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