June 24, 2021
Early in the Covid vaccine rollout, the cities of Issaquah and Sammamish, Eastside Fire & Rescue, and the Snoqualmie Tribe formed the Snoqualmie Tribe Vaccine Partnership.
As a sovereign nation, the Snoqualmie Tribe provided the vaccines necessary to make the planned mass vaccination site at Lake Sammamish State Park a reality, thereby establishing the first community-based mass vaccination site on the Eastside.
The site, which opened April 12, 2021, was administered by Eastside Fire & Rescue personnel and trained volunteers. The following interview has been edited for length and clarity.
Overall, how was your experience working with Signetic and MVS?
We were super stoked with you guys. I mean, this tool was fantastic. It was very easy and user-friendly. Ninety percent of the research I did in planning this site—the roadblocks and the hurdles and the problems that we were seeing out there—we didn’t experience with you guys.
I don't exactly remember which tool it was that [some colleagues of mine] were using, but that was like the bane of their existence. They had to take the data from the registration system, and then manually finger punch it into WAISS [Washington State Immunization Information System] for every single vaccination. I'm so glad I didn't have to do that. I was able to run basically an entire site—600 people a day, some days.
[My colleagues’] site had dozens and dozens of people just trying to do data entry, or some operations were hiring contractors or companies to do just that part. MVS just streamlined everything. It was firefighter friendly, on the iPads, so our guys could figure it out, the volunteers could figure it out, and the people could figure it out.
While we only did about 15,000-plus vaccines in a pretty short time, that contributed I think to the Eastside having some of the best vaccine rates in the nation. Sammamish, which is sitting at 95 percent of residents that have started their series, and I think it's probably over 90 have completed their series—everyone aged 12 and up. So, awesome job.
How did the relationship with the Snoqualmie Tribe work out?
It worked out amazingly well. We were able to just register them on the spot. So if we did have someone who was a walk-up, we were always able to pull extra doses if we needed them. So we never really had to account for that. We could just say, “Hey, somebody wants to get a vaccine, send them down, we'll just give it to them.”
The first couple of weeks, we'd open up appointments, and they were gone in like a half-hour. And right when we were planning on getting busy is right when the saturation kind of hit maximum overload, and things started slowing down. So we never got to that crazy amount.
And it worked out really well with the tracking, being able to title the vaccines a common name was extremely helpful, because—especially at the end there—we started getting the same lot number again.
I remember once we got the same lot from Seattle Fire, because we needed something that was going to expire later than what the casino had, so we traded them some vaccine. I'm looking at it, and I'm like, "I recognize this number,” and I looked it up and realized, “Oh, well it's a different expiration.They probably thawed it out at a different time.”
But we were able to just name it something else and it still tracked to the WAISS data entry every night—never had to worry about it. You know, I'd get my report with no errors. I'm like, that made me look good, so. [laughs]
Yeah, you had fun with it. You were one of the few groups that was naming them separately from the lot number, after Pokemon, right?
Yes, they were all after Pokemon. I'm like, “What's something I'm never going to run out of? There's like a thousand Pokemon. We're good.”
People liked it. We'd have a little white board with the vaccine, what lot number they're using, and who their practitioner was, so they could always make sure. The greeter station showed [the names we used]. We had some head honcho from Nintendo, and he's like, "Wait a minute, I'm getting vaccinated with Pikachu?" We're like, "Yeah, let's do this." It was fun.
Yeah. People were very happy. We were also able to really work out the language translation stuff on site. Connectivity never seemed to be a problem. We had a cradle point donated by T-Mobile, and that’s running our Wi-Fi throughout the area, where we also have cellular-enabled iPads. Being able to do all this on an iPad was really useful.
It wasn’t until, I think, the last week when we finally had to waste some doses. I mean, basically our entire operation from January, when we were doing it in-house, through the casino, through [the site at Lake Sammamish and the mobile units], the only times we wasted doses is when we maybe had one or two vials that were just going to expire and we didn't get rid of them because that's just how many appointments we had. We had to account. I didn't want to be short. I knew theoretically we'd have half a dozen or more no-shows, but you can't plan for that.
