National Immunization Conference

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Vaccine Management Business Improvement Project

• National Immunization Conference
• Dallas, TX
• April 1, 2009
• Ad Hoc Part 2 1215 145 PM

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Agenda

• VMBIP Overview Kim Lane
• VACMAN Karron Singleton
• VTrckS Provider Order Pilot (VPOP) John
  Visser
• VTrckS Janet Kelly
• Data Warehouse Joe McDowell
• Contact Center Julie Orta
• Questions Answers Open Discussion

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VMBIP Overview
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VMBIP overview

• Today, I will be answering the following
  questions
• Why did VMBIP get started?
• What is VMBIP?
• What has been accomplished and what is left to
  do?
• How is VMBIP getting done?

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VMBIP was influenced by many factors

• VMBIP comprehensive review of how public vaccine
  is managed
• The first top-to-bottom study conducted since
  inception of VFC in 1994 many existing
  processes established decades ago
• Several factors drove need for the assessment
• Public health expectations following 9/11
• Vaccine shortage monitoring
• Implementation of a national pediatric stockpile
  and accounting changes
• System limitations to support vaccine funding
  allocations to grantees and DA-vaccine funding
  changes
• Outdated legacy systems (VACMAN supported via
  FoxPro)
• Need to ensure a stable infrastructure for
  decades to come

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2003 VMBIP Business Case Findings
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VMBIPs vision continues to guide us in all of
our decisions

• Establish a world class logistics system in
  support of the public-sector vaccine management
  activities
• VTrckS will process orders in real time
• Adopt commercial industry best practices, create
  efficiencies, and bring more transparency to
  vaccine management
• Deliver the expected levels of service and
  responsiveness to providers, while minimizing
  total supply chain costs
• Processes should be convenient, scalable, and
  flexible
• Ensure appropriate program and financial controls

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VMBIP Benefits To Date

• Improved shortage management capabilities
• Increased visibility into national public-sector
  supply
• Eliminated multiple DA-vaccine funding rounds via
  grant awards
• Supported emergency response vaccine requests
• Able to project national vaccine demand based on
  actual data
• Funds management efficiencies

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VMBIP has financed itself with the savings
realized to-date

• 496M in one-time vaccine savings
• 220M Inventory Reduction - 176M for VFC and
  44M for 317
• 276M Funds Management Transition (VFC vaccine)
• 317 vaccine savings targeted for the Adult
  Hepatitis B Initiative
• Centralized Vaccine Distribution Savings
• Cost per dose savings of 0.09 for centralized
  distribution after benefits

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VMBIP is a multi-year initiative
Key Activities
Baseline current process and develop new model
Centralized Distribution
Centralized Distribution Implementation (June
2008)
VTrckS Provider Order Pilot
Centralized Ordering Implementation
Ordering
Continue process improvements CQI (e.g., EOQ)
Transition grantees to New Funds Management Model
Internal Efficiencies
Stockpile Pilot
Rescoping Pilot
Transition of product
Stockpile
2005
2006
2007
2008
2009
2010
2011
2013
2012
2003-2004
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VMBIPs size and importance require Program,
Business and IT Support
Coordinating Center for Infectious Diseases (CCID)
State/Local Immunization Programs
Financial Management Office (FMO)
Procurement and Grants Office (PGO)
Information Technology Services Office (ITSO)
Coordinating Center for Health Information and
Service (CCHIS)
Management Information Systems Office (MISO)
Providers
SAP
Northrop Grumman
McKesson Specialty
Booz Allen Hamilton McKing
CDC Internal Divisions External
Stakeholders Contractors
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A governance model supports all aspects of VMBIP
and VFC funding
VMBIP Governance Model
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Next Steps

• Realization of centralized distribution benefits
• Data and data analysis (e.g., new vaccine uptake)
• Process improvements
• CQI initiatives (EOQ, etc.)
• Continue enhancing the VMBIP governance model
  with advanced budget planning and process
  improvements
• Funds management/legislative/contractual changes
• VTrckS development and implementation
• Communications and marketing
• Organizational change management
• Training

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We have eleven VMBIP workstreams that are
frequently monitored
VMBIP Executive Sponsor Kimberly Lane
Communications
Project Management Office
Organizational Change Management
VTrckS
Stockpile Storage
Centralized Distribution
Internal Efficiencies
Continuous Quality Improvement
Stockpile Support
Centralized Distribution Support
VTrckS Blueprint
VTrckS Provider Order Pilot
Funds Mgmt Replenishment
VMBIP Contact Center
Data Warehouse
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VMBIP project and change management support

