# Presentation: 947850

## 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 **

## Agenda

**Background**
**Results**
**Feedback**
**Open Question & Comment**
**Next Steps**

## 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**

## Aggregate Reporting Options via CRA

**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**

## 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 #**

## 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**

## 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 **

## 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**

## 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)**

## DAX 2008 Task Expectations

**Phase I: Pre-Exercise Planning**
**Apr-Sep 2008**

**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**

## DAX 2008 Results

|  | DAX 2008 | Pilot 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 |

## Option Choice Breakdown

|      Options |   DAX 2008 |   Pilot 2007 |
| --- | --- | --- |
| Option 1 | 21 | 22 |
| Option 2 | 34 | 34 |
| Option 3 | 7 | 6 |

## DAX 2008Option Choices by Project Area

**LA county**

**DC**

**NY City**

**Chicago**

**Web Entry aggregate**

**Web Entry Detail**

**Data ****Exchange**

## 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**

## DAX 2008 vs. 2007 Pilot 

| Requirements | DAX 2008*
 | 2007 Pilot
 |
| --- | --- | --- |
|  | Number of Project Areas | Number of Project Areas |
| Submitted some data
 | 57 | 55 |
| Did not submit any data
 | 5 | 7 |
| Met # of clinics requirement
 | 53
(≥8 clinics)
 | 53
(≥ 2 clinics)
 |
| Met reporting frequency requirement
 | 55                    
(≥4 weeks)
 | 53                       
(≥2 reporting) |
| Met fully successful criteria
 | 32                        
(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. 2007 Pilot**** **

## Reporting Timeliness by Method

**Reporting Timeliness by Method**

## Delay Indicator Through Reporting Period  

**Delay Indicator Through Reporting Period  **
**DAX 2008**

**Notes:**
Generally PA are submitting data on time and have demonstrated the ability to report data in acceptable timeframe.   

When we look at the data  in more detail in indicates that It shows that some PA will need to improve timeliness of reporting, with either technical enhancements, education or training interventions 

When 

## 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**

## 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**

## 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**

## 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**

## 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)**

**Notes:**
Can provide more specific information to use as talking points. If this needs to be broken down by Options, I can do that.

## 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**

## Total Data Submitted for DAX 2008

| Tier Group  | Vaccinations |
| --- | --- |
| Tier 1:  Pregnant women and infants                 /toddlers 6 month to 3 years
 | 93,240  |
| Tier 2:  Household contacts of infant < 6 months and children 3 -18 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 19-64

 |  150,693  |
| Total | 613,615  |

## 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**

## 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.)**

## Questions or Comments?

## Question: How beneficial was this exercise test to you in preparing for a pandemic influenza event in the future?

|   DAX 2008 |   Pilot 2007 |
| --- | --- |
|  24 respondents – Very Beneficial
 25 respondents – Somewhat Beneficial
 3 respondents – Not Beneficial
 |  14 respondents - Very Beneficial 
 38 respondents - Somewhat Beneficial
 3 respondents - Not Beneficial
 |

## Question: What issues, if any, did you encounter while transmitting data to CDC?

|   DAX 2008 |   Pilot 2007 |
| --- | --- |
|  15 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
 |

## Question: How adequate was the introduction and initial communication?

|   DAX 2008 |   Pilot 2007 |
| --- | --- |
|  41 respondents – Adequate
 6 respondents – Neutral
 5 respondents – Not Adequate
 |  40 respondents - Adequate 
 11 respondents - Neutral
  4 respondents - Not Adequate
 |

## Question: How adequate was the support from CDC in preparing for and during exercise?

|   DAX 2008 |   Pilot 2007 |
| --- | --- |
|  42 respondents – Adequate
 9 respondents – Neutral
 1 respondents – Not Adequate
 |  45 respondents - Adequate 
 7 respondents - Neutral
 3 respondents - Not Adequate
 |