Program Managers Meeting

1
Vaccine Management Business Improvement
Project(VMBIP)

• Program Managers Meeting
• New Orleans, LA
• November 18, 2008

2
Todays Speakers

• Brad Prescott, VMBIP Team Lead
• Julie Orta, VMBIP Assistant Lead
• Jeanne Santoli, Acting Branch Chief, VSAB, and
  Deputy Division
  Director, ISD
• Karron Singleton, VACMAN Team Lead
• Tonya Martin, CCID Informatics Lead
• Janet Kelly, ISD VTrckS Lead

3
Agenda

• Describe VMBIP and its workstreams Brad
• Overview of communications team Brad
• Recommendations from AIM vaccine distribution
  workgroup Brad
• Continuous Quality Improvement (CQI) Update Brad
• Economic Order Quantity (EOQ) Julie
• Centralized distribution update Jeanne
• Flu update Jeanne

• VACMAN update Karron
• VTrckS update Janet, Tonya
• VTrckS background and overview
• Governance and release strategy communications
• Project level update
• Grantee Advisory Committee update
• Pilot and Contact Center update Brad and Julie
• Next steps

4
VMBIP Overview
5
VMBIP Workstreams

• Communications
• Continuous quality improvement (CQI)
• Data systems and reporting
• Grantee/provider efficiencies
• Economic order quantity (EOQ)
• Centralized distribution
• VACMAN
• VTrckS
• VTrckS pilot
• Contact center
• Funds management and replenishment
• Data warehouse
• Stockpile

6
VMBIP Communications

• In order to support the vast communications needs
  of VMBIP, a larger communications team has been
  established
• The communications team will focus on the
  following tasks
• Develop a communications strategy for VMBIP
• Create a marketing strategy to showcase the VMBIP
  milestones
• Coordinate the project-specific communication
  tasks to ensure consistency of message
• Establish a partnership with stakeholders such as
  AIM and grantees through initiatives such as the
  Grantee Advisory Committee (GAC) and the Provider
  Advisory Committee (PAC)
• Ensure stakeholders are kept abreast of changes
  in the program and how they will be impacted

7
The AIM Vaccine Distribution Workgroups
recommendations

• Provision of real time, accurate inventory
  information (CQI)
• Replenishment and monitoring reports (RAM)
• Monthly allocation (VSAB)
• Shipment of vaccine as quickly as possible (CQI)
• Quality improvement for vaccine distribution and
  shipment monitoring (CQI)
• Timeliness of data receipt and vaccine shipments
  (CQI)
• VACMAN

8
CQI update
CQI Project Accomplishments
Cold Chain Study - Closed McKesson has hired dedicated FTEs to monitor VMBIP package movement throughout the nation McKesson has implemented additional review activities to improve the cold chain processes McKesson has qualified all pack-out designs for all shipping containers, including both hot and cold ambient temperatures
Product Shipment Integrity - Ongoing McKesson has updated their training program to monitor manual processes via the Quality Control program Improved vaccine pick stations to include pack-out diagrams and consolidated order ticket distribution activities and increased team lead responsibility
CA Efficiencies - Closed Enhanced grantee order processes and accountability methods in support of a more streamlined order processing system Created standardized tools to support order receipt, order submission, and storage policies at the providers office
Influenza Vaccine - Closed Identified and disseminated grantee best practices around preplanning for flu vaccine orders Developed an allocation system to manage grantee orders provide grantees with daily balances Import/export file support to allow grantees to preplan outside the system and then upload their files when they receive their allocation
9
Data, Systems, and Reporting CQI Initiatives
CQI Project Status Description Accomplishments
Data, Systems, and Reporting (DSR) Phase One ClosedMay 1 Create a baseline of the data touch points, reports, and systems involved with VMBIP Created systems architecture diagram to understand the inputs and outputs of VMBIP Reports matrix was created to provide visibility into the data outputs of the program
Data, Systems, and Reporting Phase Two Open iDoc Error Report (McKesson) Create a report to monitor the volume of iDoc errors for a given period to provide a gauge of data quality (ship dates, inventory levels, etc.) between SAP and TecSys Data, Systems, and Reporting Phase Two
Data, Systems, and Reporting (DSR) Phase Two Closed Sep 18 Legacy Systems Call Type Report Create a report to provide visibility into the types of calls related to VACMAN to better understand grantee concerns or system issues Call activity report was created and is delivered monthly to VACMAN leadership to better understand current call types and address issues
Data, Systems, and Reporting (DSR) Phase Two Closed Nov 4 Reports Review Interview recipients of VMBIP distribution data to determine if users needs are met. If gaps are identified present them to the Change Control Board for review Interviewed CDC and Grantee representatives to identify reporting needs, successes, and deficiencies Identified 77 changes that would fill the identified gaps in the reports currently in use by CDC and the Grantees The Reporting Change Control Board will evaluate the change requests to determine if they should be incorporated into the program
10
Grantee/Provider Efficiency CQI
The CQI is targeted to provide grantees,
providers, and field representatives tools and
methods that are designed to improve operational
performance as it pertains to vaccine orders.
Grantees
Providers
Field Representatives