• Project Management Office (PMO)
• The PMO is a business group/office that defines
  and maintains standard operating procedures,
  provides guidance, evaluates metrics and supplies
  project management to the overall program
• Develop an integrated master schedule
• Develop and implement project performance
  measures (e.g., reduction in depots and quantify
  reduction in order timeline with VTrckS)
• Organizational Change Management (OCM)
• OCM is the implementation of a systematic
  approach to accelerate adoption and acceptance of
  a new process and/or system
• Analyze VTrckS requirements to review the degree
  of change to the stakeholders processes
• Plan VTrckS Provider Order Pilot training
  deployment activities

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Todays ad hoc sessions will cover a majority of
the 11 workstreams
VMBIP Executive Sponsor Kim Lane
Communications Julie Orta
Project Management Office
Organizational Change Management
Stockpile Storage
Centralized Distribution
Internal Efficiencies
VTrckS
VTrckS Blueprint Janet Kelly
Continuous Quality Improvement GPE/EOQ Julie Orta
Stockpile Support Jeanne Santoli
Centralized Distribution Support Jeanne Santoli
VTrckS Provider Order Pilot John Visser
Funds Mgmt Replenishment
VMBIP Contact Center Julie Orta
VACMAN Karron Singleton
Data Warehouse Joe McDowell
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VACMAN
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VACMAN Background

• VACMAN is the system currently used by grantees
  to place vaccine orders with CDC
• All grantees were on centralized distribution as
  of June 2008
• Points of Contact
• Karron Singleton
• VACMAN Help Desk

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VACMAN Where are we now? (1 of 5)

• Centralized Distribution Order Statistics
  February 7, 2007 March 25, 2009
• Orders processed for distributor 2,460,409
• Direct ship orders processed 225,679
• Grantee bulk orders processed 3,782
• Order receipts processed 2,637,749
• Orders cancelled 11,030
• Shipments cancelled from McKesson 1,292
• Replenishment orders processed 6,878

Data Source NIPVAC
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VACMAN - Where are we now? (2 of 5)

• VACMAN 4.1.4.3 released March 13, 2009

• Import Feature Corrections
• The flu order import was rejecting because the
  cost entered on the spreadsheet for the import
  did not match the federal vaccine contract cost.
  The precision of the cost in the vaccine table
  was greater than the user could see on the screen
• The non-federal vaccine import was rejecting
  because there is no cost on the non-federal
  vaccine table however, the user was required to
  enter a cost on the import spreadsheet so there
  was no cost match. VACMAN will now validate and
  process the import based on whatever cost the
  user enters on the import spreadsheet for
  non-federal vaccines
• The direct ship vaccine import was failing
  because VACMAN was not properly matching on upper
  and lower case characters

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VACMAN - Where are we now? (3 of 5)

• VACMAN 4.1.4.3 released March 13, 2009

• Flu Screen Corrections
• In previous versions of VACMAN, the non-federal
  flu vaccines could not be ordered from the Flu
  Order Screen this capability was added in this
  release
• Users were getting an incorrect order quantity
  for orders entered on the flu screen due to the
  way the quantity was being calculated
• Duplicate Order Message Correction
• Previous versions of VACMAN gave users a warning
  when they entered duplicate orders however, they
  were allowed to continue with the order. VACMAN
  will no longer allow duplicate orders, and the
  verbiage for the Duplicate Order Message has been
  updated to provide guidance to the users

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VACMAN - Where are we now? (4 of 5)

• VACMAN 4.1.4.3 released March 13, 2009

• Bulk Order Screen Correction
• Grantees were able to order direct ship vaccines
  on the Bulk Order screen. This has been
  corrected so that direct ship orders can no
  longer be entered on the Bulk Order screen
• Multi Order Screen Correction
• The vaccine description/NDC mismatch that was
  occurring on the Multi-Order screen was fixed in
  this release

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VACMAN - Where are we now? (5 of 5)

• VACMAN 4.1.4.3 released March 13, 2009

• Provider Lookup Screen Correction
• The Order History screen was displaying the
  incorrect provider because the PIN search on the
  provider lookup screen was performing a partial
  match instead of a complete match on the PIN
• Reports Correction
• The Orders Entered, Not Yet Sent to CDC report
  did not show duplicate orders that needed to be
  deleted. The report has been fixed so that
  duplicate orders will be displayed. (NOTE
  Although the report has been fixed, with this
  VACMAN release, there should be no duplicate
  orders.)

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VACMAN Where are we going?

• Improve Help Desk support to grantees
• Improve the quality of VACMAN product releases
• Provide VACMAN product updates to grantees in a
  more timely manner
• Ensure VACMAN product improvements reflect needs
  of the grantees

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VACMAN How are we going to get there?

