TM1

Tracking Influenza Vaccine Doses Administered: Pilot Test of CDC’s Countermeasure and Response

Administration SystemPHIN Conference Atlanta, GA

August 26, 2008

Jeanne Santoli, MD, MPH1 and Jeanne Tropper, MS, MPH2

1Immunization Services DivisionNational Center for Infectious and Respiratory Diseases

Centers for Disease Control and Prevention

2Division of Emergency Preparedness and ResponseNational Center for Public Health InformaticsCenters for Disease Control and Prevention

TM2

Co-Authors

• Jeanne Santoli, MD, MPH• Jeanne Tropper, MS, MPH• Tom Shimabukuro, MD, MBA, MPH• Sanjeeb Sapkota, MBBS, MPH• Warren Williams, MPH• Charles Williams, MPH, MA• Ulrica Andujar, MPH• Sabrina Walton, MPH

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Talk Outline

• Background• 2007 Vaccine Doses

Administered Pilot Results; Lessons Learned

• 2008 Vaccine Doses Administered Exercise

• Question and Answer

TM4

Background

• The National Strategy for Pandemic Influenza: Implementation Plan calls for monitoring appropriate use of scarce pre-pandemic/pandemic influenza vaccine

• To accomplish this, Project Areas are expected to track pandemic influenza (PI) vaccine doses administered at the individual patient level and then send a subset of data (minimum data set) on a weekly basis to the CDC; Project Areas are the 50 states, 4 large cities and 8 territories

• CDC’s CRA system has been modified to provide flexible ways for Project Areas to report vaccine doses administered

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PI Vaccine Doses Administered Minimum Data Set for Reporting

to CDC • Project Area ID• Reporting Period Start and End Dates• Vaccine Type (CVX code)• HHS Pandemic Priority Groups

• Homeland and Nations Security• Health Care and Community Support Services• Critical Infrastructure• General Population

• Dose #• Count of Doses Administered per Priority

Group and Dose #

TM6

HHS Proposed Pandemic Priority Groups

http://www.pandemicflu.gov/vaccine/allocationguidance.pdf

TM7

Countermeasure Response & Administration (CRA) Overview

• Genesis was Pre-Event Vaccination System (PVS) for national smallpox vaccination campaign

• Capability to support mass tracking during an event

• System has been evolved to support any countermeasure, any event

• Includes the ability to track both detail (person level) and aggregate counts of countermeasures

TM8

Pipe-delimited File

State enter data into state’s Immunization Information System or some other equivalent application and is extracted in one of these format.

CRA Option 1 Data exchange

Aggregate data entered directly intoCRA via the web-based aggregate reporting interface

CRA Option 2Direct web entry

The file is then securely transferred to CDC via either CRA application or PHIN MS and loaded into CRA for reporting

Individual level data is entered directly into CRA via the web based flexible Treatment interface

CRA Option 3Individual level data entry

Data is available in CRAfor reporting

Individual level data are automatically aggregated by CRA system and isavailable for reporting

XML File

Aggregate Reporting Options

HL 7

TM9

2007 Aggregate Reporting Pilot Test

• To test the capability to monitor vaccines doses, a pilot using seasonal influenza vaccine as proxy for pandemic was developed

• Pilot Test Purpose:• Project areas on ability to collect and report

to CDC; access aggregate reports • CDC assessed on technical capability of CRA

to accept and aggregate data • Exercise was designed to be minimally

invasive to normal operations• Time frame: November 1 – December 31,

2007• Frequency: Repeatable; at minimum - twice

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Pilot Minimum Data Set

• Project Area ID• Date of Clinics• Age

• 6 – 23 months• 2 – 18 years• 19 – 49 years• 50 – 64 years• 65+ years

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Parameters for Participation in 2007 Pilot

• Identify Point of Contact (POC)• Select option choice• Identify minimum of two clinic

dates• Send data for both clinics within 48

hours – “fully successful”

