Agile Engineering: A New Application for Reporting H1N1 Immunizations

USIIS ProgramNancy McConnell, J.C. Alexander

Immunization ProgramJanel Jorgenson, Karen Tsuyuki

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

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

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

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

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

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

Web application Supportive components• Specifications: screen layout,

navigation, data elements, reports, data export

• Internal process roles & backup

• User access instructions• Develop—iterative tweaks • User documentation• Internal Test & Pilot Test • Customer support• Release• Update(s)

H1N1 Doses Administered application

Export file generation

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

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

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

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