• Help Desk
• Realign Help Desk staff to improve telephone
  coverage
• Dedicate a resource full-time to address VACMAN
  technical issues
• Quality Assurance Added a full-time tester
• Timely Releases Adding another developer
• Change Control Board Modified the composition

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VACMAN How is your feedback incorporated? (1 of
2)

• Establish a VACMAN Users Group
• Recommended by AIM leadership
• Implementation strategy still to be developed
• Use the VACMAN Help Desk

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VACMAN How is your feedback incorporated? (2 of
2)

• VACMAN Change Control Process
• Initiate a Change Request (CR) form
• Submit CR to VACMAN development office for
  technical evaluation
• Hold Change Control Board meeting
• Schedule approved CRs for a release
• CRs will be evaluated based upon complexity, time
  to implement, and benefit to users

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VTrckS Provider Order Pilot (VPOP)
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VPOP Background (1 of 3)

• Key terms
• VTrckS Vaccine Tracking System
• VPOP VTrckS Provider Order Pilot
• PAC Provider Advisory Committee
• IIS Immunization Information Systems
• Points of Contact
• Tonya Martin, Joe McDowell, and Brad Prescott

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VPOP Background (2 of 3)

• Why are we doing the VTrckS Provider Order Pilot?
• Conduct a test run of the online ordering process
• Engage the provider community
• Capture feedback and lessons learned from both
  the grantees and providers to apply to full
  VTrckS
• Reduce burden of handling paper forms and
  increase order accuracy

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VPOP Background (3 of 3)

• How does VPOP fit into the VTrckS schedule?
• VPOP focuses only on the provider ordering aspect
  of VTrckS grantees will still use VACMAN to
  process orders

VPOP
VTrckSRelease 1
VTrckSRelease 2
VTrckSRelease 3
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VPOP Where are we now? (1 of 2)
VPOP Participants
Massachusetts
Chicago
California
Colorado
PR
FM
VI
GU
MH
4 VPOP grantees 18 PAC members 260 participating
providers and growing
PW
MP
AS
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VPOP Where are we now? (2 of 2)

• The Provider Advisory Committee started meeting
  in March 2009. The groups mission is to
• Support VPOP by understanding the approach and
  actively participate in the projects
  implementation
• Serve as early adopters and champions for direct
  web-based provider vaccine ordering
• Discussions occur during monthly meetings
  throughout the pilot period

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VPOP Where are we going?

• VPOP go-live in May 2009
• VPOP providers will enter vaccine requests into
  the online ordering system
• VPOP grantees will review, approve, and load VPOP
  data into VACMAN
• The team will collect user feedback for
  consideration for full VTrckS

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VPOP How will VPOP participants provide their
feedback?

• Monthly evaluations
• Help desk activity reports
• System change requests
• PAC and grantee discussions
• POB Project Officer

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VPOP How will the feedback received be
incorporated?

• Currently, there are two VMBIP workstreams that
  support feedback collection
• Organizational Change Management (OCM)
• Communications
• Change Control Board
• Internal body that reviews all change requests
  and determines if they should be accepted,
  modified, or rejected

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How does VPOP differ from VTrckS?
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Vaccine Tracking System (VTrckS)
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VTrckS Background (1 of 2)

• Vaccine Tracking System (VTrckS) will be a full
  functionality online ordering system that will
  support centralized distribution
• Benefit to providers ability to directly enter
  vaccine requests (orders)
• Benefit to grantees ability to manage vaccine
  orders by exception
• Benefit to CDC legacy systems, including VACMAN,
  will be replaced

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VTrckS Background (2 of 2)

• Key Terms
• External Information System (ExIS)
• Immunization Information Systems (IIS)

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VTrckS Who is involved?

• Stakeholders
• Executive Sponsor and Steering Team
• CDC Subject Matter Experts
• Grantees and providers
• Northrop Grumman to build VTrckS
• Booz Allen to provide business support
• CDC Points of Contact
• Doug Correll and Janet Kelly

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VTrckS Where are we now?
BLUEPRINT

• A Blueprint document has been developed
• A Blueprint is an architects plan OR a detailed
  plan or program of action
• Subject matter experts are VTrckS architects

Source Websters online dictionary
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A Blueprint
BLUEPRINT

• Defines what business processes and
  procedures will be automated
• Defines how our business requirements fit into
  SAP software, a commercial-off-the-shelf product
• Identifies key gaps and options to address

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How did we get there?

• Intense Subject Matter Expert review and update
  of desired Program functionality with refinement
  of system requirements

Current Stage
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Next Steps Build VTrckS (Realization)

• April 2009
• Obtain an approved Blueprint document
• Build full VTrckS functionality
• October 2009
• Final Preparations
• December 2009
• Go-live Pilot 1st Release

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How are we going to get to Release 1 and beyond?

