Incident: Vaccine Appointment Software Failures in Multiple States Causing Chaos

Published Date: 2021-03-12

Postmortem Analysis
Timeline 1. The software failure incident happened when coronavirus vaccines first became available, which was reported in the article published on 2021-03-12 [Article 111842]. Therefore, the software failure incident related to the scheduling software for coronavirus vaccine appointments occurred in early 2021.
System 1. VAMS software recommended by the Centers for Disease Control and Prevention [Article 111842] 2. PrepMod software [Article 111842] 3. Salesforce vaccine software [Article 111842] 4. Microsoft vaccine software [Article 111842]
Responsible Organization 1. Developers behind the software such as PrepMod and VAMS were responsible for causing the software failure incident by creating systems with usability issues and flaws [111842].
Impacted Organization 1. State and local health departments in Virginia and around the country [Article 111842] 2. Health care workers in Richmond and Henrico County [Article 111842] 3. Seniors in Virginia who faced confusion and overbookings for vaccination appointments [Article 111842] 4. People in California, Massachusetts, and North Carolina who experienced tech mishaps, crashing websites, and difficulties in signing up for vaccinations [Article 111842] 5. Ineligible individuals who were able to snatch up appointments due to tech mishaps [Article 111842] 6. Black and Latino communities with low vaccination rates due to issues with appointment scheduling software [Article 111842]
Software Causes 1. The software recommended by the Centers for Disease Control and Prevention, VAMS, was too confusing for older adults to use, leading to complaints and difficulties in scheduling appointments [Article 111842]. 2. The alternative system, PrepMod, had issues where links sent to seniors for their appointments were reusable, leading to overbookings and confusion [Article 111842]. 3. PrepMod did not reserve appointment slots as people filled out their information, causing individuals to be booted out if someone else secured the slot first, affecting the efficiency of the scheduling process [Article 111842]. 4. Some of the sign-up software did not allow for unique registration links that expire after a single use, leading to issues in places like California where codes were shared widely, impacting the vaccination process [Article 111842].
Non-software Causes 1. Lack of knowledge about how to use the software by health providers [111842]. 2. Constantly shifting needs of states during the pandemic [111842]. 3. Developers condensing work that would normally take years into weeks, leading to glitches [111842]. 4. Varied approaches to determining eligibility in different localities using the software, making it difficult to develop a one-size-fits-all approach [111842]. 5. Inadequate communication and coordination between different appointment scheduling systems used by federal, state, and local agencies, private hospitals, and pharmacies [111842].
Impacts 1. Delays in vaccine rollouts in places like Washington State and Pennsylvania [Article 111842]. 2. Overbooking of a vaccination event in Richmond due to reusable appointment links, leading to confusion and irate individuals threatening health care workers [Article 111842]. 3. Inefficient vaccine distribution processes, with some regions resorting to first-come, first-served policies due to the strain of managing appointments online [Article 111842]. 4. Frustration among state officials and residents due to crashing websites, tech mishaps, and ineligible individuals snatching up appointments [Article 111842]. 5. Lack of coordination and communication between different appointment scheduling systems, leading to difficulties in managing vaccine distribution efforts [Article 111842].
Preventions 1. Proper user testing and feedback collection before implementing the software to ensure it is user-friendly, especially for older adults [111842]. 2. Implementing unique registration links that expire after a single use to prevent unauthorized access and overbooking issues [111842]. 3. Investing in technology for public health departments to develop more robust and tailored software solutions rather than relying on imperfect tools from external companies [111842].
Fixes 1. Implementing a more user-friendly and efficient appointment scheduling software that addresses the specific needs of older adults and is easy to use [111842]. 2. Ensuring that appointment links are unique and expire after a single use to prevent overbookings and misuse [111842]. 3. Investing in technology for public health departments to develop more robust and tailored software solutions for vaccine distribution [111842]. 4. Standardizing eligibility criteria and appointment scheduling processes across different localities to create a more streamlined and consistent approach [111842]. 5. Providing adequate training and support to health providers on how to effectively use the software tools to avoid misunderstandings and operational issues [111842].
References 1. State health officials in Virginia 2. Ruth Morrison, policy director for the Richmond and Henrico County health district 3. President Biden 4. Tiffany Tate, creator of PrepMod and executive director of the Maryland Partnership for Prevention 5. Claire Hannan, executive director of the Association of Immunization Managers 6. Andrew Therriault, Boston data scientist 7. Darrel Ng, California health department spokesman 8. Dr. Christopher Longhurst, UC San Diego Health’s chief information officer 9. Dr. Ghazala Sharieff, Scripps’s chief medical officer 10. Mary Beth Kurilo, senior director at the American Immunization Registry Association 11. Lu Hickey, Health Department’s spokeswoman in Johnston County, N.C.

