How do you solve a problem like… mass pandemic influenza vaccination? Private Provider Pre-Registration! Kelly L. Moore, MD, MPH Tennessee Immunization Program January 2010 Immunization Program Manager Meeting AIM Bull’s Eye Award Presentation

Lessons Learned: Chiron 2004 October 5 influenza vaccine supply halved State health departments tapped by CDC to place orders for providers using redistributed Sanofi product Challenges –Did not know who needed vaccine –Lacked contact information for all private providers –No structure for quick, targeted communication to reach all relevant providers Millions of leftover doses –Slow deployment of available vaccine –Slow expansion beyond priority groups –Public lost interest

July: The 2009 H1N1 Vaccination Campaign Challenges Vaccine coming October 15 (…or earlier!) State public health responsible for distribution Major features of federal program undecided Probably going to use a federal distributor/ VACMAN TN Department of Health (TDH) still lacks reliable and rapid means of communication with most private sector healthcare providers

Pre-Registration of Private Providers: Purposes of System Interested private providers self-identify Target non-VFC providers Obtain valid shipping and contact details Enroll providers in Immunization Registry (“TWIS”) –Exclude inappropriate vaccine recipients No cost to pre-register No obligation to order Create an H1N1 Vaccine Provider Network with whom we communicate electronically and keep them engaged with us

Notification of Pre-registration Option Pre-registration launched inside TWIS on August 5 (3 week development) Simple 1-page notice widely distributed (message: go to to sign up!) –Professional organizations (TMA, TNAAP, TN Pharmacy Association, etc.) –Conference call with hospitals - state hospital association –TN Health Alert Network –Posted on TDH, TWIS web pages –TDH press release and media interviews –Local public health-private provider contacts –Mail out letters to licensed providers (for completeness)

Weekly Pre-Registered Provider Updates Began on August 13 Communicated latest developments Update them on any problems we had Reminders, FAQs Via blast s to all 1° and 2° contacts Blast fax (VFC) Special editions (e.g., recalls)

Pre-Registered Provider PINs 6 characters, needed in VACMAN; one per ship-to location “## P###” format distinct from VFC All pre-registered providers received with PIN, link to Survey Monkey questionnaire to place orders Used PIN to link to all provider info –Prioritized providers by facility type

Participation in Pre-Registration: Impact on TWIS TWIS users as of August 4, 2009: –458 authorized private providers 2,436 individual users (staff enrolled as separate users under provider’s account) New TWIS users since August 5: –1,969 new private providers (4x previous) 6,110 individual users (2.5x previous) Private sector not required to enter H1N1 doses in TWIS –15.3% increase in doses entered in TWIS per day –Average 255 doses/day in previous calendar year –Average 294 doses/day, 8/5/09-1/15/10

Participation in Pre-Registration: Impact on H1N1 Vaccine Distribution 1,642 ship-to locations were pre-registered (PINs) 1,178 non-VFC pre-registered private facilities got shipments of ≥100 doses of H1N1 Awaiting final data, but CRA doses administered reports submitted to CDC always exceeded expected based on population (2%) Early CDC data provided to TN on January 14 show state H1N1 vaccine coverage point estimate higher than national or regional average

Challenges Had PIN problems (duplicates created by a random number generator) Registry coordinator overwhelmed by unexpectedly huge and rapid increase in new providers registering (delays in processing registration applications) Multi-stage process was clunky –Prone to confusion or failure to place a valid order, especially in providers who did not read carefully

Conclusions Online pre-registration met all goals Pre-registration provided for an efficient, effective communication and distribution and response network that was manageable for the small H1N1 Vaccine Distribution Team Applications in future emergencies that require an ongoing collaboration between public health and a network of private sector providers

Acknowledgments: TN Pre-Registration Design Team Marion Kainer, MD, MPH –Director, TN Hospital Infections Program Brian Moore –TIP Registry Coordinator Rami Abuhamdeh –BCS Healthcare (TWIS contractor) Michael Creighton –IT Business Manager Beth Anne Frost –CSTE Fellow All the volunteer staff who assisted registering new providers

Discussion/Questions Kelly L. Moore, MD, MPH