Then at the very end, when we'd only have maybe 56 appointments or something, you can't pull those six extra doses out of five vials and you'd have to crack open that one and we wouldn’t be able to use what’s leftover. It was unavoidable in those cases. But we did pretty good. Out of 24,000 doses, I think we may have wasted about 25 total.
That's very efficient.
We were driving the truck around the beach, picking up people. At the beginning, we'd have an extra dose. It was different. I mean, you saw how things evolved, where at the end I'm like, "Do not pull 11 doses. I want to account. I need to get rid of these vials before they expire."
When we first started, vaccines were like the most valuable thing on the planet. It's like, "Pull 12 out only if you can do it. Every dose counts!" and we were accounting for that, but it was definitely kind of screwing up our numbers on the ordering side. So, we learned.
I think I ended up transferring, probably something like 2,500 doses, that the casino had over-ordered, to other clinics across the state who could use them at that moment—before we could, before they'd expire.
So your clinics all talk to each other, then? Did you have a network or a phone call once a week or something?
Some of this was through just common networking. At the end there, when we realized, "Wow, we ordered too much. This thing kind of dropped off." We're calling different counties, the Tribes were able to connect some through different Tribal clinics. Then I was working with Seattle Fire on some of theirs, but mostly just calling different [environments of care] or public health, and they helped facilitate some of that transfer. But it was nerve-wracking at first, because I'd call Pierce County and they were like, "Yeah, we’ve got 3000 that are expiring this week as well, and we can’t get rid of them."
I'm like, "I am not burning thousands of doses. We are going to find a solution." We were driving up towards Stillaguamish [River] up North, and just transporting this stuff across the state if we had to. We had a team ready. "Let's just get on a plane and go to India, get it done." [laughs]
That would be better in the future to have some sort of broader overarching coordination. The state should have been able to mutually transfer these things out to places.
Working with the Puget Sound Fire and Fire Authority, they had five other fire departments working with them. So Bellevue and Issaquah, and a couple others. So they were all kind of in the same group together. That seemed to have been another model in the future.
Yeah, they created classified lists on WAISS, where organizations could post extras, and people can look for them that way. I don't know how successful that was. We did daily reports to the casino, to let them know how many vials we used, how many we were holding on to, and what was fulfilled every day.
People loved the dashboard, which is probably one of the simpler things you developed compared to all the stuff in the back. But that helped immensely, when we were presenting to councils and presenting to boards, to be able to visualize and heat map out those demographics. It made the operations a very easy sell to elected officials, when they can see a map and their jurisdiction is the darkest color and they're like, "Yay. We did it."
Ted [Clark, VP of Data and Business Analytics] made the dashboard, and everybody loved Ted. The rest of the team was kind of mad at Ted because he was getting all the credit.
So Ted's like the AmeriCorps intern? "I got it, guys." [laughs]
Yes, and he got all the compliments.
So I also have to give props to Jakub [Svec, Customer Success Manager] and Lukas [Svec, VP of Product]. I probably called you guys more than I deserve, or you should charge me more. But you guys were always quick to answer and pick up the phone and resolve any problems we had and talk me off the ledge, especially when we were first going. So, thank you.
You really made our lives a lot easier. So, if you would have asked me a couple of months ago if we'd be in this business, I would have said probably not, but it worked out very well. It gives us a good win, which is always great as an organization. People love the site. They loved how easy it was.
I mean, no matter what, in this vaccine process, as a patient, you're forced to wait at least 15 minutes. We had that process down where people were in and out of our site in 18 minutes. It was really easy to get people registered and do all that. I never had any complaints about it—very easy functionality.
Do you remember how specifically you heard about Signetic MVS? Somebody told me you'd heard about Lumen Field?