Software Taxonomy of Faults

Category Option Rationale
Recurring one_organization, multiple_organization (a) The software failure incident having happened again at one_organization: The article mentions that in Richmond, Virginia, health officials were considering trying the VAMS software again despite the initial issues with it. Ruth Morrison, the policy director for the Richmond and Henrico County health district, mentioned that they were "even thinking about trying VAMS again" as they were cobbling solutions together at the local level [111842]. (b) The software failure incident having happened again at multiple_organization: The article highlights that many state officials have switched software providers due to issues with the appointment scheduling systems, but they have seen little or no improvement. States like California, Massachusetts, and North Carolina have faced various tech mishaps and challenges with their vaccine appointment systems, indicating a recurring problem across multiple organizations [111842].
Phase (Design/Operation) design, operation (a) The software failure incident related to the design phase can be seen in the article where it mentions that developers condensed work that would normally take years into weeks, leading to glitches in the software rollout [111842]. This indicates that the rushed development process introduced contributing factors that led to software failures. (b) The software failure incident related to the operation phase is evident in the article where it describes how health providers' lack of knowledge about how to use the system or the constantly shifting needs of states contributed to criticisms of the software [111842]. This highlights that operational issues and misuse of the system by users played a role in the software failure incident.
Boundary (Internal/External) within_system, outside_system (a) within_system: - The software failure incident was within the system as it was caused by flaws and issues within the appointment scheduling software tools like VAMS and PrepMod used by state health departments [111842]. - Developers of the software systems mentioned that the criticisms largely stemmed from health providers' lack of knowledge about how to use the systems or from the constantly shifting needs of states, indicating internal challenges within the software [111842]. - Issues such as reusable appointment links, glitches, crashing websites, and lack of unique registration links that expire after a single use were all internal problems within the software systems causing failures in the vaccine appointment scheduling process [111842]. (b) outside_system: - The software failure incident was also influenced by factors outside the system, such as the evolving nature of the pandemic and the constantly shifting needs of states, which made it challenging for the software systems to keep up with the demands and changes [111842]. - The varied approaches to determining eligibility in different localities and the lack of a one-size-fits-all approach added complexity to the software rollout, indicating external factors impacting the software's effectiveness [111842]. - The reliance on imperfect tools from outside companies underscored the need to invest in technology for public health departments, suggesting external factors affecting the software's performance [111842].
Nature (Human/Non-human) non-human_actions, human_actions (a) The software failure incident occurring due to non-human actions: - The article mentions that the software systems faced challenges due to condensed work that would normally take years being completed in weeks, leading to glitches [111842]. - Various approaches to determining eligibility in different localities using the software made it difficult to develop a one-size-fits-all approach, contributing to the software rollout complications [111842]. (b) The software failure incident occurring due to human actions: - Human actions contributed to the issues with the software systems, as some health providers lacked knowledge about how to use the systems effectively, leading to criticisms of the software [111842]. - Problems such as reusable appointment links being shared on social media platforms were caused by human actions, leading to overbookings and confusion at vaccination events [111842].
Dimension (Hardware/Software) hardware, software (a) The software failure incident occurring due to hardware: - The article mentions that the software issues faced by the Virginia health officials were partly due to flaws in the appointment software tools used, such as VAMS and PrepMod, which were recommended by the Centers for Disease Control and Prevention [111842]. - It is highlighted that the reliance on outside companies' imperfect tools underscored the need to invest in technology for public health departments, many of which still use paper and fax machines to keep records, indicating a potential hardware infrastructure gap contributing to the software failures [111842]. (b) The software failure incident occurring due to software: - The article discusses various software-related issues contributing to the failures, such as the confusing nature of the software for older adults, problems with appointment links being reusable and shared on social media, crashing websites, glitches in scheduling systems, and the inability of some systems to communicate with each other [111842]. - Specific software tools like VAMS, PrepMod, Salesforce, and Microsoft's vaccine software are mentioned to have faced criticisms and challenges, including issues with appointment slot reservations, unique registration links, and evolving needs of states during the pandemic, indicating software-related shortcomings [111842].
Objective (Malicious/Non-malicious) non-malicious (a) The articles do not provide any information indicating a malicious software failure incident where the failure was due to contributing factors introduced by humans with the intent to harm the system. (b) The software failure incidents discussed in the articles are non-malicious in nature. The failures were primarily attributed to issues such as confusing interfaces for older adults, reusable appointment links leading to overbookings, glitches in scheduling systems, lack of knowledge on how to use the software, constantly shifting needs of states, condensed development timelines leading to glitches, varied approaches to determining eligibility, and the inability of systems to communicate with each other [111842]. These factors point to failures introduced without the intent to harm the system.
Intent (Poor/Accidental Decisions) poor_decisions, accidental_decisions (a) The software failure incident described in the articles can be attributed to poor decisions made in the selection and implementation of the appointment scheduling software for COVID-19 vaccinations. State health officials in Virginia initially turned to the VAMS software recommended by the CDC, which was found to be confusing for older adults to use. Subsequently, they switched to PrepMod, but this system also had issues such as reusable appointment links leading to overbookings and chaos at vaccination events [111842]. (b) On the other hand, the failure can also be linked to accidental decisions or unintended consequences. For example, the issues with the software tools used for vaccine appointments were exacerbated by the constantly shifting needs of states and the evolving nature of the pandemic, which required a high level of flexibility from the software platforms. Additionally, the varied approaches to determining eligibility in different localities made it challenging to develop a one-size-fits-all solution, leading to glitches and delays in the software rollout [111842].
Capability (Incompetence/Accidental) development_incompetence (a) The software failure incident related to development incompetence is evident in the article where state health officials in Virginia faced challenges with the software systems recommended for scheduling vaccine appointments. The software called VAMS was deemed confusing for older adults to use, leading to issues with appointments and overbookings [111842]. Additionally, the article highlights how some developers condensed work that would normally take years into weeks, leading to glitches in the software rollout [111842]. (b) The software failure incident related to accidental factors is seen in the article where issues arose with the software systems used for vaccine appointments due to constantly shifting needs of states and evolving pandemic situations. For example, criticisms of the PrepMod system were attributed to health providers' lack of knowledge about how to use it and the challenges of keeping up with the evolving pandemic [111842].
Duration permanent, temporary The software failure incident described in the articles can be categorized as both temporary and permanent: Temporary: The articles mention instances where the software failures were temporary due to specific circumstances. For example, the article discusses how the vaccine appointment website in Massachusetts went down for several hours after a surge in demand, which was a temporary issue [111842]. Similarly, the MyTurn system offered more appointments than it was supposed to at a vaccination site in San Diego, forcing the site to close for several days because it ran out of doses, indicating a temporary failure [111842]. Permanent: On the other hand, the articles also highlight underlying issues that contribute to a more permanent state of failure. These include fundamental flaws in the software systems used for vaccine appointments, such as confusing interfaces, reusable appointment links leading to overbookings, and inability to reserve appointment slots properly [111842]. The challenges faced by various states and localities with different software providers and the lack of interoperability between systems also point to more systemic and long-term issues in the software infrastructure for vaccine distribution. Therefore, the software failure incident can be seen as a combination of temporary failures caused by specific circumstances and permanent failures resulting from broader systemic issues in the software tools being used for vaccine distribution.
Behaviour crash, omission, timing, value, other (a) crash: The software failure incident mentioned in the articles includes crashes, where the systems lost state and did not perform their intended functions. For example, the HealthCare.gov site crashed early on [111842]. Additionally, the vaccine appointment website in Massachusetts went down for several hours after a surge in demand [111842]. (b) omission: The incident also involved failures where the systems omitted to perform their intended functions at instances. For instance, the PrepMod system did not reserve an appointment slot as people filled out their information, leading to them being booted out if someone else beat them to that particular slot [111842]. (c) timing: There were instances of failures due to timing issues, where the systems performed their intended functions correctly but either too late or too early. An example is when the MyTurn system offered more appointments than it was supposed to at a vaccination site in San Diego, forcing the site to close for several days because it ran out of doses [111842]. (d) value: The software failure incident also involved failures where the systems performed their intended functions incorrectly. For example, tech mishaps in California allowed ineligible people to snatch up appointments [111842]. (e) byzantine: The incident did not specifically mention failures due to byzantine behavior, which involves erroneous and inconsistent responses and interactions. (f) other: The software failure incident exhibited various other behaviors not covered by the options listed, such as reusable appointment links being shared widely, causing overbookings and confusion [111842].

