1. Agile Engineering: A New Application for Reporting H1N1 Immunizations USIIS Program Nancy McConnell, J.C. Alexander Immunization Program Janel Jorgenson, Karen Tsuyuki

2. USIIS Overview  Utah’s Immunization Information System Lifespan IIS Maintains residents’ immunization histories, consolidating immunizations across providers Forecasts immunizations due, for managing patient care Vaccine inventory management  Web application & Data interfaces  Standards-based: CDC, HL7, PHIN, IHS  Used by public and private providers, schools, daycares IIS use is not mandated in Utah Used by ~62% of private providers  Supports Immunization Program roles

3. Usual response to a new vaccine  Add vaccine to database table  Add manufacturer to database table  Update forecast with the vaccine’s schedule Age(s) when recommended If multiple doses, interval between doses Special cases: combination vaccines, manufacturer-specific approvals  Add to applicable reports  Inform users …then came H1N1

4. Immunization Programs’ H1N1 Role  Receive vaccine and ancillary material CDC-funded for the entire country CDC distributed to states via usual routes  Distribute vaccine to Local Health Departments (LHDs) Weekly shipments Ship to private providers as specified by LHDs  Report doses administered to the CDC Doses of H1N1 vaccine administered All states required to report weekly Report content = summary data across the state

5. Moving Targets  Vaccines Injection, Nasal One-dose, two-dose Age recommendations Manufacturers Availability  Required reportable data Age groups Doses Inventory wasted Reporting periods Priority groups  Local Health Departments’ plans for administering vaccine

6. Response  Vaccine Developed ordering and distribution plans Obtained and provided information  USIIS Prepared to report state-summarized H1N1 doses administered, in specified data export format Evaluated options Summarize H1N1 data in USIIS  Vaccinators = subset of USIIS users  Uncertain timeliness of receiving H1N1 data  USIIS is a complex application  not enough time to train all vaccinators (non-USIIS users) Providers fax or spreadsheet  manual UDOH consolidation and manual data submission to CDC Providers use Web application  automatic consolidated data and data formatting for CDC

7. USIIS Response  Developed a Web application for H1N1 vaccinators to report doses administered Tracked moving requirement targets Modified application as information became available, then final  Development process & components Web applicationSupportive components Specifications: screen layout, navigation, data elements, reports, data export Internal process roles & backup User access instructions Develop—iterative tweaks User documentation Internal Test & Pilot Test Customer support Release Update(s)

8. H1N1 Doses Administered application

9. Export file generation

10. USIIS Technical Strategies  New application to become a step in the USIIS roadmap Developed in new technology: JSP, Netbeans Wrote a new login application  Application extensible to flexibly manage authorization and authentication for all USIIS-related components in the future  Existing USIIS users’ login credentials to provide access to the new application  Use USIIS database Common infrastructure

11. Results  Utah acknowledged by CDC as one of two states to report doses administered on schedule—from the onset and ongoing Key: Providers required to submit Doses Administered before receiving the next week’s vaccine shipment  USIIS and non-USIIS users successfully used the new application Keys: Application design; User documentation  USIIS JSP rewrite underway Key: Strategic response to an urgent situation

12. Additional results  Internal processes Agile software engineering  Adapted to urgent, changing situation  Prioritized minimum requirements, adding features as time permitted  Focused on quality  Delivered on schedule USIIS-IP collaboration  Non-USIIS user authorization process (provider agreements, user agreements, logins and passwords)  Backups for each manual process role Leveraged data for UDOH weekly situation meeting reports and LHD reports  Smith’s/Kroger became the first pharmacy data supplier to USIIS - via data interface

13. Utah H1N1 Doses Administered  First doses given: October 4-10  Total doses given: 559,294 [thru 3-Mar-10] 6-23 months: 40,172 (7.2%) 24-59 months: 67,633 (12.1%) 5-18 years: 162,801 (29.1%) 19-24 years: 40,671 (7.3%) 25-49 years: 144,517 (25.8%) 50-64 years: 65,942 (11.8%) ≥ 65 years: 37,555 (6.9%)  Dose#1: 479,849 Dose#2: 40,705 Unknown Dose#: 38,740  Waste: 1,967 doses