• Grantees can be provided the tools and methods to
  improve internal efficiencies by understanding
  their labor requirements and communicating real
  performance

• Providers can benefit by implementing operational
  best practices to improve efficiencies and
  accountability

• Field Representatives will be better equipped to
  support the providers vaccine storage needs for
  their assigned providers and reduce wastage

11
(No Transcript)
12
EOQ Pilot Grantees
Benefits and Discussion

• Pilot grantees selected based on potential cost
  savings and grantees interest in EOQ
• Monthly reports of the grantees ordering
  behavior and comparisons to ideal EOQ tiers
• Development and implementation of tools,
  educational materials, change management
  strategies
• VTrckS will support EOQ implementation
• Current ordering behavior primarily occurs during
  the beginning of the month, leading to large
  peaks initially
• Smoother ordering throughout the month brings
  predictability to the workloads at the DCs
• EOQ tiers reduce the number of orders placed by
  each provider and entered by grantees

13
Centralized Distribution

• Transition of Centralized Distribution Support
• Transmission of Orders from CDC
• Flu vaccine ordering/distribution

14
Transmission of Orders from CDC

• Once received at CDC, provider orders are
  transmitted to McKesson each morning in a single
  batch
• If the transmission is interrupted for any
  reason, fewer orders (or no orders) may be
  transmitted to McKesson, with a concomitant
  increase in transmission the following day
• This situation is generally infrequent, but we
  are aware of two examples that occurred within a
  5 week period this fall Sept 8 and October 13

15
Transmission of Orders from CDC

• The first interruption due to temporary SDN
  outage, the second due a federal holiday when
  automatic transmission was inadvertently not
  programmed to occur.
• Transmission interruptions have significant
  impacts on McKesson
• We have put in place some strategies to
• Prevent transmission problems that can be
  prevented (holiday transmission)
• Implement real time monitoring of order line
  transmission to identify problems as soon as they
  occur.
• Once a transmission problem is identified, CDC
  will work with McKesson to determine an estimate
  of impact and communicate the information with
  grantees immediately.

16
Non Flu Work Queue at McKesson
9/12 - 9/26 Orders Held For Hurricanes
10/13 Columbus Day
9/9 CDC SDN Issue
91.3
86.4
82.3
69.1
73.3
69.7
52.2
55.0
17
New Allocation Functionality in NIPVAC

• Initiated this year for flu vaccine, but a
  potential model for other allocated vaccines
• Tracks orders versus allocation and holds orders
  at CDC if they are over the allocation
• Limited to doses available on CDC contract
  (though it includes doses purchased on CDC
  contracts as well as other mechanism)
• Provides daily balance information to grantees
  via an auto-generated email

18
Daily Flu Allocation Balance Report
Grantee Vaccine NDC
Season Avail Approved Held Bal
Example
19
Challenges (so far)

• Initial inability to make manual changessolution
  developed
• Confusion over grantee receipts for flu vaccine
  purchased with state funds on the CDC contract
• Allocations for non-contract doses
• Novartis swap out
• Returning cancelled orders to the
  allocationsolution developed
• Flu swaps

20
Assessing the delivery of flu vaccines

• Goal for flu is delivery within 3 business days
• The day the order is received at McKesson is the
  first business day
• Current weekly metrics do not take provider
  office hours into account
• Shorter processing time for flu vaccine makes
  provider office hour restrictions critical to
  assess performance
• VACMAN data on provider office hours is difficult
  to manipulate (VTrckS will address this)
• CDC working to finalize flu metrics to take
  provider office hour restrictions into account

