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Kelly L. Moore, MD, MPH Tennessee Immunization Program

How do you solve a problem like… mass pandemic influenza vaccination? Private Provider Pre-Registration!. Kelly L. Moore, MD, MPH Tennessee Immunization Program January 2010 Immunization Program Manager Meeting AIM Bull’s Eye Award Presentation. Lessons Learned: Chiron 2004.

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Kelly L. Moore, MD, MPH Tennessee Immunization Program

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  1. How do you solve a problem like… mass pandemic influenza vaccination?Private Provider Pre-Registration! Kelly L. Moore, MD, MPH Tennessee Immunization Program January 2010 Immunization Program Manager Meeting AIM Bull’s Eye Award Presentation

  2. Lessons Learned: Chiron 2004 • October 5 influenza vaccine supply halved • State health departments tapped by CDC to place orders for providers using redistributed Sanofi product • Challenges • Did not know who needed vaccine • Lacked contact information for all private providers • No structure for quick, targeted communication to reach all relevant providers • Millions of leftover doses • Slow deployment of available vaccine • Slow expansion beyond priority groups • Public lost interest

  3. July: The 2009 H1N1 Vaccination Campaign Challenges • Vaccine coming October 15 (…or earlier!) • State public health responsible for distribution • Major features of federal program undecided • Probably going to use a federal distributor/ VACMAN • TN Department of Health (TDH) still lacks reliable and rapid means of communication with most private sector healthcare providers

  4. Pre-Registration of Private Providers: Purposes of System • Interested private providers self-identify • Target non-VFC providers • Obtain valid shipping and contact details • Enroll providers in Immunization Registry (“TWIS”) • Exclude inappropriate vaccine recipients • No cost to pre-register • No obligation to order • Create an H1N1 Vaccine Provider Network with whom we communicate electronically and keep them engaged with us

  5. Notification of Pre-registration Option • Pre-registration launched inside TWIS on August 5 (3 week development) • Simple 1-page notice widely distributed (message: go to http://twis.tn.gov to sign up!) • Professional organizations (TMA, TNAAP, TN Pharmacy Association, etc.) • Conference call with hospitals - state hospital association • TN Health Alert Network • Posted on TDH, TWIS web pages • TDH press release and media interviews • Local public health-private provider contacts • Mail out letters to licensed providers (for completeness)

  6. Weekly Pre-Registered Provider Updates Began on August 13 • Communicated latest developments • Update them on any problems we had • Reminders, FAQs • Via blast emails to all 1° and 2° contacts • Blast fax (VFC) • Special editions (e.g., recalls)

  7. Pre-Registered Provider PINs • 6 characters, needed in VACMAN; one per ship-to location • “## P###” format distinct from VFC • All pre-registered providers received email with PIN, link to Survey Monkey questionnaire to place orders • Used PIN to link to all provider info • Prioritized providers by facility type

  8. Participation in Pre-Registration: Impact on TWIS • TWIS users as of August 4, 2009: • 458 authorized private providers • 2,436 individual users (staff enrolled as separate users under provider’s account) • New TWIS users since August 5: • 1,969new private providers (4x previous) • 6,110 individual users (2.5x previous) • Private sector not required to enter H1N1 doses in TWIS • 15.3% increase in doses entered in TWIS per day • Average 255 doses/day in previous calendar year • Average 294 doses/day, 8/5/09-1/15/10

  9. Participation in Pre-Registration: Impact on H1N1 Vaccine Distribution • 1,642 ship-to locations were pre-registered (PINs) • 1,178 non-VFC pre-registered private facilities got shipments of ≥100 doses of H1N1 • Awaiting final data, but CRA doses administered reports submitted to CDC always exceeded expected based on population (2%) • Early CDC data provided to TN on January 14 show state H1N1 vaccine coverage point estimate higher than national or regional average

  10. Challenges • Had PIN problems (duplicates created by a random number generator) • Registry coordinator overwhelmed by unexpectedly huge and rapid increase in new providers registering (delays in processing registration applications) • Multi-stage process was clunky • Prone to confusion or failure to place a valid order, especially in providers who did not read carefully

  11. Conclusions • Online pre-registration met all goals • Pre-registration provided for an efficient, effective communication and distribution and response network that was manageable for the small H1N1 Vaccine Distribution Team • Applications in future emergencies that require an ongoing collaboration between public health and a network of private sector providers

  12. Acknowledgments: TN Pre-Registration Design Team • Marion Kainer, MD, MPH • Director, TN Hospital Infections Program • Brian Moore • TIP Registry Coordinator • Rami Abuhamdeh • BCS Healthcare (TWIS contractor) • Michael Creighton • IT Business Manager • Beth Anne Frost • CSTE Fellow • All the volunteer staff who assisted registering new providers

  13. Discussion/Questions Kelly L. Moore, MD, MPH Kelly.moore@tn.gov 615-741-7247

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