Louisiana Department of Health and Hospitals Office of

Louisiana Department of Health and Hospitals – Office of Public Health Doris G. Brown, RN, M Ed, MS, CNS Public Health Executive Director Louisiana Immunization Network for Kids Statewide Scientific Technologies Corporation Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Presentation Objectives – Drill Overview – Drill Goals – Louisiana Challenges – General Systems Requirements – Solutions to Fit Drill Objectives – Real-Time Data Collected at the State EOC – Event Results – Looking Ahead – Prepare for All Event Scenarios Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Drill Overview • Pandemic Flu Grant drill requirement: – 2 mass vaccination clinics using influenza vaccine in each CRI city (4 total), 2 community sites. – Set up site as a point of dispensing clinic – Measure throughput Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Drill Overview, cont. • LA has extensive experience with mass vaccination • Challenge: 9 simultaneous sites, one in each Public Health Region • All off-site, no public health buildings used • 2 hours to set up, 6 hours of vaccination • Opened the State EOC Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Drill Goals • Open 9 simultaneous Community Point of Dispensing Sites • Limited set-up time • Use POD principals to set-up, operate, and evaluate site • Offer free flu vaccine to the public for participating • 200 vaccinations/hour at each site • Open the State EOC to evaluate the drill real-time Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Core POD Team Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health POD Communications Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Louisiana Challenges • Collecting patient & immunization data with paper forms has been problematic – Time consuming – data is handled at least twice – Inaccurate – illegibility, difficulties transcribing – Inefficient communications required to manage multiple sites, inventories, patient flows, etc. – Data not available for real-time inspection Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Louisiana Challenges, cont. • Some skepticism and resistance to paperless data collection during an MI event • Potential patient flow high due to a large mass media campaign – Each of the nine facilities expected average of 200 patients/hour – Unclear what actual flow would be Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Louisiana Challenges, cont. • The Louisiana Immunization Network for Kids Statewide (LINKS) system is feature rich with steps and workflow to meet IIS standards • Success of paperless reporting required – Streamlining the data entry steps – Reduce application training requirements – Reduce time of data entry per patient to less than that required to fill out a paper form Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health General Systems Requirements for Paperless Reporting • Three system “levels” make up the LA solution – The SIIS (LINKS) – Mass Immunizations Module – Mass Immunizations Standalone • Together, these systems can eliminate the problems of paper data collection and provide real-time or delayed electronic information for EOC activities. Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health General System Requirements for Paperless Reporting • The SIIS (LINKS) – Fully featured statewide immunization information system. Provides extensive reporting on patients, vaccinations, vaccine inventory levels by facility – The EOC typically uses the system at this level during an event to determine patient flows and vaccine inventory levels – Accessible via the OPH network or via the Internet (includes wireless, wi-fi, cellular air-card, etc. ) Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health General System Requirements for Paperless Reporting, cont. • Mass Immunizations Module – Accesses the same database as LINKS – Can search against patients existing in the LINKS database – User interface designed specifically for mass immunization event requirements – Accessible via the OPH network or via the Internet (includes wireless, wi-fi, cellular aircard, etc. ) Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health General System Requirements for Paperless Reporting, cont. • Mass Immunizations Standalone – No network or Internet data access • No real-time information for the EOC – No software to install on the PC or notebook – Self contained on USB memory stick (87 MB for small Java application) – Exports data to text files (three files: patients, vaccinations and contraindications) for upload to the SIIS Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Solution to fit the drill objectives • Mass Immunizations Module – a Web-based module to LINKS – For the “front-line” user • Three data entry screens – – Search Add patient Select vaccination and optionally, contraindications Save and search for next in line • Fewer than 20 total possible data elements to complete • Date and SSN field auto-masking • Auto-fill city & state with entry of Zip code – Less than one minute to search, add, select and save data while patient is in line Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Solution, cont. • Patient search Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Solution, cont. • Patient add Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Solution, cont. • Complete and save record • Next patient in line… Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Data Entry Stations Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Full Mass Vaccination Clinic Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Solutions to fit the drill objectives, cont. • For the manager/user… – The Mass Immunizations module provides • Ease of use • On-Site reporting – Patient names & counts by facility/date – Patient detail (demographic and vaccination) by facility/date • For the EOC users – Using the same database, LINKS provides other management tools: • Full power and tools of the SIIS application Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Real-Time data Collected at State Emergency Operations Center • Real-time patient flow by site • Real-time patient demographics by site • Vaccine inventory by local providers near the site Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Event Results • Activity at each facility much higher than projected – Expected 10, 800 patients total – Expected 200 patients/hour for the six hour event at each of the nine facilities – Actual count for the six hours was approximately 27, 000 patients/vaccinations – 500 patients/hour average at each site Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Event Results, cont. • Data entry – 92% of the data entry completed in real-time – Backup plan (paper forms) used when Internet connectivity was lost at one facility – All data entry completed within 24 hours – Accuracy of data entry highly satisfactory – Users convinced of paperless reporting benefits Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Event Results, cont. • Vaccine inventory supplies – Due to real-time data entry in Mass Immunizations, use of LINKS allowed managers at the EOC to project that all sites would run out of vaccine during the six hour period – Local stockpiles were assessed and vaccine was transferred. No sites ran out. Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Looking Ahead – Prepare for All Event Scenarios • Be prepared! – System reliability and IT staff readiness – Consider standalone electronic applications for events with no network availability – Mass Immunizations, “USB Thumb Drive” version provides this capability to LA – Prepare to revert to paper forms as a backup option Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Drive-through Clinic Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Drive-through Clinic Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Conclusions • Using LINKS Mass Immunization Module was a huge success • Allowed for real-time data analysis • Users report it was no more time consuming or complicated than paper • Public/Media very supportive Center for Community Preparedness

Louisiana Department of Health and Hospitals – Office of Public Health Contact Frank J. Welch, MD Medical Director, LA Immunization Program fwelch@dhh. la. gov Ruben Tapia, MPH Program Manager, LA Immunization Program rtapia@dhh. la. gov Mike Garcia Scientific Technologies Corporation Mike_Garcia@stchome. com Center for Community Preparedness