Breakout Session Overview 

Paul Robinson 

Deloitte Consulting 

86 

"Reviewed November 2014"
Breakout Agenda
 

Time Duration Session 

11:15-11:20 AM 5 minutes Overview of breakout sessions 

Room assignments are marked on your 

nametag 

11:20-11:25 AM 5 minutes Transition to breakout rooms 

11:25-12:00 PM 65 minutes Participate in breakouts 

12:30-1:00 PM 30 minutes Break for lunch 

1:00-2:00 PM 60 minutes Resume Breakout Sessions 

2:00-3:00 PM 60 minutes Transition to Cabildo Room for Readout Session 

Each readout in main session will be given 15 – 

20 minutes to take the larger group through 

recommendations 
Top Challenges Suggested by Forum Registrants 
 

Implementation 

• Workflow changes 

• Package-level scanning 

• Combination and reconstituted 

vaccines 

• Office configuration 

• Training and supporting state 

registry and provider scanning 

operations 

• Future opportunities for 2D 

barcoding 

• Mobile applications 

Adoption 

• Financial considerations of 

equipment, implementation, 

and training for registries 

• Immediate provider efficiencies 

• Balance between cost, 

effectiveness, and availability

of barcoded data 

• Increase adoption 

• EMR/IIS vendors 

• Vaccine Manufacturers 

• Practitioners 

 Adoption incentives 

Standards 

• Impact of serialization on 2D 

barcodes 

• Package-level GTIN 

considerations 

• Reconstituted vaccine 

barcodes 

• Standard capabilities of 

EMR/IIS solutions 

• Use of both linear and 2D 

barcodes on the same product 

• Location of 2D barcodes on 

packages and cartons 
Please return to the Cabildo Room 

by 2:00 PM 
Breakout Sessions underway
 

Forum will resume at 2:00 PM
 
Breakout Session 1
 

Standards 

91 
 

 

 

 

 

 

 

 

Session Overview 

1. Introduction of all participants in breakout – Name, title,	 organization – two 

minutes total 

2. Identify breakout champion to deliver readout in plenary session 

3. Rules of Engagement 

• Every member in the group should contribute 

• Share your experience and perspective 

• Respect the opinions of others 

• Maintain confidentiality and respect antitrust requirements 

• Focus on the topic at hand and try not to move on to tangential issues –

Parking lots will be used for the discussion 

4. Last five minutes 

• Confirm champion is prepared 

• Scribes to send final completed templates to Paul for consolidation and 

projection in main center 
Breakout Agenda
 

Time Duration Session 

11:15-11:20 AM
 5 minutes •Overview of breakout sessions 

•Room assignments are marked on your 

nametag 

11:20-11:25 AM
 5 minutes •Transition to breakout rooms 

11:25-12:00 PM
 65 minutes •Participate in breakouts 

12:30-1:00 PM
 30 minutes •Break for lunch 

1:00-2:00 PM 60 minutes •Resume Breakout Sessions 

2:00-3:00 PM 60 minutes • Transition to Cabildo Room for Readout 

Session 

• Each readout in main session will be given 15 – 

20 minutes to take the larger group through 

recommendations 
 

 

Standards Starter Questions
 

Question Discussion 

Serialization: What is the impact of 

serialization on the 2D barcode? The GTIN? 

Additional data elements? 

Package-level GTIN: We know that 2D 

barcoding will extend beyond primary 

packaging to the secondary package. The 

AAP guideline applies to unit of use. 

Other than GTIN, what data do you plan to 

include, e.g., lot#? If lot#, are you planning to 

use the same lot# as on the vaccine unit of 

use or would it be different? 

How do you plan to handle the reconstituted 

vaccines or combination vaccines that may 

have a different lot #? 
 

 

Standards Starter Questions
 

Question Discussion 

Should 2D barcoding expand beyond primary 

and secondary packaging to the tertiary 

level? Would it be helpful? 

What challenges are posed by adding tertiary 

package barcodes and how can they be 

overcome? 

Reconstituted vaccines: What are the 

challenges? From a barcode perspective, 

how can reconstituted vaccines be 

addressed consistently? 

EMR/IIS Solutions: How do we ensure 

uniform capabilities within the vendor 

community? 
 

Standards Starter Questions
 

Question Discussion 

What are the challenges and opportunities for 

EMR/IIS vendors to standardize 2D 

capabilities? 

Linear Barcodes: There may be a time period 

when both linear and 2D barcodes appear on 

the same product. Is there enough benefit to 

want to retain the linear barcode? What is it 

being used for today? What are the benefits 

and challenges of keeping or removing it? 

