving at the hospital the same questions were asked three times before seeing the nurse.

- I know people who have said that on their second visit either the system lost their record or showed that they had taken AZ, when their first one was Pfizer.

- I found a link to the Westmead Hospital Pfizer clinic and, after creating a account and wrestling with the booking form, managed to make an appointment. Subsequently, I needed to change the booking date but found it was impossible to change or cancel an appointment. The website lists your appointments but has no option to cancel them. I tried replying to the confirmation email but it is a "no reply" unmonitored account. After attempting a few other options, I started getting reminder notifications as the date approached. Having run out of ideas, I let the appointment pass, then received an text message saying I missed the appointment and would I like to rebook it! By this stage I had received my first AZ shot from my GP.

- Couldn’t have been easier. Age 57, Pfizer vaccine. WA health vaccination booking system online. Clear information, efficient booking system with calendar options to book vaccination at place and time of choosing and information about the vaccine. Follow up reminder email. vaccine centre at claremont show grounds. Vax administered promptly. No waiting, easy parking. Follow up email with link for booking second vaccine appointment. All connected by wa vaccine system account. Vaccination record uploaded to MYHR. SMS link 2 days after to report any side effects.

- Brilliant & very efficient & fast given the thousands waiting in line

- Really smooth. Dodged the IT altogether, phoned my regular GP practice and got a first appointment for a week later.

- Could not fault the experience. As soon as I was eligible (Phase 2A), completed eligibility checker on line, which then sent me through to HotDoc, which gave me options for GP booking. Made both 1st dose and 2nd dose booking online. Can't see what all the fuss is about.

- It was not easy to find out where to book. Once booked the process was well organised. Why dont the government sent text messages to all citizens with a link to nearest vaccine centre. Not all Gp vaccinate and if GPs do..they will only vaccinate if you are a usual patient of their practice. Why isnt there Hubs.

- Same as you have described in your online article about the NSW online vaccination system It takes dogged perseverance in many instances to get vaccinated (particularly if your own GP is not part of the vaccine roll out). Some of us have had to travel into another LGA in order to be vaccinated.

- I found a link to the Westmead Hospital Pfizer clinic and, after creating a account and wrestling with the booking form, managed to make an appointment. Subsequently, I needed to change the booking date but found it was impossible to change or cancel an appointment. The website lists your appointments but has no option to cancel them. I tried replying to the confirmation email but it is a "no reply" unmonitored account. After attempting a few other options, I started getting reminder notifications as the date approached. Having run out of ideas, I let the appointment pass, then received an text message saying I missed the appointment and would I like to rebook it! By this stage I had received my first AZ shot from my GP.

- Mass vaccination clinic in Melbourne (MCEC) - staff & experience was SENSATIONAL!

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