Pandemic Influenza Doses Administered Pilot Reporting Exercise

1
Pandemic Influenza Doses Administered Pilot
Reporting Exercise
2008 National Immunization Conference Atlanta,
GA Joint Presentation March 19, 2008
by Immunization Services Division National
Center for Immunization and Respiratory Diseases
and Division of Emergency Preparedness and
Response National Center for Public Health
Informatics
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Objectives

• Present results from Fall 2007 Pandemic Influenza
  Doses Administered Pilot Reporting Exercise
  (PIDAPRE)
• Share insights and lessons learned
• Discuss early plans for 2008 influenza season
  exercise

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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 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
• CDCs CRA system has been modified to provide
  flexible ways for project areas to report vaccine
  doses administered

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Countermeasure and Response Administration (CRA)

• Genesis in Pre-Event Vaccination System (PVS) for
  national smallpox vaccination campaign
• Supports mass tracking during an event
• Evolved to support any countermeasure, any event
  (medical interventions such as vaccines,
  pharmaceuticals non-medical such as patient
  isolation and quarantine, scarce medical
  equipment and social distancing measures)
• Tracks both detail (person level) and aggregate
  counts of countermeasures

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Aggregate Reporting of Pandemic Vaccine Doses
Administered

• Data Exchange (Option 1) Project area has own
  system (IIS or other CRA) may send using pipe
  delimited, XML file, HL7
• Web Entry Aggregate (Option 2) Project area
  collects/aggregates data manually or
  electronically enters via aggregate reporting
  screen
• Web Entry Detail (Option 3) Project area
  collects individual data via CRA minimum data
  set is automatically aggregated

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2007 Seasonal Influenza Pilot Test

• To test the capability to monitor vaccines doses,
  a pilot using seasonal influenza vaccine as proxy
  for pandemic was developed
• Priority areas to be assessed
• 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
• Vaccination Dates
• Age Groups
• 6 23 months
• 2 18 years
• 19 49 years
• 50 64 years
• 65 years

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Parameters for Fully Successful Participation

• Identify Point of Contact (POC)
• Select option choice
• Identify minimum of two clinic dates
• Send data for both clinics within 48 hours

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Pilot Task Expectations
Phase I Pre-Pilot Planning Apr-Oct 2007
Phase II Pilot Test Nov-Dec 2007
Phase III Post-Pilot Jan-Mar 2008

• Webinars - Orientation introduction

• Conference Call -After Action Review feedback of
  pilot

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

• Webinars - Option specific open QA

• Develop After Action Report

• Pilot Test Project Area support trouble
  shooting

• Conference Calls - Individual project areas
  follow up for QA

• Conduct results briefings

• Develop/administer feedback questionnaire

• PHIN conference presentation

• Apply lessons learned CRA development, future
  pilot

• CRA Development - Version 1.6 release

• Selection of POC

• Submit influenza vaccine doses administered data
  to CDC

• Respond to feedback questionnaire

• Identify submit option choices

• Finalize submit clinic dates

• Participate in After Action Review conference call

• Review option-specific checklist

• Obtain digital certificates

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Option Choices by Project Area
Data Exchange
Chicago
American Samoa
Web Entry aggregate
NY City
Marshall Islands
Web Entry Detail
Guam
DC
Mariana Islands
Virgin Islands
LA county
Palau
Puerto Rico
FS Micronesia
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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
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Data Submission Timeline All Options
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 12
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Need for More Than Systems!
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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)
• 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 have scheduled meeting with
  Chief Information Security Officer to determine
  what is feasible during an emergency during
  normal times
• Timeliness
• Process for accessing
• Data exchange specifications in process of
  clarifying and improving data exchange document
• Timing-out user sessions immediate issue
  corrected reviewing configuration to avoid in
  future
• Communications training conference being
  considered

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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 administered collected)
• Issues/barriers identified will assist in
  improving Pandemic Influenza preparedness
• Broader/deeper testing recommended for next
  influenza season project areas are supportive

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Proposed 2008 - 2009 Seasonal Influenza Exercise
Objectives

• Increase frequency to test weekly reporting
  capability, project areas send data for a minimum
  of four consecutive weeks
• 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
• Increase timeframe to ease participation,
  expand exercise timeframe to October 1 - December
  31, 2008

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HHS Proposed Pandemic Priority Groups as of
October 2007
http//www.pandemicflu.gov/vaccine/prioritization.
pdf
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Current Thinking on Data Collection and
Aggregation Strategies

• The proposed HHS prioritization format lists 4
  Categories, 14 Tier Groups and numerous Target
  Groups
• Data collection and aggregation will be
• by Category,
• by each Tier Group (1, 2, 3 ) within each
  Category, and
• by each Tier Group across all Categories
• Data collection and aggregation will not be done
  at the individual Target Groups
• Examples next slide

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Proposed Doses Administered Category and Tiers

• Homeland and Nations Security
• Tier 1 (HNSt1)
• Tier 2 (HNSt2)
• Tier 3 (HNSt3)
• Health Care and Community Support Services
• Tier 1 (HCCSSt1)
• Tier 2 (HCCSSt2)
• Tier 3 (HCCSSt3)

• Critical Infrastructure
• Tier 1 (CIt1)
• Tier 2 (CIt2)
• Tier 3 (CIt3)
• General Population
• Tier 1 (GPt1)
• Tier 2 (GPt2)
• Tier 3 (GPt3)
• Tier 4 (GPt4)
• Tier 5 (GPt5)

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Priority Groups for 2008 Exercise

• Focus on General Population Category and its Tier
  Groups
• General population, Tier 1 (GPt1) contains
• "Pregnant women
• Infants and toddlers 6 - 35 months old"
• General population, Tier 2 (GPt2) contains
• Household contacts of infants lt 6 months"
• Children 3 - 18 years with high risk
  conditions"
• General population, Tier 3 (GPt3) contains
• Children 3 - 18 years without high risk
  conditions"
• General population, Tier 4 (GPt4) contains
• Persons 19 - 64 with high risk conditions"
• Persons gt 65 years old"
• General population, Tier 5 (GPt5) contains
• Healthy adults 19 - 64 years old"
• Build Other 9 Tier Groups - Not planning to
  collect data on these for the 2008 exercise

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Next Steps

• Continue to disseminate pilot test results
• Seek input from project areas and other partners
  on 2008-2009 seasonal influenza exercise plan
• Update exchange specifications
• Continue CRA application enhancements
• FY 2008 opportunities for project areas to obtain
  funding to enhance their ability to and report
  doses administered data
• CDC\Funding COTPER competitive proposal
• To immunization grantees via Section 317
  mechanism
• Begin Webinars and training for 2008-2009 exercise

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Thank you!