TM 1 Doses Administered Exercise DAX 2008 Webinar Presented February 11, 2009 Joint Presentation by: Division of Emergency Preparedness and Response National Center for Public Health Informatics and Immunization Services Division National Center for Immunization and Respiratory Diseases

TM 2 Agenda Background Results Feedback Open Question & Comment Next Steps

TM 3 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

TM 4 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 into CRA via the web-based aggregate reporting interface CRA Option 2 Direct 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 3 Individual level data entry Data is available in CRA for reporting Individual level data are automatically aggregated by CRA system and is available for reporting XML File Aggregate Reporting Options via CRA HL 7

TM 5 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 #

TM 6 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

TM 7 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

TM 8 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

TM 9 Overall Proposed Doses Administered Category and Tiers for Data Reporting 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)

TM 10 Phase I: Pre-Exercise Planning Apr-Sep 2008 CDCTasksCDCTasks DAX 2008 Task Expectations Phase 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 PATasksPATasks

TM 11 DAX 2008 Results DAX 2008Pilot 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

TM 12 Option Choice Breakdown Options DAX 2008 Pilot 2007 Option Option 234 Option 376

TM 13 DAX 2008 Option 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 Detail Data Exchange

TM 14 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

TM 15 RequirementsDAX 2008*2007 Pilot Number of Project Areas Submitted some data5755 Did not submit any data57 Met # of clinics requirement53 (≥8 clinics ) 53 (≥ 2 clinics) Met reporting frequency requirement 55 (≥4 weeks) 53 (≥2 reporting) Met fully successful criteria32 (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 Pilot

TM 16 Reporting Timeliness by Method

TM 17 Delay Indicator Through Reporting Period DAX 2008

TM 18 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

TM 19 Question: How easy was CRA to use to transmit/enter and submit data to CDC? 30 respondents – Very Easy 17 respondents – Somewhat Easy 4 respondents – Not Easy

TM 20 Question: How beneficial was this exercise test to you in preparing for a pandemic influenza event in the future? 24 respondents – Very Beneficial 25 respondents – Somewhat Beneficial 3 respondents – Not Beneficial

TM 21 Question: Has DAX 2008 helped to improve communication/coordination between Immunization and Preparedness branches/sections at your health department? 37 respondents - Yes 15 respondents - No

TM 22 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)

TM 23 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

TM 24 Total Data Submitted for DAX 2008 Tier GroupVaccinations Tier 1: Pregnant women and infants /toddlers 6 month to 3 years 93,240 Tier 2: Household contacts of infant < 6 months and children 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 years 149,437 Tier 5: Healthy adults ,693 Total 613,615

TM 25 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

TM 26 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.)

TM 27 Questions or Comments?

TM 28 Question: How beneficial was this exercise test to you in preparing for a pandemic influenza event in the future? DAX 2008 Pilot respondents – Very Beneficial 25 respondents – Somewhat Beneficial 3 respondents – Not Beneficial 14 respondents - Very Beneficial 38 respondents - Somewhat Beneficial 3 respondents - Not Beneficial

TM 29 Question: What issues, if any, did you encounter while transmitting data to CDC? DAX 2008 Pilot 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

TM 30 Question: How adequate was the introduction and initial communication? DAX 2008 Pilot respondents – Adequate 6 respondents – Neutral 5 respondents – Not Adequate 40 respondents - Adequate 11 respondents - Neutral 4 respondents - Not Adequate

TM 31 Question: How adequate was the support from CDC in preparing for and during exercise? DAX 2008 Pilot respondents – Adequate 9 respondents – Neutral 1 respondents – Not Adequate 45 respondents - Adequate 7 respondents - Neutral 3 respondents - Not Adequate