When Allentown started vaccinating health workers last month, people who weren’t tech-savvy had trouble signing up for appointments. Sites were sometimes overbooked. Clinic employees would be ready to vaccinate 500 people, health director Vicky Kistler said, and 600 would show up with appointments.

The city was using a registration software called PrepMod, which it could access for free under a state contract and, most important, synced with the commonwealth’s immunization record system. It sounded like the easiest option for scheduling thousands of vaccinations and saved workers hours of tedious work manually inputting demographic data that must be reported within 24 hours of vaccination.

But the challenges soon outweighed the benefits, Kistler said.

“PrepMod was a bit cumbersome,” she said. “We were kind of under a crunch to get our clinics up and running.”

The Pennsylvania Department of Health paid $852,000 for the software — and is now weighing whether to use it in soon-to-be-created mass vaccination clinics. But according to officials whose clinics serve five counties, the program has serious flaws: It can’t create private appointment links, overbooks clinics, sends patients incorrect or conflicting scheduling reminders, and lets people make appointments even if they aren’t eligible for the vaccine.

Their complaints highlight one of the key problems with the vaccine rollout nationwide: the lack of a centralized scheduling and tracking system for the shots that need to get into millions of arms.

They also, officials in Southeastern Pennsylvania said, have added to the confusion surrounding the already fraught rollout and in some cases, have even slowed distribution efforts, something clinics can barely afford when vaccine supply is low and appointments scarce.

“Not having enough vaccine is the biggest issue, but this is right behind it,” Montgomery County Commissioners’ Chair Val Arkoosh said Monday.

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Despite repeated complaints to the state and software developer over the last several weeks, local officials said few fixes have come. Arkoosh said staffers in her county and others have shared their concerns with PrepMod representatives and asked for fixes, “and so far that’s not been coming.”

PrepMod’s creator, Tiffany Tate, executive director of Maryland Partnership for Prevention, did not respond to calls from The Inquirer and emails to a company address were not answered. The Pennsylvania Department of Health said it was making requests to PrepMod for fixes in future versions of the software, but declined to describe the extent of the complaints about the system.

County officials said they and others participated in regular calls with PrepMod and with the Department of Health about the program. A state spokesperson declined to say how many requests for fixes the state has made, saying the Health Department could not comment while “in contract” with PrepMod.

In Allentown, the health bureau ditched the software within weeks and reverted to Schedule-Me, a service it had previously used that was familiar to residents.

“To build the ship in the middle of the hurricane,” Kistler said, “is much harder than steadying your own boat.”

Few alternatives

PrepMod was created by Tate under a subsidiary of her organization, a software company for health providers called Multi-State Partnership for Prevention.

Tate has run vaccine clinics in communities of color for years, and last spring offered the software to the Centers for Disease Control and Prevention, the New York Times reported Saturday, but the Trump administration instead contracted with Deloitte. Tate, who according to the Times has sold PrepMod to 27 states and jurisdictions, has accused Deloitte and the CDC of stealing her intellectual property, claims the firm and the agency deny.

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Pennsylvania’s Health Department offered the software to county and municipal health departments, which are not generally equipped for large-scale vaccine administration, and encouraged them to use it, hoping to save them money.

“PrepMod offered a cost-effective and efficient solution that has the potential to not only support the department’s COVID-19 mission but to support future department vaccination efforts,” said Department of Health spokesperson Maggi Barton.

PrepMod has distinct benefits: Along with automatically sending patients’ racial and demographic data to the state record system, it also schedules and keeps track of patients’ second-dose appointments. The state has also offered free training, county officials said.

The Department of Health could not say how many counties are using the software.

“Overall the system is fairly comprehensive,” said Bethlehem Health Director Kristen Wenrich, “but it does have some kinks that we have been actively trying to iron out with PrepMod.”

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In California, vaccine providers have alleged that the software was slowing the rollout. In Maryland, Virginia, and Minnesota, people have scheduled appointments, not knowing that PrepMod was booking more slots than were available or allowing them to access a system for which they weren’t yet eligible.

It’s not clear whether there are better alternatives. States have reported problems with the CDC’s Deloitte-developed system, which the Times reported only 10 states are using.

But creating a different system is also fraught with challenges.

“We’re essentially building the plane as we’re flying it,” said a Health Department spokesperson in New Jersey.

It worked with Microsoft to create its own software, but the NJ Vaccine Scheduling System has encountered technical issues — workers at the Gloucester County site gave shots last month to hundreds of extra people after appointments were double-booked. The spokesperson said Microsoft has worked to fix problems and the system has largely been efficient.

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Chester County is using a system it already had in place called Acuity; so is Delaware County. In Philadelphia, most vaccine providers, including hospitals, are using their own scheduling programs, said Health Department spokesperson James Garrow. The city uses PrepMod at its “relatively small” clinics and has not run into issues, Garrow said.

‘Quite frustrating’

Others haven’t been as lucky. When last week’s snowstorm cleared, Montgomery County staff meticulously rescheduled two days’ worth of canceled appointments. But PrepMod sent conflicting emails to residents, notifying them of appointments that didn’t exist or sending double messages, a county spokesperson said.

In Bucks County, residents have also gotten appointment reminders showing incorrect times, officials said.

In Bethlehem, where the health bureau serves residents in both Lehigh and Northampton Counties, the system let people register for appointments even when clinics were already fully booked.

Counties have received reports of people having to start over and reenter all their data if their chosen appointment time gets taken while they’re registering. The system also reportedly functions poorly on certain internet browsers, and it’s difficult for counties to customize emails, officials said.

One of the most challenging problems: The software doesn’t create unique appointment links that can be used only once. So people share their appointment links with friends and on social media, allowing ineligible people to sign up and thwarting counties’ efforts to offer appointments to residents in the order in which they signed up online.

» READ MORE: The (im)morality of line-jumping to get COVID-19 vaccine

As a result, staffers spend precious time canceling appointments made by people who aren’t eligible. The Allegheny County Health Department has been slowed by checking registrations and canceling anyone ineligible, Health Department Director Debra L. Bogen said last week. Like Arkoosh, she asked residents to stop sharing links, and also asked people to help their neighbors use it.

“The online registration system is not easy to navigate and can be quite frustrating,” she said.

Barton, the spokesperson for the Department of Health, said the counties are responsible for their own vetting processes.

She said the state is working with PrepMod and local health departments to recommend improvements and request software updates, but she would not provide specifics about conversations with PrepMod, any fixes the state has asked for, and whether or when the changes will be made.

Now, Montgomery County officials are considering whether to keep using PrepMod or find a different system, Arkoosh said. If they don’t use PrepMod, staffers would have to do double data entry, which would be extremely time-consuming. But as long as they continue, they’re concerned about the effect on the rollout and disappointment for residents seeking appointments.

“These issues,” Arkoosh said, “are creating confusion and distrust of the system.”