SNS Exercise Support Rochester, New Hampshire

1. SNS Exercise SupportRochester, New Hampshire PHIN Conference Atlanta, GA August 28th, 2007 Joint Presentation Christine Adamski, MA New Hampshire Department of Human Health Services Jeanne Tropper, MS, MPH Division of Emergency Preparedness and Response National Center for Public Health Informatics Centers for Disease Control and Prevention

2. Agenda • Purpose • Background • NH & CDC Observations • NH & CDC Summaries • CRA CAT System Updates

3. Purpose • The purpose of field test was twofold: • For New Hampshire Department of Human Health Services (NHDHHS) – to determine whether the CRA CAT system was more effective than manual forms for tracking information • For Centers for Disease Control and Prevention (CDC) – to evaluate the CRA CAT system for utilization at a point of dispensing (POD), and gain better understanding of off-line requirements

4. Background • The exercise’s original intent was to test Strategic National Stockpile (SNS) preparedness; New Hampshire DHHS added the CRA CAT testing to the planned exercise • The exercise was conducted in three locations; Concord, Rochester, and Berlin (central, southeast, and northern areas of the state, respectively) • The Rochester point of dispensing (POD), used the CRA CAT application; other locations relied on manual processes

5. Scenario • Event: The Verizon Wireless Arena in Manchester, New Hampshire hosts the high school hockey finals with a filled capacity of 10,000 people. • Outbreak: Over an eight day course, multiple patients reported with high fever, difficulty breathing, body aches, and skin rash; majority of the infected are high school students and their parents. • Analysis: Symptoms do not respond to decongestants, analgesics, or antiviral therapy; rapid antigen screening tests for influenza have come back negative; based on a gram stain and a blood smear, the laboratory suspects Bacillus Anthracis. • Diagnosis: Local news channel receives anonymous phone call reporting anthrax attack; investigators find small amounts of anthrax in the Heating, Ventilation and Air Conditioning (HVAC) system of the Verizon Wireless Arena in Manchester. • Action: The New Hampshire DHHS requests countermeasure supplies from SNS.

6. Site Information • Objective: Administration of countermeasures to contain the outbreak of Anthrax in the Rochester, New Hampshire area • Location: Local gymnasium of the Rochester Middle School • Technical Set Up: Local Area Network (LAN) connections, 4 laptop computers and one additional laptop acting as the server • Placement: The data entry was located at the backend of the process • Duration: 2 hours

7. POD Patient Flow Door Door Door Door Door Meds Dispensing / Vaccination Area Medical Screening Area 6 Table Table Table Table Routine Patients Enter POD Table Table Table Table 12 CRA Data Entry Station Table Table Table Table 2 Medical Counseling Area Special Table Yes Meds/ Vaccination Table Table Special NoMeds/ Vaccination 4 Table Mental Health Area Table Table 2 Table Table Door Door Patients Exiting POD Door LEGEND - Staff - Patient - Number of stations #

8. New Hampshire Observations • Users were able to effectively use CRA CAT with minimal to no training and the Quick Tips user instructions provided by CRA CAT staff. • CRA CAT was flexible and allowed data entry staff to enter fields “on the fly.” • A timed CRA CAT data entry operator revealed an average of 42 seconds to enter a single person form and 41 seconds per person for multi-person forms. • CDC LAN was preloaded and arrived at the POD without incident. It was unpacked and set up efficiently. • Delays occurred with medical dispensing station of the operation. • State data form should be revisited and revised based on actual data needs. • The speed at which the data entered varied greatly, because data entry operators were Registered Nurses (RN) and not staff with specific data entry skills. • System navigation could be improved, i.e. tab, field defaults, order of information.

9. New Hampshire Summary • The CRA CAT system is more effective as a tool than manual forms to track information during a public health event • Improved accuracy • Ability to find patients • Operational reports • Future Considerations: • Needs of computers, informatics systems, and system users must be taken into account in POD planning • Planning for adequate data entry staff and workstations needs to be done and shared with partners

10. CDC Observations • Exercise was an effective method to gather requirements. • Users were able to effectively use CRA CAT with minimal to no training and the Quick Tips user instructions provided by CRA CAT staff – underscored the need to keep things simple • Rapid data entry feature worked efficiently. • LAN setup worked efficiently; optimally it would incorporate reports to provide analysis at the POD. • The CRA application produced summary statistics quickly. • Wireless option to be explored, or possibly a hybrid LAN combined with wireless capabilities. • Explore methods to capture data at the beginning of the process, as forms are completed by patients and finalized at the data entry when countermeasures are administered or dispensed. • Consider real time data entry to capture: how many victims are processed; how much, and of what kind of countermeasure was dispensed; how much throughput for each individual dispenser; where are they in the process (may combine with above) • The canned & ad hoc reporting were not available at user level. • Navigation i.e. tab, date defaults, etc. • Family and group entry

11. CDC Summary • To be most effective CAT needs to be deployed at the front end of the process • Needs to continue to be cheap and easy • Needs to be flexible enough to support a variety of operational flows • Future Considerations: • Alternate methods of data entry; methods for accepting data • Wireless capability • Offline deployment

12. Areas of Improvements CRA CAT System Updates Updated? Details • Release 1.6 will allow PHA users to design the Rapid Data Entry screen to match forms used at a POD. Functionality include: • Adding existing Patient fields to screen • Ordering fields to match form Rapid Data Entry form designs should be improved Tracking of contraindications or drug allergies capabilities should be added • Release 1.6 will include the ability to: • Add new fields, not supported by CAT • Add new vocabulary lists to support the new fields Ability to tab from field to field should be added Release 1.5 provides the ability to quickly add data by using a tab, rather than the mouse, to move from field to field • Future releases of CAT will allow PODs to: • Download and install CRA CAT for off-line use • Report off-line data to the central CAT • Provide for code update of deployed versions of CAT Download and install CAT DES could not enter new products or staff members Release 1.5 allows DES users to add new products (drugs) and staff members rather than relying upon PHAs to perform this task Reports and extracts were not readily available Release 1.6 will provide access to reports and extracts through the user interface. Future releases will expand the reports offering to include throughput and analysis reports. CAT could only support data entry using laptops Future releases of CAT will provide for data entry at various POD stations including registration. Mass data entry, through uploads, will also be supported as will use of wireless and hand-held technology

13. Questions?