Companies of all stripes hoping to get in on the massive infusion of public dollars in the fight against the COVID-19 pandemic were aggressive and fast in ramping up amid the fierce competition.
Among these were the makers of business scheduling software that could be adapted to streamline the task of getting shots into hundreds of millions of arms. By mid-December there were dozens of them jockeying for position, but one emerged as the clear winner in the Utah market: a company named Salesforce.
Not only did the global company with headquarters in San Francisco land a $1.8 million contract with the Utah Department of Technology Services for a vaccination scheduling platform made available to all county health departments, but it scooped up the entire $4.5 million in federal CARES Act money spent by the state for such software services. These included projects with Utah’s departments of transportation, technology services, environmental quality and the division of risk management.
Salesforce didn’t have to go through a new competitive bidding process for these contracts. It was prequalified through an existing state cooperative contract for these other non-vaccine scheduling services, according to the state’s Department of Technology Services.
Some state and local health officials have raised concerns about the selection, a conflict of interest with the powerful lobbyist involved and suggested politics played an outsized role. And while several counties using the Salesforce scheduler praise its effectiveness, fewer than half the local health districts in the state, serving a bit more than 40% of the population, have adopted it. Davis County skipped the software while Weber-Morgan adopted it, and those departments had different experiences.
Pressure, politics and lobbying
“I’m not sure what is going on with this Salesforce issue,” Utah Department of Health Executive Director Richard Saunders emailed Phil Dean, then-interim director for the Governor’s Office of Management and Budget, early last November.
Saunders told Dean and others copied on the email that he and Rich Lakin, the health department’s immunization manager, did not intend to use Salesforce for vaccine distribution.
“I’ve since received at least three phone calls asking if we are going to use Salesforce, and now this email. I would be very grateful if someone would share the other reasons, if any, we need to be using Salesforce,” Saunders said in that Nov. 3 email.
“I feel like I’m being rushed to make a decision which is not a good way to proceed,” Lakin said in his email response to Dean.
Despite those objections, the state contract with Salesforce was signed the next month.
Lincoln Shurtz, then the government affairs director for the Utah Association of Counties, provided the heavy lift for Salesforce in the state, emails obtained through open-records requests show. In addition to his duties with the county group, funded by public monies, Shurtz signed on as the Utah lobbyist for Salesforce last July.
Shurtz said there was nothing nefarious with his work for this client — one of 29 for which he is currently registered as a lobbyist — adding that the county association actually tasked him with the project and state decision-makers knew of his conflict of interest.
The deal just made sense, he said.
“We had numerous counties trying to architect their own software solutions from the ground up,” Shurtz said. “So the cost of doing that was going to be more expensive than a collective solution.”
He noted that the Salesforce software has served the counties well and is also used by the federal Centers for Disease Control and Prevention (CDC).
In truth, only five of the state’s 13 local health districts signed on to use the program — and one of those five abandoned the software after giving it a trial run.
Still, the four local health districts currently using Salesforce — Salt Lake, San Juan, Tooele and Weber-Morgan — cover 42% of the state’s population, according to state technology services spokesperson Stephanie Weteling.
Vaccines began arriving in Utah in mid-December, initially earmarked for front-line health care workers. By year’s end, people 75 and older could begin signing up.
But the five local health districts that opted into Salesforce’s platform didn’t sign on until February or, in one case, early March.
Utah’s latest statistics show more than 2.5 million vaccines have been administered. But more than a fifth of those shots — 559,921 — had already been put into residents’ arms before the Salesforce project started scheduling appointments.
Because of that slow start, how much of an assist the $1.8 million Salesforce program actually provided is difficult to measure. But local health districts were tasked with quickly pulling together all available resources to beat back the virus.
Weber and Morgan
The Weber-Morgan Health Department, which receives 8% of Utah’s weekly vaccine allotment based on population, began scheduling vaccinations in early January. Weber is Utah’s fourth most populous county.
Weber-Morgan began using Salesforce in early March, but the more rural Morgan area stuck with the simpler JotForm system instead. Weber-Morgan Executive Director Brian Cowan described Salesforce as a “one-size-fits-all” service.
“In some ways we haven’t been able to tailor it specific to what we would like, but in other ways it improved our process,” Cowan said, noting it streamlined reporting to the state and also cut down on data entry errors.
“We’ve definitely seen more benefits with the transition than detriments,” Cowan said.
Some individuals had bad experiences with the system. Ogden resident Kathie Darby expressed frustration with trying to line up appointments for herself and her husband, Joe.
“The only way to get an appointment … was online. There was never an answer to calling. Their system crashed and held up everything,” Darby said. “When I finally got through on a call, my only option was to get on a waiting list.”
