tm 1 doses administered exercise dax 2008 webinar presented february 11, 2009 joint presentation by:...
TRANSCRIPT
TM1
Doses Administered ExerciseDAX 2008
Webinar Presented February 11, 2009
Joint Presentation by:Division of Emergency Preparedness and Response
National Center for Public Health Informatics and
Immunization Services DivisionNational Center for Immunization and Respiratory
Diseases
TM2
Agenda
• Background• Results• Feedback• Open Question & Comment• Next Steps
TM3
Background
• The National Strategy for Pandemic Influenza: Implementation Plan calls for monitoring of the appropriate use of a scarce pandemic influenza vaccine
• To accomplish this, states/ project areas will track vaccine doses administered, collect and aggregate minimum data elements and transmit weekly to CDC
• CDC’s CRA system was modified to provide three ways for states and partners to report vaccine doses administered
TM4
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 via CRA
HL 7
TM5
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 National Security• Health Care and Community Support Services• Critical Infrastructure• General Population
• Dose #• Count of Doses Administered per Priority
Group and Dose #
TM6
DAX 2008 Summary
• The 2007 pilot had very basic objectives for:• Project areas to demonstrate their ability to
collect and report doses administered to the CDC
• CDC to demonstrate the CRA systems capability to accept and aggregate data
• The 2008 exercise expanded on these objectives to more closely match pandemic conditions:• Weekly reporting• Increased volume• Priority group tracking
TM7
DAX 2008 Requirements
• To be considered fully successful, Project Areas had to meet the following criteria:• Weekly reporting: for any four consecutive
weeks between Oct. 1 – Dec. 31, doses administered had to be sent by on Tuesdays by 11:59 pm (in Project Area respective time zones) for the previous reporting week (based on MMWR week of Sunday through Saturday);
• Increased volume: data had to be sent from a minimum of eight clinics over the four weeks
• Priority group tracking: priority groups had to be tracked for the general population
TM8
COTPER Bio-Surveillance Requirement
• Project Areas were required to participate in DAX 2008 to meet the PHEP cooperative agreement bio-surveillance exercise requirement
• Where applicable, Project Areas needed to send vaccination data from at least one clinic in CRI MSA, and one in non-CRI MSA
TM9
Overall Proposed Doses Administered Category and Tiers
for Data Reporting
Homeland and Nations SecurityTier 1 (HNSt1) Tier 2 (HNSt2) Tier 3 (HNSt3)
Health Care and Community Support ServicesTier 1 (HCCSSt1)Tier 2 (HCCSSt2)Tier 3 (HCCSSt3)
Critical Infrastructure Tier 1 (CIt1) Tier 2 (CIt2) Tier 3 (CIt3)
General PopulationTier 1 (GPt1) Tier 2 (GPt2) Tier 3 (GPt3) Tier 4 (GPt4) Tier 5 (GPt5)
TM10
Phase I: Pre-Exercise Planning
Apr-Sep 2008
CDC
Tasks
DAX 2008 Task ExpectationsPhase II: Exercise
Oct-Dec 2008
Phase III: Post-Exercise
Jan-Mar 2009 Webinars-Orientation &
Introduction
Webinars-Option specific; DAX updates; open Q&A; option specific final exercise preparations
Selection of POC
Conf. Calls-Individual project areas; follow up for Q&A
PHIN conference
Identify & submit option choice
Development & Deployment-Version 1.8 release
Receive clinical data from 62 project areas
Finalize & submit reporting weeks & clinic location (including CRI)
Review option guide
Develop feedback questionnaire
Respond to feedback questionnaire
Develop After Action Report
Conf. Call-After action review exercise feedback
Obtain digital certificates
Briefings and conf. presentations
Participate in After Action Review
Screen for priorities groups
Submit doses administered data to CDC via CRA
Exercise support & trouble shoot
PA
Tasks
TM11
DAX 2008 Results
DAX 2008 Pilot 2007
Pre-exercise
•100% (62/62) identified a POC•100% (62/62) selected an Option
•90% (56/62) submitted Clinic dates
•100% (62/62) identified a POC•100% (62/62) selected an Option
•85% (53/62) submitted clinic dates
Exercise •91% (57/62) submitted some data
•52% (32/62) were fully successful
•613,615 vaccinations reported
•89% (55/62) submitted some data
•56% (35/62) fully successful•56,667 vaccinations reported
Post-exercise
•84% (52/62) completed on-line feedback poll
•73% (45/62) participated in After Action Review
•55 respondents completed on-line feedback poll
•61% (38/62) participated in After Action Review
TM12
Option Choice Breakdown
Options DAX 2008 Pilot 2007
Option 1 21 22
Option 2 34 34
Option 3 7 6
TM13
DAX 2008Option Choices by Project Area
LA county
DC
NY City
Chicago
Marshall Islands
Guam
Mariana Islands
Virgin Islands
Puerto Rico
Palau
FS Micronesia
American Samoa
Web Entry aggregate Web Entry DetailData Exchange
TM14
Aggregation Method Among Web Entry Aggregate Users
(Option 2)
DAX 2008* Pilot 2007
IIS or equivalent system
6/34 (17.6%) 8/34 (23.4%)
Spreadsheet 9/34 (26.4%) 14/34 (41.2%)
Paper based 12/34 (35.3%) 6/34 (17.6%)
Did not submit data
5/34 (14.7%) 6/34 (17.6%)
* Data for 2 project areas has not yet been received
TM15
Requirements DAX 2008* 2007 Pilot
Number of Project Areas Number of Project Areas
Submitted some data 57 55
Did not submit any data 5 7
Met # of clinics requirement 53(≥8 clinics)
53(≥ 2 clinics)
Met reporting frequency requirement
55 (≥4 weeks)
53 (≥2 reporting)
Met fully successful criteria 32 (by 11:59 pm Tuesdays)
35 (within 48 hours)
Met bio-surveillance requirement†
55†
*DAX 2008 requirements were considerably more complex than for Pilot 2007; this table shows increases/decreases in comparable activities; however, the activities themselves are not equal in magnitude†Data on meeting the bio-surveillance exercise requirement have not yet been confirmed for 2Project Areas
DAX 2008 vs. 2007 Pilot
TM16
11
14
7
10
15
5
0
2
4
6
8
10
12
14
16
Option 1 (Data Exchange) Option 2 (Web EntryAggregate)
Option 3 (Web Entry Detail)
No
. of
Pro
jec
t A
rea
s
Yes (all four weeks on time)
No
Did not report
Reporting Timeliness by Method
TM17
32
3
910
3
5
0
5
10
15
20
25
30
35
On time 1 out of 4 wksdelay
2 out of 4 wksdelay
3 out of 4 wksdelay
all wks delay Did not senddata
No
. o
f P
roje
ct
Are
as
Delay Indicator Through Reporting Period DAX 2008
TM18
Feedback Poll
• Project Areas were asked to complete anonymous, on-line feedback poll
• Ten questions highlighting:• CRA ease of use• Efficiency of communication from CDC• Benefits of exercise• Issues/barriers encountered• Collaboration between Immunization and
Emergency Preparedness• Feedback to improve future exercises
TM19
Question: How easy was CRA to use to transmit/enter and submit data to CDC?
