H1N1 & Seasonal Flu Vaccination Tracking University of California Davis Health System

May 17, 2010 Project Title: H1N1 & Seasonal Flu Vaccination Tracking University of California Davis Health System Submitted by: Dan Cotton, Education Technology and Application Develop

May 17, 2010

Project Title:

H1N1 & Seasonal Flu Vaccination Tracking

University of California Davis Health System

Submitted by:

Dan Cotton, Education Technology and Application Development Manager

Daniel.cotton@ucdmc.ucdavis.edu

(916) 734-2019

Mike Minear

Chief Information Officer

michael.minear@ucdmc.ucdavis.edu

(916) 734-7131

TABLE of CONTENTS

A SUMMARY 3

B PROJECT LEADERS AND TEAM MEMBERS 3

C PROJECT DESCRIPTION 4

D TECHNOLOGY USED TO CREATE THE VACCINATION APPLICATION 6

E PROJECT TIMEFRAME 7

G CUSTOMER SATISFACTION 8

A Summary

With the massive outbreak of H1N1 Virus throughout the United States in 2009 the UC Davis Health System started taking the steps to require all employees at the UC Davis Sacramento Campus to be immunized for both seasonal influenza and H1N1 In 2009, the University of California Davis Health System (UCDHS) initiated a project to assist in the tracking of H1N1 and seasonal influenza flu vaccinations administered to 12,000+ staff, students and faculty via a web application This new web application would also store the data into the recently

implemented a new Employee Health EMR system (STIX HER) There were several factors that contributed to the need to capture this data electronically:

 The health concerns over a possible pandemic of the H1N1 flu

 Brand new H1N1 vaccinations

 Concerns over outbreaks of H1N1 and the ability to track back to departments and persons who did or did not receive vaccinations

 Ability to track the various lot numbers associated to the H1N1 vaccinations

 Patient, staff, student and faculty safety & exposure concerns

The main project goals were to create a web based application that allowed departments to track individuals who either received the vaccinations by UCDHS, received them elsewhere, or who declined to received the vaccinations By collecting this information, UCDHS leadership has real-time and detailed data to manage whatever issues arose from the H1N1 or seasonal influenza vaccinations Clinical and administrative leadership knows by department, by building,

by area; who did or did not get vaccinated should an outbreak or exposure concerns arise They would also be able to report on the various lot numbers of the H1N1 vaccinations should the need arise

B Project Leaders and Team Members

One of the key elements leading to the success of this project was the deep level of

partnerships created throughout UCDHS The collaborative efforts of the IT teams and several business teams allowed the project to reach a successful conclusion

Executive Leadership

 Allan D Siefkin, MD - Chief Medical Officer

 Stephen Chilcott, J.D Interim Executive Director, Human Resources

 Michael Minear, Chief Information Officer

Information Technology

 Daniel Cotton - Application Development Manager

 Mark Pratt - Application Development Supervisor

 Jeff Chilton - Application Developer, technical lead

 David Haake - Application Developer

 Kevin Stead - Project Development Analyst

 Andre Chu – Database Administrator

 Donna Davis - Database Administrator

 Sue Walker - Programmer, People Soft

 Amy Mentjox - Manager Information Technology

Clinical and Employee Health Leadership

 Susan Sutherland, RN - Manager of Employee Health Services

Page 3

 Neil Speth, MD - Employee Health Services

C Project Description

The UCDHS IT department in cooperation with Employee Health services and clinical

leadership outlined a plan and process that would leverage existing software applications, services, and technologies; to deliver an integrated application that would provide

comprehensive information regarding UCDHS employees and their vaccinations This new electronic process would replace a previous paper based system that only allowed departments

to review their own departmental compliance after sorting through stacks of paper vaccination forms The legacy paper-based system was not efficient and did not support real-time

compliance and data reporting There was a process where this paper based information was collected and entered manually into STIX but this process was usually 3-4 months post

vaccination; long past the time of relevance in an influenza outbreak

The new flu software application leveraged existing user Active Directory authentication,

departmental employee listings from the payroll application, and the STIX employee health management application (that is used throughout UC medical centers)

UCDHS held a number of ‘flu vaccination rallies’ throughout the campus and in multiple

buildings with the intent on making it easy and convenient for employees to receive the unusual number of multiple vaccinations required in late 2009 (the regular seasonal flu vaccination and H1N1)

The data collected was entered into the new flu vaccination application was fed directly into the employee health services application called STIX Employees attending either the rallies or coming to employee health services for vaccinations have their vaccination status noted as

