In partnership with the Ocean State Immunization Collaborative

State Supplied Vaccines (SSV) Workshop Mark Francesconi, BS Rhode Island Department of Health Immunization Program, Vaccine Manager

Vaccine Products (Influenza)  Providers will be required to track usage based on products and age groups being administered the vaccines.  Available for order every 5 business days  once RIDOH receives supply from manufacturers Vaccine (Funded use) Manufacturer / DistributorNDC Quadrivalent / TrivalentPkg Preserve Free Latex Free Fluzone PF 0.25ml (6-35 mos)Sanofi Pasteur QuadSYRYes Fluzone PF 0.5ml (3+ yrs)Sanofi Pasteur QuadSYRYes Fluarix 0.5ml (3+ yrs)GlaxoSmithKline QuadSYRYes Fluzone HD (65+ yrs)Sanofi Pasteur TriSYRYes

Vaccine Products (Non-Influenza) Pediatric Supply Menactra (MCV4)Boostrix (TDaP) Prevnar 13 (PCV 13)PedvaxHib (Hib) Infanrix (DTaP)Gardasil (HPV9) Pediarix (DTaP/Hep B/IPV)MMR II Kinrix (DTaP/IPV)Proquad (MMRV) Havrix (Hep A)Rotarix (Rota) Engerix-B (Hep B)Varivax Special Order Vaccines DTTenivac (TD) IPOL (EIPV)Bexsero (MenB) Pneumovax23 (PPV23)MenHiberix (Men/Hib) Adult Supply Pneumovax23 (PPV23) Gardisal (HPV9) MMR II (MMR) Varivax Prevnar 13 (PCV13) Tenivac (Td) Adacel (Tdap) Menactra (MCV4) Recombivax (Hep B) Vaqta (Hep A) Special Order Vaccines Bexsero (MenB) Twinrix (Hep AB)  Vaccine listed on this page are available for monthly order  Special Order Vaccines require special permission by RIDOH due to limited supply or special circumstances

Vaccine Eligibility Pediatric Supply  Due to agreements with bordering states there are no restrictions for administering vaccines to children (<19) Adult Supply  > 19 years of age  RI resident or receives health benefits through a RI employer  Insurance status:  Insured: Free vaccine, bill insurer for admin  Uninsured: Free vaccine, waive admin fees (optional)  Use of SSV for non-eligible patients is prohibited

Adult Vaccine Eligibility Medicare  Due to current changes in the way RIDOH is to assess insurers, Medicare recipients will be allowed to receive State Supplied Vaccines for State Fiscal Year 2017 (July 1, 2016 – June 30, 2017)  Part A / B plans covered through insurer assessments  those with an Advantage plan (a Medicare plan offered through an HMO or PPO)  Fee-for-service (MFFS) included in this year’s supply  No need for reimbursement to RIDOH or order of private supply  This may not apply in future years.

Delivery Schedule Influenza Vaccine Pediatric and Adult  First orders  Dependent on manufacturer releases and inventory amounts received  All Subsequent Orders  Orders will be based solely on the amount of vaccine that RIDOH has received  If RIDOH has received 35% of our total allocation for the season the provider may order up to 35% of their season’s reserve  Once 100% has been received providers will be allowed to order up to 20% over their total reserve. Manufacturer release schedule  50% by September 15, 2016  100% by November 1, 2016*

OSMOSSIS RI Vaccine Online Ordering System  Ocean State Management of State Supplied Immunizations System (OSMOSSIS) Orders must be submitted on-line  OSMOSSIS Monthly ordering section  OSMOSSIS Flu ordering section Ordering process  Submitted by Provider  Approved / Denied by RIDOH  Processing (submitted to CDC)  Shipped  Received

