# Presentation: 364381

## Countermeasure and Response Administration Working Group Webinar

**Countermeasure and Response Administration Working Group Webinar**

**Webinar Presented July 30, 2008 **
**Jeanne Tropper, MS, MPH **_[jwu0@cdc.gov](mailto:jwu0@cdc.gov)_
**&**
**CRA Development Team**
**Division of Emergency Preparedness and Response**
**National Center for Public Health Informatics**

## Agenda

**Purpose**
**Background of CRA**
**V1.8 New Features and Demonstration**
***Question and Answer*****   **
**Discussion of V1.9 Topics**
***Question and Answer***** **
**CRA Working Group Organization and Schedule**

## Purpose

**Foundation for All Hazards support near completion**
**V1.9 likely last  release before migrating to open source (OS) environment; closer alignment with OMS and Epi Info TM**
**Formalize process for prioritizing development of  final release**
**Position CRA to move to Outbreak Management  Community of Practice (CoP) governance structure**

## What is CRA?

**Genesis was Pre-Event Vaccination System (PVS) for national smallpox vaccination campaign**
**Capability to support mass tracking during an event **
**System has since evolved to support *****any countermeasure, any event; *****may include medical interventions such as vaccinations, pharmaceuticals and non-medical interventions such as patient isolation and quarantine or social distancing measures**
**Includes the ability to track both detail (person level) and aggregate counts of countermeasures  **

## Implementation Options

**Centralized implementation – application is centrally located and managed by CDC;  accessible using any standard web browser in conjunction with a CDC issued digital certificate  **
**Offline implementation - new with V1.7, CRA may be deployed offline on a stand-alone basis**

## What is New with CRA?

**V1.8 due for release September 15, 2008**
**Aggregate Group & Reporting Enhancements (with Data Exchange)**
**Priority groups**
**National reporting**
**Adverse Event Support**
**Patient Follow-up**
**Event Reports/Data Extracts Enhancements**
**Sub-jurisdiction Support**
**User-Defined Fields Support**

## Definitions

*Countermeasure* – intervention taken to help prevent and/or slow the spread of disease; countermeasures may include medical interventions such as vaccinations, pharmaceuticals and non-medical interventions such as patient isolation and quarantine
*Event* – public health programs or emergency responses that require the administration of countermeasures
*User Roles* – CRA has role based user access; the user can only access system functions appropriate to their role; two roles
- Public Health Administrator (PHA)
- Data Entry Specialist (DES)
*Aggregate Reporting – *CRA has updated to support project areas reporting a subset of data to the CDC; the capability was established  to support vaccine doses administered during a pandemic; however, it could be applied to any situation

## POD Patient Flow

- Table

- Table

- Table

- Table

- Table

- Table

- Table

- Table

- Table

- Table

- Table

**Patients Exiting**
**POD**

**Medical Counseling Area**

- Table

- Table

- Table

- Table

**Mental Health Area**

**Meds Dispensing / Vaccination Area**

- - Staff

- - Patient

- 6

- 12

- Table

- Table

- Table

- #

- - Number of stations

- 2

- 2

- 4

**Medical Screening Area**

**CRA**
**Data Entry**
**Station**

**Yes****  ** Meds/ Vaccination

**No**** **Meds/ Vaccination

**Routine**

- Door

- Door

- Door

- Door

- Door

**Patients Enter POD**

- Door

- Door

**POD Patient Flow**

- Table

- Table

**LEGEND**

- Door

**Special**

**Special**

## Anthrax Scenario

- Multi-city event with affected populations in Washington, DC, New York City and Florida
- Scope of attack unknown; post exposure prophylaxis advised
- Central dispensing center established
- Emergency supply of antimicrobials ordered

## CRA Demonstration

**Anthrax Event in Washington, DC**
**Demonstrate person data entry process**
**Data entry of patient countermeasure **
**Data entry of patient registration**
**Demonstrate patient import feature – mail handlers**

## Teen Vaccination Scenario

- Campaign to administer vaccines to pre-teens and teens in Long Beach School System
- Vaccination centers established in three middle schools
- CRA used for follow-up with students receiving HPV vaccine

## CRA Demonstration

**Teen Vaccination Event **
**Demonstrate data entry of vaccine with follow-up dose schedule **
**Demonstrate process to record adverse event**
**Demonstrate event set up and ability to customize screens **
**View follow-up configuration**
**Add user defined field**

## CRA Future Development Topics

_**Head of Household Dispensing**_** **
**Look at all household dispensing options; group patients by family**
_**Alternate Data Entry**_** **
**Use barcode scanners, handwriting recognition; allow multiple data entry points, such as intake and dispensing; allow use of CRA on handheld devices****	**
_**Ability to Exchange Data with Other PH Systems including but not limited to Immunization Registries, Surveillance, Outbreak Management Systems**_
**Aggregate and line listed bi-directional data exchange in multiple formats****	****	**

## CRA Future Development Topics, Continued

_**Population Health Management**_**	**
**Provide for import of population registries - nursing homes, hospital staff, EMS, etc; track denominator data; patient de-duplication/merge **
_**Data Elements for Patient Intake/Screening **_
**Risk factors; prior and current medical conditions; contraindications specific to countermeasures of interest **
_**CRA, Epi-Info, OMS Integration – what form should it take**_
**Bi-directional data exchange among applications; use standard architecture; same look and feel of applications; developing user-defined variables/questionnaires/forms**
**	****	**

## CRA Future Development Topics, Continued

_**Support Linkages with Strategic National Stockpile and Other Inventory Tracking Systems**_** **
**Support linkages with inventory systems; deployment of CRA with SNS Push packs preloaded with countermeasure information****	**
_**Analysis, Visualization and Reporting**_** **
**GIS capability; add query function; access to data entered into online and offline CRA; add staff management reports, duplicate identification,  clinic and sub jurisdiction countermeasure administration, etc; print user record prior to countermeasure  dispensing ****	****	**

## CRA Future Development Topics, Continued

_**Provide a Patient Consent Form **_
**Document permission for countermeasure administration,  follow-up, tracking and Epi research****	****	**
_**Decentralized Deployment**_
**Export data from off line installations to CDC and other localities; preload user, organization , and event data through import or batch entry;  automate updates of offline  installations;  enhance offline system security ; enhance data encryption ; offer offline Web access and standalone access****	****	**

## CRA Working Group Organization

**Development of Working Group Charter**
**Generation of meeting minutes**
**Development of committees**
**Becoming a part of the Outbreak Management CoP**
**CRA Working Group Webinar August 13, 2008**
**Workshop at PHIN Conference Tuesday, August  26, 7 am **
**Review prioritized enhancements**
**User feedback in focused areas, e.g., reporting, person-level data entry, other**

## Getting Started with CRA

**Consider using during an exercise**
**Demonstration version will be available for partner “try outs”**
**CRA training available**
**PHIN Help Desk first line of contact for accessing CRA**
**Telephone 1-800-532-9929:  8 AM to 8 PM EST **
** ****Email:  **_[Phintech@cdc.gov](mailto:Phintech@cdc.gov)_
** **