Yes. So, back in February, I was tasked with organization, essentially, "We want a mass vaccination site," and I'm like, "Okay, let's do this." So, I started researching around, and we figured we'd learn how to do it, build a plan real quick, look at the different models and the partners—with the City of Sammamish, and Issaquah, and originally Swedish Hospital.
I believe it was Swedish who might've sent us your way, or at least let us know that Seattle was using MVS. I really quickly moved to a drive-through model. I just felt that it'd be easier on staff, on volunteers. You wouldn't need such a footprint. It was hard to find a space that was not going to be dedicated. Things were already starting to slowly reopen, like schools, so some of the traditional sites that we may have wanted were unavailable.
So I wanted to do a vehicular site. I'm looking at [the operations my colleagues were running]. We kind of built a plan based around their model and found a scalable option to be able to do it and then identified what the roles would be. The main thing we wanted to avoid was the data entry piece.
Talking to their leadership, they kept saying, "This is the biggest pain right now. This system."
They hated it, loathed it. Then I'm [observing their operation], and they had a whole team, a whole tent, full of just data people.
I'm thinking “Well, that's going to one be a real pain, because you're dealing with volunteers.” We got to a point where I was pricing out a temp agency. Where we'd have volunteers to do some of these other jobs, but if you could have the same four or five people doing just data entry all day, they could learn the tool and make it easier.
I go back to [check out my colleagues’ operation] a few more times, and now they’ve moved these people into a side office, and they're having to make sure it's all done quickly, while patients are waiting in observation, because the staff are encountering issues, and they didn't have all the information, so they're having to run out and talk to the people in observation. So I said, "Okay, if I can do anything to avoid that, I will."
So, I heard the rumor that Seattle had a program that can talk directly to WAISS. I said, "Okay, well, I'd like to find out who that is." So, I sent out an email, got some bids together, and I'm like, "Perfect. This sounds affordable, sounds doable." Talking it over with the cities, they're like, "Yes, we love this idea. It's going to save us ..."
I'm thinking “It's going to save me more money in the long run, probably just because I won't have to hire a data management company, just to make sure it's done right.”
How did things go after you made the decision to go with MVS?
We started going through the process, getting the iPads, getting the tools. We had a site that was sitting there basically vacant for a month. I mean, it was built. I called it the Field of Dreams site, because we were planning on getting some dang vaccines through public health. We're arguing then, "This is why we need this here, we can support it, we can staff it. All you have to do is give us a piece of your pie."
This is the same time they're standing up Lumen, and of course I'm talking to them every week. I'm saying, "If you can do 20,000 vaccines here, do 19,000, give me a thousand a week. That's a thousand less people that have to drive to Seattle." There was no other publicly run operation for Eastern King County.
There was the Redmond site up at Microsoft. But again, every other site was run by a hospital or University of Washington or something like that. The only King County public health-driven sites were down in Southern King County, and then they started opening the Seattle sites. I'm thinking, “That doesn't work for our population.”
At what point did you start working with the Snoqualmie Tribe?
We had been working with the Snoqualmie Tribe in the past, doing the medical components of their vaccine operations. They had been doing weekend clinics at the casino for their staff, for their family. Then they started opening up to the public as well. I think we did about 6,800 doses through that operation, a couple of months with them.
I asked them, I said, "Okay, things are opening back up. You're going to want your ballroom back, your casino back. Can we just move our operations to the Lake Sammamish site? We'll do it all. Your staff can go back 100 percent to their normal jobs, and we can work it out." They said “absolutely.” It was an awesome partnership.
They're pushing a whole new ancestral lands movement as well, so this brought a lot of attention to that, the importance, the significance of our site location, to their ancestral lands. It worked out really well. Then we did a soft opening April 8th, and then basically from April 12th on, we were pushing 300-plus a day appointments. It worked out extremely well.
Nice. So, did you set up in a couple of different places?
Right, so our main site was at Lake Sammamish, and that was a permanent drive-through operation. Very quickly we moved away from public health because we had been working with King County Public Health on our mobile vaccine teams, and that was to go out and target vulnerable seniors, and sub-populations, home-bound populations, nursing homes.