Weekly Ordering (Influenza) Weekly Influenza Ordering Module  Report doses administered  By Product and Age Group  Pregnant Women and Healthcare Workers  Report inventory on-hand  Request additional vaccine supply  Based on supply % available by RIDOH  20% Over Reserve allowed if 75% of all vaccine shipped has been administered Orders will be filled:  Same week ordered if order is approved on a Monday or Tuesday  The following week for orders approved Wednesday – Friday  Based on available supply

Monthly Ordering Orders must be submitted on-line:  OSMOSSIS Monthly Order section  Orders are available no more than once every 30 days Orders will be filled:  May take up to 10 business days after RIDOH approval Reporting Requirements:  Maintain 60-day supply  Inventory on-hand is required with each monthly report  regardless of ordering additional doses

Waste / Returns Waste/Returns must be reported through OSMOSSIS  Return is vaccine that is still in original condition and may be returned as such  Waste is vaccine no longer in original condition and cannot be returned (pre-drawn, damaged, reconstituted, etc…)  Returns are not allowed for viable vaccine unless:  Spoiled due to temperature breach  Viable Flu vaccine cannot be returned unless:  RIDOH reports zero influenza activity or end of influenza season HEALTH will submit returns on a bi-weekly or monthly basis (as needed)  Store returns in a plain box for courier pick-up.  No cold chain required  Print OSMOSSIS Packing Slip and ed Shipping Label

Transfers OSMOSSIS will allow providers to transfer vaccines between participating SSV Practices  Requires initiation from the practice releasing the vaccine  Requires acceptance from the practice receiving the vaccine  If a transfer is rejected by the receiving practice the initiating practice must Approve or Deny the rejection.  RIDOH will intervene if the rejection is denied  Unavailable if a vaccine order is in “Submitted” status  Unable to place additional orders while there is an active transfer  May need to remind receiving practice to accept the transfer

Enrollment /OSMOSSIS Demo

Cloud-based Temperature Monitoring September 14, 2016 National Immunization Conference Mark V. Francesconi, BS

Why Cloud-Based? What did we really want? Real-time data Reduce paper (fax) reporting 24/7 accessibility Remote programming Ease of use Capture twice daily check electronically

EL-WiFi-TP+/Glycol Everything we were looking for PLUS… Large LCD display Min/Max display Alarm display Graph/Data reports Event logs Enterprise Network with administrator rights

Project Steps Gather storage unit data Conduct survey of practice storage units Identify types and quantity Rollout product Manufacturer shipped directly to provider office Online training Providers given access to online installation and user guide Simple, We had it all figured out, right? Not really!

Lessons Learned Data collection Only 50% of providers completed survey Data collection inaccurate Reported wrong number of storage units Did not understand “combination” vs. “stand-alone” Multiple entries per provider Little knowledge of office Wi-Fi capability Lesson learned Need to be more specific in instructions with limited answer options

Lessons Learned (cont.) Product rollout and training Product shipped directly to provider office with instructions in the package Providers (especially IT folks) do not read instructions or watch user/installation webinars Approximately 30% of units installed by the practice staff Approximately 50% installed incorrectly Lesson learned Require, in advance, the provider office to review the installation materials in full. Upon completion and certification release the product for distribution.

Lessons Learned (cont. 2) Technology issues b Wireless Networking (2.4GHz) Smaller practices not an issue Large or corporate facility issues IT staff reluctant to share info b outdated; need g/n (5GHz) Lesson learned Technology is always changing; need to be on top of current features and specs or risk falling behind quickly

Where Are We Today? Over 350 devices installed Enterprise network view (dashboard) Remote administration Real-time data (within 30 minutes) Better temperature data Able to view long-range data trends Able to zoom info specific date ranges Alarm notifications for follow-up Event logs Viewable from dashboard Sent to practice via daily Demonstration

Thank You Mark V. Francesconi Vaccine Manager Thank you. Denise Cappelli Adult Program Coordinator Tricia Washburn Chief, Office of Immunizations Viviana Ciccia Vaccine Distribution Coordinator