21
2008 Influenza Season Metrics

• 80 of all influenza received has shipped (as of
  11/14)
• 10.8 MM Doses Shipped
• 13.5 MM Doses Received
• Doses Returned/Wasted (as of 11/14)
• 32K Doses Wasted (.29)
• Undeliverable/Customer Not Available
• Incorrect Address
• Order Error
• Temp Monitor

10/20/2016
21
22
VACMAN UPDATEOrders Processed 2/5/07
11/14/08

• VACMAN/NIPVAC STATS
• ORDER LINES PROCESSED 1,992,767
• ORDER LINE RECEIPTS PROCESSED 2,106,009
• ORDER LINES CANCELLED 9,323
• SHIPMENTS CANCELLED FROM MCKESSON 1,292
• REPLENISHMENT ORDERS 5,625

Data Source NIPVAC
23
VACMAN UPDATERelease Status
VERSION NUMBER RELEASE DATE DATE ISSUE FOUND ISSUE
4.1.4 7/7/08 7/11/08 Bug in code would not process orders for vaccines with three or less characters in the name
4.1.4.1 8/28/08 9/15/08 Bug in VACMAN communications would not process flu vaccine orders. Workaround was to import flu orders into VACMAN.
4.1.4.2 9/17/08 N/A Validate order process causing too many issues with rejected orders file.
4.1.4.3 TBD Turn off the second validate order process that was rejecting orders.
24
VACMAN UPDATERelease Status

• CORRECTIVE ACTIONS
• CONTROL SOURCE CODE
• DEVELOP COMPREHENSIVE TEST PLAN
• -- FULL REGRESSION TESTING
• INDEPENDENT TESTER FOR QUALITY ASSURANCE

25
VACMAN UPDATEGrantee Questions/Comments
VACMAN reports generated/exported to Excel cuts off after 16,800 records This is a limitation of Excel. You may want to export using a .dbf and MS Access.
When transmitting orders, internal staff name is on screen. After transmission, it changes to CDC. If staff are making errors during this process, we are unable to coach them in the proper procedures. A Change Request will be opened for this enhancement, and presented to the next VACMAN Change Control Board.
VACMAN will not allow identical number of doses for the same vaccine type (e.g., cannot order 10 Boostrix and 10 Adacel) for the same provider. The development team tested this scenario on the provider order screen, the multi-order order screen and import feature in both VACMAN 4.1.4.2 and VACMAN 4.1.4.3. We were unable to replicate VACMAN saved both TDAP orders.
Flu email notifications Researching report of non-receipt of this info
VACMAN statuses are 2 weeks behind and sometimes orders are placed on backorder but are cancelled before the backorder status is received in VACMAN. It is possible that a vaccine order placed on backorder will either be received and shipped or cancelled before the statuses in VACMAN sync up.
26
High-level architecture of the VMBIP environment,
including CDC and McKesson IT systems
27
VACMAN UPDATEGrantee Questions/Comments
OPTIMUM TIMELINE FROM ORDER TO RECEIPT (SHIPPING)
INFORMATION
Business Day 1 CDC Receives Orders from Grantees
Business Day 2 CDC Processes Orders McKesson Picks Up Order File
Business Day 3 McKesson Picks, Packs, and Ships
Business Day 4 McKesson Sends Shipping (Receipt) File to CDC
Business Day 5 CDC Processes Receipt File Grantee Gets Information Upon Download from CDC
28
VACMAN UPDATEGrantee Questions/Comments
ACTUAL ORDER TO RECEIPT TIMELINE
29
VACMAN CONTINUOUS QUALITY IMPROVEMENT

• IMPLEMENTED IN 2008
• ORDER ID TRACKING
• REJECTED ORDERS EMAIL TO VSAB
• RECEIPTS OUTSTANDING gt 21 DAYS
• FUNDING THRESHOLD REPORT TO RAM TEAM
• -- QUARTERLY PROJECTIONS VICE ANNUAL
  PROJECTIONS
• MULTIPLE RECEIPT SCREEN IN VACMAN
• ALLOCATION MANAGEMENT
• WEBINAR TRAINING
• EARLY 2009
• SEND ORDERS TO MCKESSON USING EDI

30
VACMAN SUMMARY

• VACMAN/NIPVAC STATISTICS
• VACMAN UPDATE
• CONTINUOUS QUALITY IMPROVEMENT