By now, the vaccine scheduling horror stories are familiar. Websites are crashing. Bookings are canceled at random. And a laundry list of technical issues is making it all but impossible to secure an appointment.
Even more maddening? Much of this was preventable. Vaccine scheduling could have been conducted with speed and efficiency. But as healthcare leaders and government agencies have now learned, online scheduling in healthcare is much harder than it looks.
America’s healthcare infrastructure is deeply fragmented
The roots of our scheduling problems were laid long before COVID-19. America’s healthcare system is deeply fragmented, and so is its underlying technology.
There are more than 1,400 different practice-management systems that healthcare providers use to run their back-end calendars. Many of these systems are “walled gardens,” closed systems that don’t play nice with patient-facing scheduling software.
If this seems like an esoteric point, imagine if there weren’t central flight booking options such as Expedia.com—or even websites for each airline, such as Delta.com. Imagine that, instead, travelers were expected to call each plane’s pilot to book a seat, and that those seats were in unprecedented demand and extremely short supply.
The result would be nationwide chaos and frustration. This is what Americans are experiencing now as they contend with a disparate network of vaccine providers that aren’t set up to connect to each other, let alone support seamless online scheduling for patients.
Most online scheduling is built primarily for providers, not patients
Americans have found that vaccine-scheduling websites are often cumbersome, requiring pages of forms to register before it’s even clear that an appointment is available. By the time patients complete the paperwork, they often find that there are no appointments left, and so they return to the home screen, again and again, to begin it all anew.
The core problem is not technological. It’s one of competing priorities. As a patient, you want to schedule an appointment in a few clicks. But as a provider—the organization that often runs the scheduling system—your first goal is to collect patients’ medical information. To return to our flight analogy, it’s as if consumers were required to fill out all of their traveler and credit card information before even understanding the flight schedule.
For patients, the result is a gauntlet of boxes to check and fields to fill. If the process of scheduling is a race, these forms are hurdles, slowing people down, or stopping them outright, and sometimes causing otherwise motivated vaccine seekers to give up on the process entirely.
Building great technology takes time (and a lot of trial and error)
When a scheduling website works well, it looks and feels effortless. But the technology underneath is enormously complicated, and building a seamless experience for patients takes years to get right.
First, there is the matter of connecting those 1,400 practice-management systems. Building connections between those walled gardens requires years of time and investment, plus constant maintenance.
The problem of scale adds a whole new set of challenges. It isn’t good enough for a scheduling website to work on a typical day, or even most of the time. The infrastructure has to be tested to ensure that it holds up during huge spikes in demand, when thousands of people are trying to book an appointment at once. Downtime due to spikes in demand means people get frustrated and lose trust in the process.
Technology teams and systems also have to continually learn to filter out scrapers and bots that aim to abuse the system. The integrity of the nation’s vaccine rollout depends on people being who they say they are when they sign up for an appointment. For that reason and more, verification is critical.
The list of technical challenges and optimization goes on—a thousand tiny details that are essential to delivering a friendly search and scheduling experience. For instance, how important to patients is distance versus near-term availability? After the booking, how do you best ensure patients show up at the correct place and time so that precious appointments don’t go to waste? How can a system get ahead of large weather events, which impact cancellations and reschedules?
Many of these questions can only be answered through trial and error. And as a nation, we simply don’t have the time for vaccine providers to figure this all out in real time.
Vaccine providers cannot become technologists overnight
The professionals who run healthcare institutions are well aware of these problems, and they want to fix them. But they are not in a position to do so. The pandemic has put enormous strain on their organizations’ resources. As Chicago’s deputy commissioner of COVID-19 response operations recently put it, “The last thing a hospital in a pandemic wants to hear is, ‘Here’s a giant IT project.'”
In addition, the nature of vaccine scheduling means that sensitive data must be protected and handled responsibly, and the entire operation insulated from bad actors. Those kinds of privacy and security issues cannot be adequately addressed by hastily built software or by quickly deploying services never intended to be used in healthcare scheduling.
But even if time and resources are available, the fact is that software engineering is not a core competency for most healthcare organizations or government agencies. While consumer technology companies are familiar with agile development—in which technology is rapidly iterated upon and optimized—this approach is uncommon in the public sector and in healthcare. And it simply isn’t the right use of the expertise of those workers. Our nation is best served when they can focus, respectively, on policymaking and providing great clinical care to patients.
Let’s innovate only where it’s needed
The good news is that a more effective approach is hiding in plain sight. Vaccines were developed at record speed in large part due to public-private partnerships. The same model can expedite the rollout.
Public health officials are beginning to recognize the benefits of leveraging existing, private infrastructure. This month, the Biden administration announced that it will rely on a nationwide network of 21 pharmacy partners as well as independent pharmacies representing over 40,000 locations to support vaccine distribution. And on the very same day, the City of Chicago launched a partnership with my company, Zocdoc, to centralize and aggregate vaccine scheduling for its residents.
Companies with the ability to make an impact should recognize that this is their moment to give back to the country and communities that have made their success possible—it is not a time to take advantage of a desperate situation. They should lend their services to the country free of charge or at cost.
To me, the lesson is clear. To beat this novel virus, there are many novel challenges that require innovation—such as developing systems for cold-chain storage and ensuring equitable distribution. But scheduling isn’t one of them.
Let’s save the trial and error for the challenges we’ve never faced before.
Oliver Kharraz M.D. is the founder and CEO of Zocdoc.