There’s a certain irony recalling 2021 and those paper COVID-19 vaccination cards. They were laughably destructible, hastily produced, easily bent, torn, smudged, and lost in the oblivions of our clutter and couch cushions. As fate would have it, they would also be vital. They often dictated our eligibility for employment, travel, shopping, entertainment venues, and even access to government facilities. Essentially, at some point, in one twist or turn, these little precarious cards became passports for normalcy.
That was then.
Now 2023 is on our doorstep and pandemic precautions have eased. These vaccination cards aren’t as critical, and yet in another turn of irony — this time fortuitous — their legacy may prove beneficial. The California Department of Technology (CDT) thinks so at least. In response to an incessant outcry from lost, damaged, and destroyed vaccination cards, the CDT and the California Department of Public Health (CDPH) have used the challenge as an opportunity to design the state’s first digital platform for vaccine records: the Digital COVID-19 Vaccine Record (DVCR) portal.
No more panicked-induced emails and phone calls. The system offers an online option for easy, automated, secure 24/7 access to COVID-19 vaccination records. Visitors need only to provide their name, birthday, and contact info to get a SMART Health Card with dosages. The digital report includes dates, vaccination types (Moderna, Pfizer, etc.,) and a permanent QR code for quick look-up. What’s more, these SMART Health Cards can be uploaded to mobile phone apps like Apple Health, Apple Wallet, Google Pay, and Samsung Pay.
California IT officials hail the new system as a breakthrough achievement, and in this instance, the hyperbole is true. It’s a huge win. The state released the DVCR in June 2021 and by year’s end reported that 6.3 million people — or 20 percent of vaccinated residents — accessed the site. That figure has only climbed since, with the last reported tally in April counting more than 8 million residents.
In an IT awards submission to the National Association of State Chief Information Officers, California’s Chief Technology Innovation Officer Rick Klau lauded the portal for its instrumental role during the pandemic and its tangible benefits for vaccination tracking, advocacy, and verification. Klau said these impacts are now felt inside and outside California.
As an encore to the portal’s successful rollout, the state decided to open-source the front-end code to the public. This transparency has enabled Washington, Oregon, and Washington, D.C., to replicate and refashion the app for their residents. The CDT is also working with four yet-to-be-named states that are likely to do the same.
“This continues to be such a tremendous achievement for California, and a huge public service win well beyond California’s borders,” Klau said. “I’m grateful to everyone…who encouraged the original project, supported the initial launch, and played such an important role in the increasing success of the effort.”
Direction and development
While the state is transparent about the portal’s benefits, to its credit, it’s equally transparent about the initial struggles. The CDT said the platform was far from an overnight success. In fact, in the beginning, they said it had issues — lots of issues.
With more than 3.7 million confirmed COVID-19 cases during the portal’s launch and 63,000-plus residents dead, quick development became essential as were post-launch improvements. Amy Tong, California’s chief information officer at the time (now Secretary of Government Operations), directed the CDT and the CDPH to move fast, bypass traditional development procedures, and take a rapid, agile, and iterative approach to design. The command to IT staff: build as you go.
“With no time for pilots or proofs of concept, the team’s success would have to be gauged by the public’s response to the quickly built solution and be refined iteratively with new learnings,” the CDT said.
Those “learnings” materialized in user data. In its first deployment, 56 percent of users couldn’t find their vaccination records. The data disconnect was a blow, but an expected one. It made users frustrated, produced an average of 10,000 support requests per day, and left developers — at least at the outset — rightly perplexed.
The CDT and CDPH ignited a speedy investigation, discovering the problem had less to do with the portal itself and everything to do with the vaccination reporting process. The CDT uncovered that many health providers administering vaccines were not recording patients’ contact information. The result: when users entered their information and requested vaccination data, the state’s Immunization Information System (IIS) had no confirmed email address or mobile number to return vaccination details. Ultimately, this spurred outreach to major health providers and fixing a few technical issues.
“One of the historic deterrents to providing consumer digital health records is data quality,” the CDT said. “Anticipating these issues after deployment, CDPH quickly ramped up teams to focus on improving data quality and addressing expected calls and remediation requests.”
Today, the state reports 75 percent of its users can find their records without assistance, and when all contact information is available, there’s a nearly 90 percent match rate for unique recipient requests. For those still having trouble, the state launched an accompanying virtual assistant tool for public vaccination requests. The change ensured that nearly all requests (99 percent) are serviced within five days. Additionally, automated messages via text messages and email keep citizens updated on the progress of requests.
Impacts and aspirations
Now if all these benchmarks and statistics read like bullet points in an IT case study, there’s a good chance they’re designed to be. Sharing the technology is California’s next big goal.
The CDPH, along with health departments across the country, have long sought a mechanism to deliver digital vaccine records on demand. Yet the CDT said that “the resources required for such a project made it a distant dream,” that is at least, until the pandemic made it an imperative. Teams at the CDT and CDPH published a playbook for other states and agencies to replicate the portal — a kind of how-to guide accompanied with links to the portal’s open-source code.
The underlying idea for the sharing is to reduce costs for states designing similar systems, with the larger goal of creating a verification standard that can be applied nationally, and even internationally, according to the playbook. The app can be used in eight languages and California is working with the European Union, the United Kingdom, New Zealand, Australia, and Israel to accept the portal’s digital vaccination records for official travel use — and from all states using the system.
When releasing the code in September 2021, Klau underscored the portal’s potential for the future, aspirations that extend into different geographies and jurisdications, and possibly beyond COVID-19 to include a wider variety of vaccinations.
“As more states implement a system similar to what is available in California … a growing number of Americans will have access to a digital vaccination record that can be used anywhere digital records are issued and accepted,” Klau said. “This is convenient for residents and tourists who no longer need to carry their Centers for Disease Control and Prevention (CDC) card. It also standardizes the process for businesses and employers who want to verify vaccination records.”