So, we started using MVS and the Tribe's vaccine to run our mobile clinics as well. That would help us target some of our vulnerable populations as well. Because, yes, we were a vehicular site. There were some limitations with pedestrians and groups, lower incomes. It wasn't set up to kind of do just walk-ups.
So we used MVS and an outreach with human service personnel in our jurisdictions to find places. We did pop-up clinics at temples, and mosques, and lower-income HOAs, and apartment buildings and things like that. We'd open up some night clinics, so we were just looking for ways to just push those numbers.
Like, “Why might someone not be able to get a vaccine?” Maybe they work all day? Okay, well, let's run some night clinics. We would just send out a team with a van, our vaccine, and supplies and they'd have one or two iPads. One of them would be working the iPad registration.
We would send, maybe, the group organizer who was involved with that particular outreach effort. We’d say, "Hey, use your normal email communication. Here's the private link to register, send it out to your people." Then we would just run it the same way on-site with basically three people doing a 200-per-day vaccine clinic. It worked out very well.
What were the biggest pain points that went away once you started using Signetic? What were the changes that stand out in your mind?
The biggest thing was that you had a tool that was seamlessly running both our patient registration and directly interfacing that with WAISS, so there was no end-of-the-day data dump to King County. I was basically able to take an operational plan for our vaccine sites and cut that in half as far as the amount of personnel and time that was needed.
One of the big issues we were thinking about, especially when doing mobile teams and things like that, is how would we have done that at the end of the day? We were doing this on paper. We're gathering this information. Would we come back at 16:00 in the afternoon and then have to work all evening trying to finger punch in 200 entries into WAISS. I don't want to do that.
If there was ever a problem at any of our sites, I could get on a computer, or I could just walk across to an iPad and be able to solve it. There was never anything that was just so technically difficult that I’d throw my hands up and say, "I don't know what's going on."
It's, "Okay, here's a log in, or here's this." Being able to very quickly track who your practitioner is, when you have changes in personnel, when you have midday lot changes with vaccine. It was honestly a 10-second process. Stop, switch the lot, switch the whiteboard, keep moving. There was never any concern with, "Oh wow, what's going on?"
So you guys were pretty nimble? You guys were moving around, moving in the middle of the day, things like that?
Yeah. I was onsite at the Sammamish site every day, but I was helping to coordinate the mobile teams. I could call them and be like, "You got 10 more appointments, I'm going to cancel out your no shows. Don't crack open that last vile."
It helped with our medicine management, so we didn’t end up wasting vials. MVS gave us a very quick real-time picture of our appointments, who's left, who's remaining, when our slow periods were, when we can break for lunch, things like that. You could categorize it throughout the day for our mobile teams, and you could break up our appointment slots just so they can ensure they have a good break.
Being able to have those private links versus public links, so we could target specific demographics, was extremely useful. Because that was a big thing. When people ask “How did you do your operations in an equitable manner?” we have all these ways to show them. That tool allowed us to do that, because otherwise we'd show up somewhere, and it would still be probably first-come, first-serve, and you wouldn't be hitting those underserved populations.
But yeah, they built the system very well. Jakub and Lukas were always accessible. They came out to the site probably three or four times. They were there for our soft opening. They were there the first week of full operations, whether they were working, building things as we went, working with us on the side to make sure our setup worked.
How did the crew like the software? How did patients like it?
I think it worked great. If I can give it to a firefighter, who's never used it, and watch them do it for, you know, two people, and then they're off and running all day—that's an easy win for me. Because firefighters are like Marines, we can break even the easiest thing.
You guys should be involved in every state, as far as I'm concerned.
April 2, 2021
How do you work toward vaccination equity when the normal forces of supply and demand are haywire?
March 10, 2019
“We think we can do up to 20,000 [vaccinations at Lumen Field] a day,” said Seattle mayor Jenny Durkan at an outdoor Mar. 1 press conference. “But that will take us scaling up both personnel and vaccines.”