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Phase I: Pre-Pilot Planning

Apr-Oct 2007

CDC

Tasks

2007 Pilot ActivitiesPhase II: Pilot Test

Nov-Dec 2007

Phase III: Post-Pilot

Jan-Mar 2008 Webinars - Orientation &

introduction

Webinars - Option specific; open Q&A;

Selection of POC

Conference Calls - Individual project areas; follow up for Q&A

PHIN conference presentation

Identify & submit option choices

CRA Development - Version 1.6 release

Pilot Test - Receive & process clinical data from 62 project areas

Finalize & submit clinic dates

Review option-specific checklist

Develop/administer feedback questionnaire

Respond to feedback questionnaire

Develop After Action Report

Conference Call -After Action Review feedback of pilot

Obtain digital certificates

Conduct results briefings

Participate in After Action Review conference call

Submit influenza vaccine doses administered data to CDC

Pilot Test – Project Area support & trouble shooting

PA

Tasks

Apply lessons learned – CRA development, future pilot

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2007 Option Choices by Project Area

Web Entry aggregate

Web Entry Detail

Data Exchange

LA county

DC

NY City

Chicago

Marshall Islands

Guam

Mariana Islands

Virgin Islands

Puerto Rico

Palau

FS Micronesia

American Samoa

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2007 Summary Results• Pre-Planning

• 100% (62/62) identified a POC• 100% (62/62) selected an Option• 85% (53/62) submitted both clinic dates

• Pilot • 89% (55/62) submitted some data • 11% (7/62) did not submit any data• 64% (35/55) fully successful

• Post-Pilot• 55 Respondents completed on-line feedback

questionnaire • 61% (38/62) participated in After Action

Review call

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Kansas Governor, Kathleen Sebelius, getting influenza vaccination in a Pilot Influenza Clinic, Kansas

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The Kansas Bee Mascot says:“Be wise, get immunized!”

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Timeliness Among All Options by Aggregation Method

11 11

5

21

6

23

3

0

5

10

15

20

25

30

Data Exchange Web Form Aggregation Individual Pt Data

Num

ber o

f Pro

ject

Are

as Yes (Within 48 hrs)

No( >48 hrs)

Did not report

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Data Submission Timeline All Options

55

24

95

15 16

0

10

20

30

40

50

60

24 hrs 48 hrs 72 hrs 96 hrs >120 hrs Data notreported

Timeline of Data Submission (Hrs)

Nu

mb

er

of

Cli

nic

Da

tes

Note: N= 124 clinic dates

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Aggregation Method Among Web Entry

Aggregate Users (Option 2)

• IIS or other system : 23.5% 8/34• Spreadsheet : 41.2% 14/34• Paper based (reported) : 17.6% 6/34• Paper based (did not report) : 17.6% 6/34

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Timeliness by System Reporting Technique –

Options 1 and 2

21

0

24

10

65 40

63

0

5

10

15

20

25

30

Nu

mb

er

of

Clin

ic D

ate

s

Yes-48 hours

No-48 hours

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Need for More Than Systems!

26 27

4

16

0

5

10

15

20

25

30

35

40

System Manual

Data Aggregation Method

Num

ber

of C

linic

Dat

es

Yes-48 hours

No-48 hours

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Option Choice Switching

5 Project Areas (PA) switched from original option choice to other choice when data reporting began• Option 3 to Option 1: 1 PA• Option 2 to Option 1: 2 PA• Option 3 to Option 2: 1 PA• Option 1 to Option 2: 1 PA

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Feedback Questionnaire

• Project Areas requested to complete anonymous, on-line feedback questionnaire

• Nine questions highlighting:• Efficiency of communication from

CDC• Benefits of pilot test• Issues/barriers encountered• Feedback to improve future

exercises

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Question: How beneficial was this pilot test to you in preparing for a pandemic influenza event in the future?