Received at UCDHS Employees also had the ability to bring in proof of vaccination done

elsewhere and have that recorded as Not Received at UCDHS – but still compliant If

employees were allergic or had other reasons for not wanting either of the vaccinations they

would be logged with Refused

Many features were created in the new vaccination tracking application in a matter of weeks to support the requirements of employee health

 Support the ability to log the potential two vaccinations required for H1N1 as well as record the Lot number administered

 Employee Health Services has the ability to add to a “drop down list” all the lot numbers UCDHS received in their shipments of the vaccinations – to accurately record the Meta data of the vaccine drug lot numbers

 Department managers can be assigned multiple departments if appropriate, and

managers can delegate required data entry task to staff of their choosing

 Reporting and compliance checks - the application provides each department

manager to ability to review their departments’ compliance with all three influenza vaccinations

 Provides the UCDHS Chief medical Officer the ability to review compliance across the organization as well as drill down reports for each department

 Department Managers or their assignees are shown their departments compliance at the top of their summary screen

 Data and trending analysis provided for clinical and administrative staff to help assess staffing impact and requirements in the event of an outbreak – including clear

summaries of staff who have or has not been vaccinated (and is therefore safe and eligible to care for or assist patients)

 Supports a number of online and printable reports on various aspects or levels of

vaccinations

Page 5

Reports can be generated based on the overall organization, by department, by individual cost centers within departments, by the individual employee and by lot numbers associated to the H1N1 vaccinations

The granularity of reporting provides levels of reporting that the organization did not have with the previous process, in addition the new reporting function provides access to data real-time, not data that is months old

Figure 1 shows a typical example of the information that department managers have on display.

Included is a summary at the top listing the employee count and percentages

Figure2 Sample Compliance at a point in time

D Technology used to Create the Vaccination Application

 Windows 2003 Active Directory - Used for user authentication This existing service eliminated the need for users to have another username and password combination

 WhoAmI Service - Used to display the full name of the person currently logged in

 Authorization Service - Used to authorize which cost centers(departments) the person logged in can be view and updae

 Rest/Ajax Technologies – Used to retrieve and insert records via a URL call This technology eliminates the needs for the entire web page to refresh/reload which minimizes page refresh time and load on the server

 Jasper Reports – Used to generate the PDF reports

 Java and JavaScript – languages used to process data within the forms

 SQL Server – Database used to store data (part of eth STIX application)

Page 7

Figures 2 & 3 Compliance reports from February 2010

Figure 3 Shows the high level integration of the self developed application and STIX

E Project Timeframe

Need Identified for Flu management application - Initial Planning August 2009

Figure 4 - H1N1 Outbreak Timeline

Image source HHS Flu site, http://www.flu.gov/timeline/

Production STIX

XenApp Server

DR STIX XenApp Server

Influenza / H1N1 Page

On Intranet Only

Web Application updating Medical Activities

on Production DB With Flu Shot and H1N1 Shot Activities

STIX Production Database

Department Manager

G Customer Satisfaction

“The key in management of public health issues, for a city or state, or for a large employer like UCDMC, is DATA The information must be timely, accurate, and specific to the issue and the organization

The Flu tracking application came out of the most recent outbreak and the UCDMC and UCDHS response It supplied us with the information necessary to make decisions about incidence, resource deployment, and workforce planning While Sacramento County and UCDMC were hit very significantly with H1N1 this year, we were fortunate that this virus was not as virulent as it might have been

The attack rate was very high and we had many patients and employees infected, but not so many hospitalized that we could not manage Our vaccination campaigns were wildly successful, which likely also reduced the incidence of our infection among our workers Running the code green over the past year for 7 months prepared us for the next major or minor influenza or other infectious outbreak the Flu Tracking application has and will continue to play a key role in our disaster planning and management.”

Allan D Siefkin, M.D.

Chief Medical Officer, UC Davis Health System

“There was a Pandemic flu outbreak on top of the normal seasonal flu It was a novel strain that emerged Administration was looking to track all employees for both the seasonal and the H1N1 novel strain; otherwise the employee would be mandated to wear a mask In very little time, our IT department was able to assist us

by building a web based Flu/H1N1 site The tracking was decentralized for each unit to track their own employees This system in turn fed data to the employee’s health record It was easy to use, managers loved it There was no resistance in using it as it was easy to use and find

The IT team did an outstanding job in a time frame that was crucial to this program The system was able to pull data for a compliance summary site in real time for administration to view during the season This site was so successful, it was asked

to be cloned for another activity.”

Susan Sutherland, RN

Manager of Employee Health Services

Page 9