30 respondents – Very Easy17 respondents – Somewhat
Easy4 respondents – Not Easy
TM20
Question: How beneficial was this exercise test to you in preparing for a pandemic influenza event in the future?
24 respondents – Very Beneficial25 respondents – Somewhat
Beneficial3 respondents – Not Beneficial
TM21
Question: Has DAX 2008 helped to improve communication/coordination between Immunization and Preparedness branches/sections at your health department?
37 respondents - Yes15 respondents - No
TM22
Question: What issues, if any, did you encounter while transmitting data to CDC?
• 15 respondents – Digital Certificate Issues
• 16 respondents – Coordination with Local Health Departments or clinics
• 3 respondents – SDN Issues• 13 respondents – Technical Issues• 5 respondents – Data File
Formatting (Option 1)
TM23
After Action Review Call Feedback
Confirmed findings from Feedback Questionnaire
• Digital certificate process was a concern (refactoring with base system underway)
• The business rule that did not allow Project Areas to submit data before the end of the reporting period was cumbersome
Supplemented findings from Feedback Questionnaire
• CRA was easy to use• CDC/CRA support was good (technical and
project)• Communication was good throughout exercise
TM24
Total Data Submitted for DAX 2008
Tier Group VaccinationsTier 1: Pregnant women and infants /toddlers 6 month to 3 years 93,240
Tier 2: Household contacts of infant < 6 months and children 3 -18 yrs with high risk conditions
6,972
Tier 3: Children 3-18 yrs without high risk conditions and persons19 – 64 years with high risk conditions
213,273
Tier 4: Persons above 65 years149,437
Tier 5: Healthy adults 19-64 150,693
Total 613,615
TM25
Lessons Learned
• Linking the exercise to the PHEP cooperative agreement helped increase communication and interaction among preparedness and immunization staff; it is also important the program and preparedness requirements are consistent from
• Increased frequency of communication via webinars, conference calls, one-on-one calls was effective in increasing participation
• The screening requirement is challenging; Project Areas need efficient priority group screening methods; CDC may be able to assist by providing ‘best practice’ examples, facilitating discussion
• The Vaccine Doses Administered and Safety Training Conference in August 2008 helped in understanding project areas needs and ways to fill gaps
TM26
Plans for 2009
• Repeat to better measure progress using DAX 2008 as a baseline for comparison
• Ensure requirements are consistent among immunization program and preparedness
• Continue to seek supplemental funding opportunities to assist Project Areas
• Continue to provide educational opportunities (i.e. conferences, meetings, etc.)
TM27
Questions or Comments?
TM28
Question: How beneficial was this exercise test to you in preparing for a pandemic influenza event in the future?
DAX 2008 Pilot 2007• 24 respondents – Very Beneficial• 25 respondents – Somewhat Beneficial• 3 respondents – Not Beneficial
• 14 respondents - Very Beneficial • 38 respondents - Somewhat Beneficial• 3 respondents - Not Beneficial
TM29
Question: What issues, if any, did you encounter while transmitting data to CDC?
DAX 2008 Pilot 2007• 15 respondents – Digital Certificate Issues• 5 respondents – File Format• 3 respondents – SDN Issues• 13 respondents – Technical Issues• 16 respondents – Coordination with Local Health Department
• 18 respondents – Digital Certificate Issues • 12 respondents - File Format • 12 respondents - SDN Issues• 12 respondents – Technical Issues• 9 respondents - Coordination with Local Health Department
TM30
Question: How adequate was the introduction and initial communication?
DAX 2008 Pilot 2007• 41 respondents – Adequate• 6 respondents – Neutral• 5 respondents – Not Adequate
• 40 respondents - Adequate • 11 respondents - Neutral• 4 respondents - Not Adequate
TM31
Question: How adequate was the support from CDC in preparing for and during exercise?
DAX 2008 Pilot 2007• 42 respondents – Adequate• 9 respondents – Neutral• 1 respondents – Not Adequate
• 45 respondents - Adequate • 7 respondents - Neutral• 3 respondents - Not Adequate