Barcode Location: Where would the 2D 

barcode need to be located to drive 

maximum benefit? Where on the package, 

e.g., left corner, middle? 
Breakout Session 2
 

Adoption 

97 
 

 

 

 

 

 

 

 

 

 

Session Overview 

1. Introduction of all participants in breakout – Name, title,	 organization– two 

minutes total 

2. Identify breakout champion to deliver readout in plenary session 

3. Rules of Engagement 

• Every member in the group should contribute 

• Share your experience and perspective 

• Respect the opinions of others 

• Maintain confidentiality and respect antitrust requirements 

• Focus on the topic at hand and try not to move on to tangential issues – 

Parking lots will be used for the discussion 

4. Last five minutes 

• Confirm champion is prepared 

• Scribes to send final completed templates to Paul for consolidation and 

projection in main center 
Breakout Agenda
 

Time Duration Session 

11:15-11:20 AM
 5 minutes •Overview of breakout sessions 

•Room assignments are marked on your 

nametag 

11:20-11:25 AM
 5 minutes •Transition to breakout rooms 

11:25-12:00 PM
 65 minutes •Participate in breakouts 

12:30-1:00 PM
 30 minutes •Break for lunch 

1:00-2:00 PM 60 minutes •Resume Breakout Sessions 

2:00-3:00 PM 60 minutes • Transition to Cabildo Room for Readout 

Session 

• Each readout in main session will be given 15 – 

20 minutes to take the larger group through 

recommendations 
 

 

Adoption Starter Questions
 

Question Discussion 

Financial considerations: 

What are the financial considerations of 2D 

barcode scanning? Equipment, 

implementation, and training for registries 

and providers? 

What adoption incentives exist? 

What other barriers to adoption exist? 

Migration of legacy data, resistance to 

change, technological aversion, absence of 

an electronic record, change in workflow? 

Other? 
Adoption Starter Questions
 

Question Discussion 

Benefits to Providers: Is there an immediate 

efficiency for the providers? Workflow? 

Other? 

An observation has been made that concerns 

exist around the cost, effectiveness, and 

value of barcoded data. Are these concerns 

valid? What is the point at which the cost is 

palatable? Is there a logical price point? 

Increase Immunizer Adoption: How can 

providers be convinced to invest in and 

embrace barcoding technology? 
 

 

 

 

 

 

Adoption Starter Questions
 

Question Discussion 

Increase Manufacturer Adoption: Availability 

of 2D barcoded products concerns 

immunizers, registries, and EMR vendors. 

What are the benefits to 2D seen by 

manufacturers and how can their level of 

adoption be increased? 

What will motivate more vaccine 

manufacturers to apply for a PAS to add 2D 

barcodes to vaccine labels or apply for 

waivers to replace linear with 2D barcodes? 

Increase EMR/IIS Adoption: We’ve heard 

today that some EMR/IIS solutions already 

process 2D vaccine barcode data. What are 

the benefits to the solution vendors and how 

can their level of adoption be increased? 
Breakout Session 3
 

Implementation 

103 
 

 

 

 

 

 

 

 

 

 

Session Overview 

1. Introduction of all participants in breakout – Name, title,	 organization– two 

minutes total 

2. Identify breakout champion to deliver readout in plenary session 

3. Rules of Engagement 

• Every member in the group should contribute 

• Share your experience and perspective 

• Respect the opinions of others 

• Maintain confidentiality and respect antitrust requirements 

• Focus on the topic at hand and try not to move on to tangential issues – 

Parking lots will be used for the discussion 

4. Last five minutes 

• Confirm champion is prepared 

• Scribes to send final completed templates to Paul for consolidation and 

projection in main center 
Time Duration Session 

11:15-11:20 AM
 5 minutes •Overview of breakout sessions 

•Room assignments are marked on your 

nametag 

11:20-11:25 AM
 5 minutes •Transition to breakout rooms 

11:25-12:00 PM
 65 minutes •Participate in breakouts 

12:30-1:00 PM
 30 minutes •Break for lunch 

1:00-2:00 PM 60 minutes •Resume Breakout Sessions 

2:00-3:00 PM 60 minutes • Transition to Cabildo Room for Readout 

Session 

• Each readout in main session will be given 15 – 

20 minutes to take the larger group through 

recommendations 

Breakout Agenda
 
Implementation Starter Questions
 

Question Discussion 

Immunizer Workflow: What needs to change 

in inventory and administration workflows in 

order to incorporate scanning? 

Administration: What are the workflow 

challenges and opportunities related to 

incorporating scanning? 

What interim solutions exist until full 

implementation is realized? 

What clinical decision support challenges and 

opportunities exist? 
Implementation Starter Questions
 

Question Discussion 

What are the challenges and opportunities 

related to changing workflows to scan 

vaccines prior to administration? 