• Continued engagement of all stakeholders (CDC,
  grantee, and provider users)
• Utilize sound project management methodology
• Change management
• Communications
• Training

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How is your feedback incorporated?

• The Grantee Advisory Committee (GAC) provides
  recommendations to CDC
• Recommendations are documented, reviewed and
  approved/rejected via the VMBIP Governance Model

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Examples of GAC Recommendations

• 52 recommendations as of March 24, 2009
• Pre-populate VTrckS with provider account
  information and order history
• Include at least one grantee with an IIS in
  Release 1 pilot
• Include ad hoc as well as standard communications
  from VTrckS
• Provide adequate help desk functions to assist
  with ExIS/IIS messaging

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VTrckS Grantee Advisory Committee
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Potential Grantee Advisory Committee Workgroups
in the future

• ExIS/IIS Messaging Workgroup
• Reports/Support Documentation Workgroup
• Provider/Grantee Ordering - Functional Acceptance
  Workgroup
• User Acceptance Testing

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For more information

• http//www.cdc.gov/vaccines/programs/vmbip/vtrcks.
  htm

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Data Warehouse
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Data Warehouse Background

• Terms
• VMBIP Data Warehouse (DW) is a data storage area
  designed to facilitate reporting by combining
  information from multiple data systems such as
  VACMAN and the McKesson systems
• Points of Contact
• Joe McDowell and Lisa Galloway
• Your POB Project Officer

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Data Warehouse Where are we now?

• Reports available from the Data Warehouse
  include
• Several Internal Reports
• Spend Plan Monitoring
• Weeks of Coverage for Replenishment Orders
• Weekly Operations Data Report
• Nonviable Vaccine Report
• Grantee-Specific Inventory Report

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Data Warehouse Where are we going?

• Reviewing the data
• Fixing data errors
• Looking at timeliness

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Data Warehouse How are we going to get there?

• Additional reports will be available
• Nonviable Vaccine Report Enhancements
• Spend Plan Monitoring
• Information more timely
• VTrckS
• Direct access to reports

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Data Warehouse How is your feedback
incorporated?

• Solicit feedback for consideration to
• Reports desired
• Information needed but not available now
• Opportunities to provide input
• DW Points of Contact
• Joe McDowell and Lisa Galloway
• Your POB Project Officer

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Contact Center
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Contact Center Background (1 of 3)

• What is a contact center?
• A common part of an organization that provides
  support or information to customers/users by
  telephone, fax, and email
• Future centralized customer support for VTrckS
  users
• Will provide VTrckS users with timely,
  consistent, and accurate information

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Contact Center Background (2 of 3)

• Why do we need a contact center?
• Necessary to have customer support
• Necessary to provide timely, consistent, and
  accurate information to providers, grantees, and
  CDC
• Necessary to centralize and standardize support
  in order to ensure quality
• Long term will replace VACMAN and VPOP help desks

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Contact Center Background (3 of 3)

• Contact Center will support providers, grantees,
  and CDC
• VPOP providers
• Users of full VTrckS
• Points of Contact
• Julie Orta and Joe McDowell
• Your POB Project Officer
• GAC Contact Center Planning Workgroup

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Contact Center Scope
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What will the Contact Center do for me?

• Benefit to grantee
• Reduce burden of routine, non-problem calls
• Increase time for core public health functions
• Identify educational opportunities
• Benefit to provider
• Provide fast and easy access to support
• Benefit to CDC
• Enhance current information and oversight

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Contact Center Where are we now?

• VPOP
• Augmenting a customer service team within CDC
• Hiring staff (help desk agents)
• Writing procedural instructions
• VTrckS
• Working with GAC Contact Center Planning
  Workgroup CA, MI, NJ, NYC, NYS, OK, TX, WA, WI
• Working with PGO to modify a current CDC contract
  to add contact center functionality

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Contact Center Where are we going?

• VTrckS
• Develop protocols
• Continue to work with GAC Contact Center Planning
  Workgroup

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Contact Center How are we going to get there?

• Collaborate with key stakeholders
• Grantees
• Providers
• CDC
• Identify and mitigate issues and risks such as
  questions to anticipate and the handling and
  volume of contacts

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Contact Center How is your feedback
incorporated?

• Solicit feedback for consideration to
• Properly size contact center
• Train support staff
• Opportunities to provide input
• GAC Contact Center Planning Workgroup
• Review the list of potential questions from
  providers (see handout)

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This document

• This document can be found on the CDC website at
• http//www.cdc.gov/vaccines/programs/vmbip/downloa
  ds/newsletters/2009/nic-vmbip-ad-hoc-pt2.ppt