• 14 respondents : Very Beneficial

• 38 respondents : Somewhat Beneficial

• 3 respondents : Not Beneficial

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Question: What issues, if any, did you encounter while transmitting data to CDC?

• 18 respondents : digital certificate • 12 respondents : file format • 12 respondents : SDN (timing out);

technical issues

• 9 respondents : Coordination with their local health departments

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After Action Review Call Feedback

• Confirmed findings from Feedback Questionnaire• SDN timing out affected efficiency• Digital certificate process was a concern

• Supplemented findings from Feedback Questionnaire• CRA was easy to use• CDC/CRA support was good (technical and project)• Need consistent communication by CDC

• Distribution lists• Requesting all information at once• Leading implementer information

• Support for expanded pilot for 2008 - 2009 influenza season

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Strategies for Addressing Challenges

• Digital certificates: two parallel approaches• System design to allow lower level of

security; expected late FY2009 • Internal decision memorandum of

understanding• Timing-out user sessions: immediate

issue corrected; reviewing configuration to avoid in future

• Communications:• Training conference• Communication consistency• Small group calls

TM28

2007 Pilot Total Doses Administered

• 56,667 doses administered across all project areas

• Doses administered by age group:• 6 – 23 Months: 6.4% (3,618)• 2 – 19 Years: 23.0% (12,999)• 20 – 49 Years: 22.6% (12,836)• 50 – 64 Years : 24.4% (13,847)• 65 Years +: 19.6% (11,119)• Not identified 4.0% (2,248)

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Conclusions• Excellent willingness to participate across

project areas• Vast majority (89%) of Project Areas able to

collect, transmit, retrieve data• Nearly 2/3 of Project Areas submitted data

within 48 hour time period• Challenges do exist, technical issues are

being addressed • CRA able to accept, aggregate data submitted

doses • Issues/barriers identified will assist in

improving Pandemic Influenza preparedness• Project Areas supportive of broader/deeper

testing during 2008 influenza season

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2008 - 2009 Seasonal Influenza Exercise Objectives• Timeframe: October 1 - December 31,

2008• Increase volume: to test system and

operational capacities, Project Areas send data from a minimum of eight clinics during the four weeks

• Track prioritization: to test tracking priority groups, Project Areas use proposed prioritization framework

• Weekly reporting: to test weekly reporting capability, Project Areas send data for a minimum of four consecutive weeks

• Tied to 2009 CDC PHEP continuation guidance biosurveillance requirement

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PHEP Biosurveillance Credit

• PHEP biosurveillance credit• At least one of the eight clinics must be in a

CRI/MSA location• At least one of the eight clinics must be in a non-

CRI/MSA location• For Project Areas residing fully within a CRI/MSA

location (i.e. LA, DC, Chicago, NYC) all eight clinics by default will be CRI-MSA with no non-CRI-MSA clinics reported

• For Project Areas of the Pacific Islands and Territories, Puerto Rico, and the Virgin Islands, which do not have designated CRI-MSA locations, all eight clinics will be non-CRI-MSA with no CRI-MSA reported.

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DAX Status

• Release of CRA v.1.8 development is complete; testing underway

• Exercise planning underway• Vaccine Safety and Doses

Administered Conference concluded 08/22/08

• Project Areas have submitted POCs• Projects Areas are selecting Option

choices

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Acknowledgement• Collaborative effort among:

• National Center for Immunization and Respiratory Diseases (NCIRD) – Immunization Services Division

• National Center for Public Health Informatics (NCPHI) – Division of Emergency Preparedness and Response; CRA Team

• Coordinating Office of Terrorism Preparedness and Emergency Response (COTPER) – Division of State and Local Readiness

• PHEP Grantees and Project Areas – Points of Contact

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"The findings and conclusions in this report are those of the

authors and do not necessarily represent the official positions

of the Centers for Disease Control and Prevention."

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Questions?