While waiting, Darby discovered she and Joe could get vaccinated at Davis County’s drive-thru clinic in Farmington. They got their first shots the next day.
Cowan acknowledged the frustrations Darby and others experienced and said Weber-Morgan made adjustments week by week.
“We added phone lines to our building. We brought in volunteers and the National Guard to help answer phones and schedule appointments,” Cowan said.
The state’s second and third most populous counties — Utah and Davis counties — chose not to sign on to Salesforce because they had already designed their own COVID-specific vaccine scheduling systems in advance.
In Davis County, a previous pandemic provided valuable training to longtime health department staff.
“The majority of our leadership had different roles during H1N1, so they got a boatload of experience with mass vaccinations,” said Davis County Health Department spokesperson Trevor Warner. “They knew what needed to be done and how much forward planning it would take to deal with this pandemic.”
Department Director Brian Hatch enlisted the county’s IT staff to build its vaccination scheduler several weeks before the drive-thru clinic went live at the Legacy Events Center, Warner said.
“We had a lot of the bugs worked out, people were trained on it and we were able to hit the ground running with our own system and have more control over it,” Warner said. “Every time a new priority group would be announced, we triple-checked our servers that they were going to be able to hold capacity.”
Box Elder, Cache and Rich
The Bear River Health Department, which serves Box Elder, Cache and Rich counties, test-drove the system in-house and decided against transitioning from the JotForm program it already had in place.
“In the end, we wanted to keep it very simple for the public and create less barriers to get their vaccines,” Director Jordan Mathis said, noting that JotForm was “super easy for the public on the front end”
He also had misgivings as to how Salesforce became the state’s product of choice.
“I think there was some concern with how the product came to be made available to us,” Mathis said. “There was a lot of politics involved and we weren’t sure it would be the best product for public health.”
Salt Lake/Tooele/San Juan
Troy Davis, a nurse supervisor with Salt Lake County Health Department, said the state’s most populous county began using Salesforce at the end of February to schedule appointments. Prior to that time, the county used the ezEMRx system.
Davis credited Salesforce with providing the streamlined capability to schedule multiple days under one event — rather than having to create separate events for each of several vaccination locations every day.
Like other agencies, though, he says they had to field roughly 1,000 calls a day, from those lacking emails or internet.
Leena Chapman, Tooele’s family, school and health secretary, said when her county switched to Salesforce in April it added more work on the front end during the scheduling process, but “once they’re in clinic and on the back end, it’s a lot more accurate.”
Mike Moulton, San Juan’s interim public health director, said his department switched to Salesforce in early March.
“There were a lot of issues that came up that we needed to iron out,” Moulton said, “but they were patient and persistent to address all our concerns and customize the program to be as useful as possible.”
Timing the shot
SalesForce lobbyist Shurtz said that vaccine rollouts were delayed in part while the state awaited key guidance from the CDC.
“To get those guidelines, get into a proven concept and then roll it out,” took until mid-February, he said.
And yet other departments were ready to hit the ground running in January, like the Summit County Health Department, which currently leads the state in vaccinations.
Spokesperson Derek Siddoway said his team was communicating with Summit County residents early by email and phone, laying the groundwork. The outreach was so successful with engaged residents, he said, that “we were giving all our vaccines out every weekend for a month and a half, kind of like Black Friday.”
Summit’s health department looked into Salesforce but decided against switching systems midway into the rollout.
“It took us about a month to get things up and running smoothly,” Siddoway said. “At that point, we decided that if it wasn’t broke, we weren’t going to fix it.”
What the numbers say
As of May 4 — roughly four months into the process of getting shots into arms — CDC data shows Summit County leading the way in terms of percent of total population who have been fully vaccinated. Here are Utah’s top 10 counties:
Summit — 40.8
Wayne — 33.2
Daggett — 32.3
Garfield — 28.5
Kane — 28.4
Salt Lake — 27.7
San Juan — 27.5
Grand — 27.1
Davis — 26.4
Morgan — 24.7
Here are the top 10 counties for percent of population 65 and older who have been fully vaccinated:
Juab — 68
Summit — 65.7
Sevier — 64.6
Weber — 63.9
Beaver — 63.5
Rich — 62.4
Wayne — 62.1
Utah — 61.9
Kane — 60.9
And here are the top 10 counties for percent of population 18 and up who have been fully vaccinated:
Summit — 53
Wayne — 43.6
Daggett — 41.7
San Juan — 38
Davis — 37.8
Salt Lake — 37.3
Kane, Morgan — 37.1
Garfield — 37
Grand — 34.5
Wasatch — 33.9
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