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TM 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 Slide 2 TM 2 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 Slide 3 TM 3 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 Slide 4 TM 4 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 Slide 5 TM 5 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 Slide 6 TM 6 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 Slide 7 TM 7 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 Slide 8 TM 8 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 Slide 9 TM 9 Phase I: Pre-Pilot Planning Apr-Oct 2007 CDCTasksCDCTasks Pilot Task Expectations Phase 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 PATasksPATasks Apply lessons learned CRA development, future pilot Slide 10 TM 10 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 Slide 11 TM 11 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 Slide 12 TM 12 Kansas Governor, Kathleen Sebelius, getting influenza vaccination in a Pilot Influenza Clinic, Kansas Slide 13 TM 13 The Kansas Bee Mascot says: Be wise, get immunized! Slide 14 TM 14 Timeliness Among All Options by Aggregation Method Slide 15 TM 15 Data Submission Timeline All Options Note: N= 124 clinic dates Slide 16 TM 16 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 Slide 17 TM 17 Timeliness by System Reporting Technique Options 1&2 Slide 18 TM 18 Need for More Than Systems! Slide 19 TM 19 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 Slide 20 TM 20 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 Slide 21 TM 21 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 Slide 22 TM 22 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 Slide 23 TM 23 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 Slide 24 TM 24 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 Slide 25 TM 25 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) Slide 26 TM 26 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 Slide 27 TM 27 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 Slide 28 TM 28 HHS Proposed Pandemic Priority Groups as of October 2007 http://www.pandemicflu.gov/vaccine/prioritization.pdf Slide 29 TM 29 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 Slide 30 TM 30 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) Slide 3165 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"> TM 31 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 < 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 > 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 Slide 32 TM 32 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 Slide 33 TM 33 Thank you!