Inventory: What are the opportunities and 

challenges presented by 2D barcodes? 

VIS: Do current practices match best 

practices and what challenges and 

opportunities exist by making 2D barcode 

VIS data available? 

Level of Scanning: What package level of 

scanning is currently taking place in 

practices? 
 

 

Implementation Starter Questions
 

Question Discussion 

What are the challenges and opportunities 

presented by scanning unit of use? 

What opportunities would exist if scanning is 

extended to secondary and tertiary level 

scanning? 

 What new challenges would be imposed by 

doing so? 

What challenges are presented by 

combination vaccines and reconstituted 

vaccines? 
Implementation Starter Questions
 

Question Discussion 

Office layout affects scanning optimization. 

How would practices be affected by 

reconfiguring office layouts? 

Training and supporting: What are the 

implementation and post-implementation 

needs related to training and supporting state 

registry and provider scanning operations. 

Who should provide the support? The EMR 

vendor? Scanner vendor? 

Mobile Applications: Would it be desirable to 

have applications built by the EMR 

community that would allow the products to 

be scanned with smart phones? 

What are other future opportunities for 2D 

barcoding? 
Breakout Session 1
 

Readout 

110 
 

Standards Starter Questions
 

Question Discussion 

Package-level GTIN: We 

know that 2D barcoding will 

extend beyond primary 

packaging to the secondary 

package. The AAP guideline 

applies to unit of use. Other 

than GTIN, what data do you 

plan to include, e.g., lot#? 

A. Package-level GTIN: 

• 4 data elements: NDC, Lot, Exp, Serial# 

Challenges: 

1. Primary and secondary packages must be related to avoid 

reconciliation errors. 

• Different NDCs would require a redesign of IIS systems 

• How to link lot#s between second and primary packages 

• Should there be a service/web page where manufacturers send 

component information so EMR/IIS can access the information? 

• Manufacturers see more cost than benefit than going to lot level; 

there should be an NDC table that gives the quantity per package? 

• FDA NDC list does not have every NDC 

• EMR-the more scanning required the less the users will do 

• Encoded data must be recorded on the patient record 

• Need a standard data set 

• Different NDC and lot# on primary and secondary packaging, 

Inventory won't decrement inventory 

• HL7 limitation-can only receive one NDC per lot # in administration 

 

B. EMR/IIS Solutions: How do we ensure uniform capabilities? 

1. HL7 messaging is intended to facilitate the EMR and IIS information 

exchange 

2. Challenges: 

• Cost and time 

• Cross matching to Inventory 

• Not all EMR have inventory modules 

If lot#, are you planning to 

use the same lot# as on the 

vaccine unit of use or would 

it be different? 

How do you plan to handle 

the reconstituted vaccines or

combination vaccines that 

may have a different lot #? 

Should 2D barcoding expand 

beyond primary and 

secondary packaging to the 

tertiary level? Would it be 

helpful? 
Breakout Session 2
 

Readout 

112 
 

Adoption Discussion
 

Question Discussion 

Financial considerations: 

What are the financial considerations of 2D 

barcode scanning? Equipment, 

implementation, and training for registries 

and providers? 

• Purchasing scanners 

• Value of a potential cost benefit assessment tool 

• Time saving versus dollar investment 

• Different states of readiness for adoption 

What adoption incentives exist? • Reports that show effectiveness of scanning 

• Grassroots buy in 

• Patient safety 

• Completeness and accuracy 

What other barriers to adoption exist? 

Migration of legacy data, resistance to 

change, technological aversion, absence of 

an electronic record, change in workflow? 

Other? 

• Costs 

• Time investment – preparation 

• Keeping barcoding as a primary concern 

• Resistance to change 
Breakout Session 3
 

Readout 

114 
 

 

Implementation
 

Topic Discussion 

Workflow • Least disruption possible is best way to go. 

• Hasn’t been a huge issue 

Package level • The barcode needs to represent how many vials 

• EMR system recognizes during inventory 

Training • Manufacturers-training needs intensify with new production 

line 

• Practice- fairly easy to do 

Future opportunities • Mass vaccinations 

Combo and reconstituted 

vaccinations 

• Big issue- see next slide 

• Potential solutions 

• Scan box at admin 

• Matching system/tables (who maintains, updates, 

shares) 

• RFID? 
 

Reconstituted Vaccine Packaging
 

NDC Lot 

Unit of Sale 123 

Linked 

ABC 

Powder 456 DEF 

Liquid 789 GHI 

116 
 

 

 

Day 1 Close

Warren Williams, MPH 

Informatics Team Lead 

National Center for Immunization and Respiratory Diseases 

Immunization Services Division 

Centers for Disease Control and Prevention 

117 
 

 

 

 

 

 

 

 

 

 

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