When coronavirus vaccines first became available, Virginia health officials turned to software recommended by the Centers for Disease Control and Prevention to schedule appointments. However, people complained that the software called VAMS was too confusing for older adults.

So the state switched to a different system, PrepMod – but that had problems too. Links sent to seniors for their appointments were reusable and found their way to Facebook, resulting in a vaccination event in Richmond with dozens of overbookings. Some of these people threatened health care workers when they were turned away.

“It was a nightmare scenario,” said Ruth Morrison, the political director of Richmond and Henrico County’s Health District. “People who show up confused and angry thinking they have an appointment.”

State and local health departments across the country continue to face delays in delivering shots, partly because appointment software tools such as those used in Richmond remain flawed. The problems threaten to slow the adoption of vaccines, even if shipments and distribution increase rapidly across the country.

Large software systems have often been problematic for companies and governments. HealthCare.gov, a website released after the Affordable Care Act, crashed early. However, the problems with the vaccination sites have an added sense of urgency as health officials try to vaccinate as many people as possible as soon as possible.

On Thursday, President Biden said his government would send technical teams to help states improve their websites. He also said that by May 1, the federal government would open a website that Americans could use to find out where the vaccine can be obtained.

Many state officials have switched software providers just to see little or no improvement. In California, technical glitches have allowed unauthorized individuals to make appointments. Massachusetts residents were hampered by website crashes. Some North Carolina residents eschew online registrations altogether and instead participate in a vaccine that’s free for everyone.

PrepMod is used by 28 states and municipalities after many states eschewed the $ 44 million VAMS tool developed by Deloitte. Salesforce and Microsoft have also developed vaccination software, and their customers are similarly frustrated. Smaller tech companies have also developed their own planning tools.

“It’s like a patchwork quilt,” said Ms. Morrison, who after the Failed PrepMod process decided her county would try something different. “Some of these systems have strengths, but all of them also have weaknesses.”

Other health officials have defended the appointment systems, and the developers behind the software said the complaints about their products were exaggerated.

Tiffany Tate, the creator of PrepMod and executive director of the Maryland Partnership for Prevention, said criticism of their system was largely due to healthcare providers’ lack of knowledge of how to use it or to the ever-changing needs of states.

“The pandemic is moving forward and we need to be able to keep up,” she said. “We just have to be a very flexible platform.”

Deloitte, whose software is used by nine states, said VAMS was originally intended for smaller groups in the early stages of vaccine adoption in the states. As a result, the company “responded quickly to changing requirements” and updated the system to handle a greater load.

Health experts say several factors made software rollout difficult. In some cases, developers condensed work that typically took years to weeks, resulting in glitches. In addition, the different approaches to determining eligibility in dozens of locations using the software made it difficult to develop a unified approach.

Some states use more than half a dozen scheduling systems, from tools used by federal, state, and local government agencies to software used by private hospitals and pharmacies to rudimentary solutions like SignUpGenius. Some websites do not support scheduling at all, but do allow users to search databases to find available vaccines or get on waiting lists. Often the systems cannot communicate with each other.

“You basically build and test data systems on the fly as millions of people try to find vaccines,” said Claire Hannan, executive director of the Association of Immunization Managers, which works for government health departments.

Updated

March 12, 2021, 9:30 a.m. ET

Microsoft, which has sold vaccination software to multiple states and Washington, DC, frustrated New Jersey with its system, and in late February, after days of website crashes in the country’s capital, the company admitted it “fell short “was.

Microsoft said in a statement that it was “designed to help governments manage their Covid-19 vaccination programs as quickly, safely and efficiently as possible”.

PrepMod’s problems have resulted in delays in vaccine rollouts in countries like Washington State and Pennsylvania. When the Massachusetts vaccine appointments website went down for a few hours after a surge in demand, PrepMod took responsibility and apologized.

Andrew Therriault, a Boston-based data scientist, said he was “amazed” at the extent of PrepMod’s shortcomings. One problem he found was that the system didn’t reserve an appointment slot as people filled out their information so that they could be booted anytime someone else hit them on that particular slot.

“I’m trying to imagine someone doing this who isn’t that tech-savvy – it basically means they don’t have an opportunity to compete,” Therriault said.

Some of the login software have also caused a huge headache by not allowing unique registration links that expire after a single use.

The reusable connections have hampered vaccination efforts in places like California, where health departments use both PrepMod and a Salesforce-based system, MyTurn.

What you need to know about the vaccine rollout

In some cases, health officials who wanted to reach black and Latin American communities with low vaccination rates issued MyTurn nomination codes for those groups that ended up being widespread, including among more affluent white communities. Because the codes did not expire after a single use, these people could use them to get vaccinated before their turn.

Ms. Tate of PrepMod said health care workers and others who improperly shared the links were to blame.

“It’s not a problem with our system. That’s a problem with people who should be responsible, ”she said. The company added an option for unique links.

Salesforce declined to comment, but Darrel Ng, a California Department of Health spokesman, said MyTurn added unique links as well.

UC San Diego Health, which operates a drive-through bulk injection facility, is using its existing software in place of MyTurn because the two systems are incompatible, said Dr. Christopher Longhurst, UC San Diego Health’s chief information officer. Otherwise, those arriving in the hospital system for a second dose would have to be separated from those scheduled in MyTurn, he said.

“We’d have to use all of our second doses in some lanes while using new software in other lanes,” he said. It would be “incredibly inefficient”.

This week, the MyTurn system offered more appointments than a Scripps Health-operated vaccination site in San Diego had, causing the site to close for several days because doses were running low.

“There are problems with the MyTurn system,” said Dr. Ghazala Sharieff, Scripps Chief Medical Officer. “These challenges add another layer of unnecessary stress to our team.”

Health officials said reliance on the imperfect tools of outside companies underscores the need to invest in technology for public health departments, many of which still use paper and fax machines to keep records.

According to Mary Beth Kurilo, senior director at the American Immunization Registry Association, state registers that track residents’ vaccination history – called vaccination information systems – could be adjusted to schedule appointments. But the federal government never asked them, she said, and they needed more money and time to prepare.

Some regions have chosen to avoid technology entirely.

In Johnston County, NC, southeast of Raleigh, the Department of Health decided it would have been too taxing for staff to manage appointments online.

The policy has been efficient, said Health Department spokeswoman Lu Hickey, but it does mean the county – which also doesn’t require personal identification – doesn’t know if people are vaccinated in the correct order and are relying on the honor must be system.

In Richmond, Ms. Morrison said officials were looking for solutions and even considered trying VAMS again.

“We cobbled it together at the local level through a lot of manual work and workarounds that we put in place to set up band aids,” she said.