Vaccine Management Business Improvement Project (VMBIP)

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Program Managers Meeting

New Orleans, LA

November 18, 2008

Vaccine Management Business Improvement Project(VMBIP)

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Today’s 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

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

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VMBIP Overview

Distribution Provider Ordering

Stockpile

VTrckS SupportVTrckS SupportDistribution SupportDistribution Support

Supply chain management expertise

Inventory management and distribution economics

Distribution contract best-practices




Stockpile SupportStockpile Support

Financial analysis and recommendations for transition timelines and seasonality factors


VMBIP

Internal Efficiencies Support

Continuous Quality Improvement Initiatives– Internal to CDC– Grantee-facing– Between CDC and McKesson

Funds Monitoring, Management, and Analysis

Grantee Funds Management Workforce Analysis




Project Management for Blueprinting, Testing, Piloting, and Implementation Phases

Stakeholder Management and Communications

Organizational Change Management

Contact Center Help Desk Design and Implementation

Data Migration Strategy






Distribution Provider Ordering

Stockpile

VTrckS SupportVTrckS SupportDistribution SupportDistribution Support







Stockpile SupportStockpile Support



VMBIP

Internal Efficiencies Support

















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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

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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

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The AIM Vaccine Distribution Workgroup’s recommendations

Provision of real time, accurate inventory information (CQI) Replenishment and monitoring reports (RA&M) 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

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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 provider’s 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

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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

Closed Nov 4

Reports Review – Interview recipients of VMBIP distribution data to determine if user’s 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

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Grantee/Provider Efficiency CQI

GranteesGrantees

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

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

ProvidersProviders

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

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

Field RepresentativesField Representatives

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

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

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.

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.

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Economic Order Quantity

The original TOF guidelines have been updated, based on recent provider ordering data, collected from all transitioned grantees

New EOQ Guidelines

As-is

4

6

12

Orders per Year

0-199

200-799

800-5,999

6,000+

Annual Volume

(Doses/ Year)

As-isVery Low Volume

QuarterlyLow Volume

Bi-monthlyMedium Volume

MonthlyHigh Volume

Order Cycle

Provider Segment

As-is

4

6

12

Orders per Year

0-199

200-799

800-5,999

6,000+

Annual Volume

(Doses/ Year)


QuarterlyLow Volume


MonthlyHigh Volume

Order Cycle

Provider Segment

As-is

4

6

12

Orders per Year

0-99

100-499

500-1999

2000 +

Annual Volume

(Doses/ Year)


QuarterlyLow Volume


MonthlyHigh Volume

Order Cycle

Provider Segment

As-is

4

6

12

Orders per Year

0-99

100-499

500-1999

2000 +

Annual Volume

(Doses/ Year)


QuarterlyLow Volume


MonthlyHigh Volume

Order Cycle

Provider Segment

Original TOF Guidelines

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

Pilot EOQ GranteesNYC, Florida, Pennsylvania, and Oregon

FloridaFlorida

PennsylvaniaPennsylvania

NYCNYC

OregonOregon

FloridaFlorida

PennsylvaniaPennsylvania

NYCNYC

OregonOregon

Centralized Distribution

• Transition of Centralized Distribution Support

• Transmission of Orders from CDC

• Flu vaccine ordering/distribution

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

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.

0

5,000

10,000

15,000

20,000

25,000

30,000

1-Sep

4-Sep

9-Sep

12-S

ep

17-S

ep

22-S

ep

25-S

ep

30-S

ep3-

Oct

8-O

ct

14-O

ct

17-O

ct

22-O

ct

27-O

ct

9/9 – CDCSDN Issue

10/13 – Columbus Day9/12 - 9/26 – Orders Held For Hurricanes

73.3%

91.3%

52.2%

69.1%

86.4%

69.7%

82.3%

55.0%

Non Flu Work Queue at McKesson

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

Daily Flu Allocation Balance Report

Grantee Vaccine NDC Season Avail Approved Held Bal

ALASKA FLU 19515-0885-07 0 0 0 0 0

ALASKA FLU 49281-0008-10 0 0 0 0 0

ALASKA FLU 49281-0008-25 9700 9700 9700 0 0

ALASKA FLU 49281-0008-50 0 0 0 0 0

ALASKA FLU 49281-0382-15 67750 67750 67750 0 0

ALASKA FLU 58160-0875-46 0 0 0 0 0

ALASKA FLU 66019-0106-01 10000 10000 10000 0 0

ALASKA FLU 66521-0111-01

0 0 0 0 0

ALASKA FLU 66521-0111-10 0 0 0 0 0

Example

Challenges (so far)

• Initial inability to make manual changes—solution 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 allocation—solution developed• Flu swaps

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

04/21/23 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

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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

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.

VACMAN UPDATERelease Status

• CORRECTIVE ACTIONS– CONTROL SOURCE CODE – DEVELOP COMPREHENSIVE TEST PLAN

-- FULL REGRESSION TESTING– INDEPENDENT TESTER FOR QUALITY ASSURANCE

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.

High-level architecture of the VMBIP environment, including CDC and McKesson IT systems


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

OPTIMUM TIMELINE FROM ORDER TO RECEIPT (SHIPPING) INFORMATION


ACTUAL ORDER TO RECEIPT TIMELINE

VACMAN CONTINUOUS QUALITY IMPROVEMENT

• IMPLEMENTED IN 2008

– ORDER ID TRACKING

– REJECTED ORDERS – EMAIL TO VSAB

– RECEIPTS OUTSTANDING > 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

VACMAN SUMMARY

• VACMAN/NIPVAC STATISTICS

• VACMAN UPDATE

• CONTINUOUS QUALITY IMPROVEMENT

Documents

Vaccine Management Business Improvement Project (VMBIP)