Oregon Health Officials Use GIS to Reach Homebound Residents for COVID-19 Vaccination

Returning to normalcy in the wake of the COVID-19 pandemic is imminent, and vaccinations are key to keeping the public safe while moving to the next phases of economic recovery. Two barriers remain in vaccinating the rest of the public. First, officials must continue to encourage vaccine-hesitant individuals to participate. Second, officials must reach the most vulnerable populations: the immobile and homebound individuals who need the vaccination brought to them directly.

In Clackamas County, the Oregon Public Health Department began taking on the task of vaccinating homebound residents. Meeting the county's target of a 70-percent-vaccinated community was not only critical for the county but also crucial in moving the state forward. Clackamas County is the third-largest county in the state of Oregon, with a population of well over 400,000 people and an area of 1,883 square miles.

County leaders recognized the need for a solution that supported a data-driven approach to reaching their homebound population. They would need to know where requests for vaccinations were coming from and their proximity to staff and vaccination supplies. Realizing that the problem of connecting available resources to those in need was inherently spatial, Clackamas county’s public health department turned to geographic information system (GIS) technology for support. In a short turnaround time, local government and county health officials stood up an operations dashboard that helped management understand the daily tasks at hand, coupled with logistics support that would improve efficiency by more than 50 percent. "Through the use of Esri's ArcGIS software, we were able to reduce the time of in-home vaccinations, that was expected to take six months, down to three months," said Kim La Croix, public health program manager at Clackamas County.

When Clackamas County began its in-home vaccination program, hundreds of people requested vaccinations at home. Initially, residents were sent an email with a link to sign up, but the volume of requests became unmanageable. Scheduling appointments was difficult, and there was no way of visualizing appointment locations. Also, the appointment locations were far apart and all over the county, which cost valuable time, lacked efficiency, and led to vaccine doses going to waste. Staff tracked and monitored the vaccination requests via email and through spreadsheets but soon realized that the manual approach was not sustainable. Instead the county needed a solution that focused on the whereabouts of staff and resources.

Through collaboration with medical professionals, scheduling assistants, technical staff, management, public and government affairs personnel, and Esri staff, the county was able to create an effective GIS solution. County staff used ArcGIS Survey123, a mobile-friendly survey app that gathers data. Staff used Survey123 to input appointment requests, generating a location on a web map with all the necessary patient information. Scheduling assistants would then be able to organize vaccination requests based on location. They used ArcGIS Workforce, a mobile app solution that uses location to coordinate a field workforce, to plan daily routes for nurses.

Each day, nurses would update appointment details, navigate to appointments through their smartphones, and communicate real-time information to managers to track the resolution of each request from beginning to end. The previous workflow required too much clerical work as well as an extra resource to constantly update information. This new GIS-enabled workflow updates data from various teams and applications automatically.

From the moment a vaccination request is entered to when a patient receives their dose, there's an immense amount of data to keep track of. All of it is summarized in a dashboard created using ArcGIS, with an interactive web map that presents location-based data on a single screen. Management staff can refresh their dashboard anytime to analyze staffing needs and communicate project status. The dashboard provides holistic and relevant information, so staff can filter for what information they need, such as upcoming scheduled appointments or the type of vaccine is being administered.

While many communities face the challenge of reaching their remaining unvaccinated population, Clackamas County realized that a geographic approach simplifies the process. Using GIS, the Clackamas County at-home vaccinations program reached its goal 50 percent faster than staff initially expected.

The pilot program had a great deal of accomplishments that led to achieving goals and running ahead of schedule, enhancing staff and patient experiences to make people more comfortable, and allowing for growth of the program. Nurses and scheduling assistants were able to adapt quickly to the new technology and integrate GIS solutions with their daily tasks. Equipping nurses with Survey123 app forms on smartphones and devices took little to no training. The project's return on investment enabled a decrease in staff time, an increase in appointments completed, and a reduction in unused vaccines.

This innovation and success shows how Clackamas County is improving the current landscape of COVID-19 vaccine distribution. Many GIS capabilities can help officials in counties across the US and at agencies in other countries deliver public health advancements to underrepresented communities. The COVID-19 pandemic amplified the need for integrating technology with public health care through the use of critical data and analysis to ensure that every community is supported and protected.