IoT System Layer

Layer Option Rationale
Perception None None
Communication None None
Application None None

Other Details

Category Option Rationale
Consequence harm, property, delay, theoretical_consequence (a) death: There is no mention of people losing their lives due to the software failure incident in the provided article [111842]. (b) harm: The article mentions that at a vaccination event in Richmond, people who had re-used appointment links showed up, overbooking the event, leading to confusion and irate behavior from individuals who were turned away [111842]. (c) basic: There is no mention of people's access to food or shelter being impacted due to the software failure incident in the provided article [111842]. (d) property: The article discusses how software issues led to overbookings at a vaccination event in Richmond, causing disruptions and potentially impacting the efficient use of resources [111842]. (e) delay: The software failure incident caused delays in vaccine rollouts in places like Washington State, Pennsylvania, and Massachusetts [111842]. (f) non-human: There is no mention of non-human entities being impacted due to the software failure incident in the provided article [111842]. (g) no_consequence: There were observed consequences of the software failure incident, such as delays in vaccine rollouts and overbookings at vaccination events [111842]. (h) theoretical_consequence: The article discusses potential consequences of the software failure, such as the need for investment in technology for public health departments and the challenges faced by health officials in managing appointments online [111842]. (i) other: The article does not mention any other specific consequences of the software failure incident beyond those discussed in options (a) to (h) [111842].
Domain health The failed system mentioned in the articles was related to the **health** industry. The software was used by state health officials in Virginia for scheduling coronavirus vaccine appointments [Article 111842]. The system faced various issues, including confusing interfaces for older adults, reusable appointment links leading to overbookings, delays in dispensing shots, and glitches in the appointment scheduling tools used by state and local health departments across the country. The software failures in the health industry had significant implications for the vaccine rollout process and the efficiency of vaccination programs.

Sources

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