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

3. Cloud-Based Temperature Monitoring
Agenda
How can you learn from Rhode Island?
Logging history
Where we have been
Why cloud-based logging?
Project implementation
Lessons learned
Where we are today / live look-in

4. State of Rhode Island and Providence Plantations
How Can You Learn from RI?
Comparable to the size and nature of most state’s counties
Geography: 1,214 square miles
Population: 1.05 million
1 Health Department (12 Immunization staff)
5 counties
39 cities/towns
35 school districts
420 schools (public, private, parochial)
630 Vaccine Providers
Pediatric, Adult, Family, Specialty, Pharmacy, Hospital Clinics, Health Centers, Urgent Care, Community Vaccinators
State of Rhode Island and Providence Plantations
Although RI is a small state it is comparable to the size of other state or territory counties. We serve a population of just over 1-million through 1 health department. The RIDOH does not offer clinical services, requiring all residents to have a PCP or seek out medical attention through clinics, pharmacy, urgent care, or pharmacy locations.
Also Known As:
The Ocean State
The Biggest Little State
The Smallest State with the Longest Name

5. Logging History Dickson VFC70 “The Black Box” 24/7 chart recorder
2006 Mandate:
Temperature log and charts faxed monthly
Cost associated with charts, pens, and calibration
Ambient air measure
From the beginning when temperature monitoring became a requirement RIDOH started using the VFC70 chart recorder. Submission of temperature logs with each vaccine order was mandated in In 2008 RIDOH started looking for other options to replace the VFC70 due to costs associated with the chart recorders and we began looking to get into the digital age of temperature tracking.

6. Logging History (cont.)
DataNet Wireless
Wi-Fi logging
Required computer accessibility 24/7
Installed software
Receiver / logger(s) / repeater(s)
Monthly temperature reports
Sent via on scheduled date
In 2010 RIDOH purchased the DataNet Wifi logging system for provider offices. Although the system had some restrictions, like having to leave the software up and running 24/7, it was the best option on the market to meet our goals of electronic temperature recording, scheduled monthly reports via , and probes in buffer materials to simulate liquid temperatures. After 5 years RIDOH decided it was time to reinvest in newer technology that could offer us a better snapshot of what was happening real time in the provider storage units.

7. 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
IN 2015 RIDOH started researching the use of cloud based temperature monitoring. We wanted the new system to offer real time data, electronic reporting in order to eliminate faxes/ s, 24/7 accessibility, remote programming, ease of use for the end user, and hopefully a feature that would capture the twice daily temperature checks.

8. 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
In 2015 RIDOH decided to replace the now outdated DataNet systems with the new Lascar Cloud Based loggers. These new units gave us everything we were looking for plus some other features, such as; a large LCD display that included the Min/Max temps, alarm indicator, graph and data table reports, event logs of all recorded activity, and the ability to set up an enterprise network for RIDOH to view all loggers from one dashboard for quick temperature access. Now that we have made our choice what do we do now?

9. Project Steps Gather storage unit data Rollout product Online training
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
We decided that we would produce a survey that would gather all the necessary information from each participating provider about the number of storage units they used and how many were stand alone versus combination units. Once we had all that data we would have the manufacturer drop ship the product to the provider address with a link to a webinar showing how to install and use the device. This is going to be simple, NOT REALLY.
We had it all figured out Simple, right?
Not really!

10. Lessons Learned Data collection Lesson learned
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
The survey data that was collected seemed pretty accurate upon initial receipt, however further reviews found that there were inaccuracies with the amount and types of storage units, duplicate entries per provider office, and providers had very little knowledge as to the type of wifi network that they had installed at their office.
Should we have to follow this approach again we would need to be extra careful on what we ask for and how we ask for it. More time would have to be put aside to review the data in more detail before passing it on to the manufacturer for distribution.

11. 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 and installation.
The next step was to release the loggers to provider office and have them install the devices with support from the manufacturer’s IT division. We found that even though we provided guidance on how to access the directions to install the units the providers and especially IT folks did not follow the directions very well. Approximately 30% of the units that were shipped were installed by the provider office, of which 50% were installed improperly. Most of the errors were that they did not associate the logger to the cloud account that RIDOH had already setup and included in the instructions.
We should have held the units until we had certification, possibly and online tutorial with questions and answers, showing that the provider office had thoroughly review the installation and use requirements.

12. Lessons Learned (cont. 2)
Technology issues
802.11b Wireless Networking (2.4GHz)
Smaller practices not an issue
Large or corporate facility issues
IT staff reluctant to share info
802.11b 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 very quickly
One final issue that arose revolved around the technology used in the device. RIDOH had not noticed that the devices required b networking protocols b is an older protocol being replaced by b/g/n technology. The manufacturer released a new b/g/n version of the device in July 2016 and we are currently offering a mix of both the b only and b/g/n devices.

13. 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
To date we have installed and are able to view temperature readings on over 350 devices. These devices allow RIDOH the ability to see temps in real time, look at long range data trends or zoom into specific events, follow up on alarm issues. The system even allows for RIDOH or the provider to add notes to the event logs in order to explain any issues that may have occurred.
Demo

14. Mark V. Francesconi
Vaccine Manager
Office of Immunization
Rhode Island Department of Health