Agile Engineering: A New Application for Reporting H1N1 Immunizations

1. Agile Engineering: A New Application for Reporting H1N1 Immunizations USIIS Program Nancy McConnell, J.C. Alexander Immunization Program Janel Jorgenson, Karen Tsuyuki

2. USIIS Overview • Utah’s Immunization Information System • Lifespan IIS • Maintains residents’ immunization histories, consolidating immunizations across providers • Forecasts immunizations due, for managing patient care • Vaccine inventory management • Web application & Data interfaces • Standards-based: CDC, HL7, PHIN, IHS • Used by public and private providers, schools, daycares • IIS use is not mandated in Utah • Used by ~62% of private providers • Supports Immunization Program roles

3. Usual response to a new vaccine • Add vaccine to database table • Add manufacturer to database table • Update forecast with the vaccine’s schedule • Age(s) when recommended • If multiple doses, interval between doses • Special cases: combination vaccines, manufacturer-specific approvals • Add to applicable reports • Inform users …then came H1N1

4. Immunization Programs’ H1N1 Role • Receive vaccine and ancillary material • CDC-funded for the entire country • CDC distributed to states via usual routes • Distribute vaccine to Local Health Departments (LHDs) • Weekly shipments • Ship to private providers as specified by LHDs • Report doses administered to the CDC • Doses of H1N1 vaccine administered • All states required to report weekly • Report content = summary data across the state

5. Moving Targets • Vaccines • Injection, Nasal • One-dose, two-dose • Age recommendations • Manufacturers • Availability • Required reportable data • Age groups • Doses • Inventory wasted • Reporting periods • Priority groups • Local Health Departments’ plans for administering vaccine

6. Response • Vaccine • Developed ordering and distribution plans • Obtained and provided information • USIIS • Prepared to report state-summarized H1N1 doses administered, in specified data export format • Evaluated options • Summarize H1N1 data in USIIS • Vaccinators = subset of USIIS users • Uncertain timeliness of receiving H1N1 data • USIIS is a complex application  not enough time to train all vaccinators (non-USIIS users) • Providers fax or spreadsheet  manual UDOH consolidation and manual data submission to CDC • Providers use Web application  automatic consolidated data and data formatting for CDC

7. USIIS Response • Developed a Web application for H1N1 vaccinators to report doses administered • Tracked moving requirement targets • Modified application as information became available, then final • Development process & components

8. H1N1 Doses Administered application

9. Export file generation

10. USIIS Technical Strategies • New application to become a step in the USIIS roadmap • Developed in new technology: JSP, Netbeans • Wrote a new login application • Application extensible to flexibly manage authorization and authentication for all USIIS-related components in the future • Existing USIIS users’ login credentials to provide access to the new application • Use USIIS database • Common infrastructure

11. Results • Utah acknowledged by CDC as one of two states to report doses administered on schedule—from the onset and ongoing • Key: Providers required to submit Doses Administered before receiving the next week’s vaccine shipment • USIIS and non-USIIS users successfully used the new application • Keys: Application design; User documentation • USIIS JSP rewrite underway • Key: Strategic response to an urgent situation

12. Additional results • Internal processes • Agile software engineering • Adapted to urgent, changing situation • Prioritized minimum requirements, adding features as time permitted • Focused on quality • Delivered on schedule • USIIS-IP collaboration • Non-USIIS user authorization process (provider agreements, user agreements, logins and passwords) • Backups for each manual process role • Leveraged data for UDOH weekly situation meeting reports and LHD reports • Smith’s/Kroger became the first pharmacy data supplier to USIIS - via data interface

13. Utah H1N1 Doses Administered • First doses given: October 4-10 • Total doses given: 559,294[thru 3-Mar-10] • 6-23 months: 40,172 (7.2%) • 24-59 months: 67,633 (12.1%) • 5-18 years: 162,801 (29.1%) • 19-24 years: 40,671 (7.3%) • 25-49 years: 144,517 (25.8%) • 50-64 years: 65,942 (11.8%) • ≥ 65 years: 37,555 (6.9%) • Dose#1: 479,849 Dose#2: 40,705 Unknown Dose#: 38,740 • Waste: 1,967 doses