Jeanne Tropper 1 , Cindy Vinion 2 , Warren Williams 1

1. Aggregate Reporting of Pandemic Influenza Vaccine Doses Administered Using CDC’s Countermeasure & Response Administration (CRA) System and State Immunization Information Systems (IIS) Jeanne Tropper1, Cindy Vinion2, Warren Williams1 1Centers for Disease Control and Prevention, 2Northrop Grumman Corporation

2. Learning Objectives • Understand approaches and technologies available for reporting to CDC aggregate Pandemic Influenza vaccine doses administered. • Select best approach for a given state jurisdiction. • Know requirements and technical assistance available for each approach.

3. Background • The National Pandemic Influenza Plan calls for Department of Health and Human Services (DHHS) agencies, specifically the Centers for Disease Control and Prevention (CDC), to enable national monitoring of vaccination program progress and the appropriate use of a scarce vaccine by providing project areas the capability of reporting weekly to CDC doses of vaccine administered and other indicators. • To accomplish this objective, project areas will track vaccine doses administered and collect and aggregate minimum data elements to monitor their programs and transmit weekly to CDC; The data set includes: age groups, priority groups and receipt of first or second vaccine doses administered. • An existing Public Health Informatics solution developed by CDC’s National Center for Public Health Informatics (NCPHI), Division of Emergency Preparedness and Response (DEPR), the Countermeasure & Response Administration (CRA) system, has been enhanced to accept aggregate counts of pandemic influenza vaccine doses administered and to aid in reporting vaccine coverage progress on a state-by-state basis. • This poster presents the range of approaches CDC has in place for states and partners to provide the aggregate reporting required of the National Pandemic Influenza Plan and Supplemental Guidance using the CRA application.

4. Methods • CDC has collaborated both internally and externally with scientific and technical experts to specify a range of mechanisms for supporting the timely and consistent reporting of aggregate vaccine doses administered. • Organizations working in collaboration included: • American Immunization Registry Association (AIRA). • Association of State and Territorial Health Officials (ASTHO). • CDC’s National Center of Immunization and Respiratory Diseases (NCIRD). • CDC’s National Center for Public Health Informatics (NCPHI). • CDC’s Pandemic Influenza Task Force. • State and partner jurisdictions. • Collaboration centered on use case and specification development via in-person meetings and conference calls.

5. Data Collection Form

6. Results • A minimum data set for vaccine doses administered was identified and agreed upon. • A form was developed for collecting required data on a manual basis. • CDC’s CRA system was modified to provide three ways for states and partners to report vaccine doses administered: • Option 1: For states and partners collecting data via an existing immunization information system (IIS) or other application, technical specifications were developed for three different data exchange formats. • Option 2: For states and partners collecting data manually, an aggregate reporting screen was added to CDC’s CRA application to allow direct data entry via a web browser. • Option 3: For states and partners using CDC’s CRA application to collect patient level information, selected data elements will be automatically aggregated

7. Option 1 Description • Healthcare provider collects information locally and submits selected data to the state IIS or other application. • The state submits aggregate data to CDC’s CRA system for weekly upload via Immunization Information System or other application using one of three data exchange formats: • Pipe-delimited upload file • Extensible Markup Language (XML) file • Health Level 7 (HL7) Version 2.5 Unsolicited Observations (ORU_R01) message following the Public Health Information Network (PHIN) Aggregate Reporting Guide Process Considerations • What level of vaccination data and by whom it will be collected must be determined; at minimum, core data elements must be collected. • Aggregate data exchange must be consolidated at the state or partner level prior to submission to CDC. Technical Considerations • Local application must have existing capability or be updated to collect core data elements; cooperative agreement funds for enhancing state Immunization Information systems may be available to approved PHEP applicants • Core data elements must be extracted and put into one of three formats following the Aggregate Reporting Guide: pipe-delimited, XML, HL7. • Transport mechanism must be determined and consistent with CDC PHIN standards. • Digital certificates must be in place for access and transfer to CRA .

8. Pipe-delimited File Option 1 or • XML File or • PHIN/HL7v2.5 Message (ORU_R01)

9. Option 2 Description • Healthcare provider collects summarized data using the Doses Administered Provider Record. • On a weekly basis, the healthcare provider submits counts to CDC via CRA’s web-based aggregate reporting user interface. Process Considerations • Determine who will enter information on-line. Technical Considerations • Staff entering data on-line must have access to the internet via web browser. • Staff accessing CRA must have a digital certificate.

10. Option 2

11. Option 3 Description • Healthcare provider collects patient level information locally using CDC’s CRA application. • CRA automatically calculates counts from patient level data entered. Process Considerations • Determine by whom and at what level of detail vaccination data will be collected; CDC’s CRA can collect detailed individual level information in addition to core data elements. Technical Considerations • Staff entering data on-line must have access to the internet via web browser. • Staff accessing CRA for upload must have a digital certificate.

12. Option 3

13. Conclusions and Next Steps • CDC has developed a flexible means for states and partners to provide the aggregate reporting required by the 2006 Public Health Emergency Preparedness Cooperative Agreement Pandemic Influenza Supplemental Guidance, CDC and HHS Pandemic Influenza Plans. • Partners can choose from a variety of approaches that satisfy these requirements, work within existing capabilities, and enable consistent and timely reporting that can be quickly and easily aggregated at the national level. • To achieve the national capability for aggregate reporting of pandemic influenza vaccine doses administered, several next steps must be taken: • CDC to work with HHS, ASTHO, AIRA and others in developing an analysis and feedback plan for assessing vaccination coverage. • CDC to conduct a series of webinars briefing state partners on aggregate reporting requirements; the first is to be scheduled for late March 2007. • State partners to establish plans to implement one of the three options available; specifications for uploading are now available via CRA Exchange: http://team.cdc.gov/. • Testing to begin with initial priority on data exchange capability.

14. CDC Resources and Points of Contact • Jeanne Tropper, jwu0@cdc.gov – CDC Science Lead for CRA applications. • PHIN Help Desk, PHINTech@cdc.gov – single point of contact for all CRA, PHIN related requirements; assistance includes: • Issuing digital certificates. • Providing access to CRA Exchange, an interactive knowledge sharing and exchange web site (http://team.cdc.gov/). • Providing access to CRA demonstration site. • Problem solving, including accessing CDC subject matter experts. • PHIN Website, http://www.cdc.gov/PHIN - website detailing PHIN requirements.