Using Tracking Technology in a Point of Dispensing Vaccination Operation

State: FL Type: Model Practice Year: 2016

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DOH-Broward promotes and protects the public’s health through the reduction and eventual elimination of vaccine-preventable diseases by providing vaccine administration, education on receiving timely immunizations, surveillance, and monitoring. Vaccines prevent infectious disease and save lives in the people who receive them and protect those who come into contact with unvaccinated individuals. DOH- Broward’s goal is 95% of kindergarten students and 7th graders to be up to date on immunizations. The model used for the POD is an evidence based intervention recommended by “Guide to Community Preventive Services.”

Historically, the weeks prior to back to school, DOH-Broward service sites have experienced a surge of children who are in need of back to school immunizations.  To accommodate community needs, DOH-Broward operated community-based immunization points of dispensing (PODs) to alleviate overcrowding at its clinical sites and provide immunizations in a convenient community setting in Broward County. 

Prior to implementing this practice, a manual system was in place. The DOH Incident Management Team determined that the manual tracking system was inefficient and a queuing, real time patient count tracking system would be a more effective means to monitor client throughput.  DOH-Broward determined that EMTrack, a hospital evacuation software program that enables emergency response teams to effectively track, plan, coordinate, and manage progressive and spontaneous evacuations could be effectively utilized in a POD setting as a creative use of an existing tool. The use of EMTrack tracking application enabled POD managers and the DOH-Broward Incident Management Team to view real time data flow of client movement throughout the POD stations.  Any stagnation of client movement was identified electronically and reallocation of appropriate resources took place to address client needs.

 

 

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Broward County Health Department
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Using Tracking Technology in a Point of Dispensing Vaccination Operation
Broward County is located in the southeastern portion of the State of Florida with Miami-Dade County to the south and Palm Beach County to the north.  Broward County’s 2014 population estimate of 1,869,235, represents 9% of the State’s population, and is the second most populous county of the 67 counties in the State of Florida and eighteenth most populous county in the United States (US Census, 2014).  Its diverse population includes residents representing more than 200 different countries and speaking more than 130 different languages.  31.5% of the residents are foreign-born.   Broward County is a minority/majority county demonstrated by its 2014 population by race (Black 28.8%, Asian 3.6%, Hispanic 27.4%, other races .5%, for a total of 60.3% and White 39.7%). The Florida Department of Health in Broward County (DOH-Broward) is the official Public Health Agency in Broward County and has been operational since 1936. DOH-Broward’s mission is “to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts”.  DOH-Broward is the lead agency providing core public health functions and essential services in the county as part of a complex public health system that includes hospitals, clinics, planning agencies, community-based organizations and others.  DOH-Broward provides population/community-based services to the county’s 1.8 million residents and over 10 million annual visitors, and is responsible for assessing, maintaining and improving health and safety within the county. The public health issue is to increase the throughput of clients receiving vaccinations through a Point of Dispensing (POD) operation with the use of the EMTrack system to improve Broward County immunization rates. EMTrack is a software program that supports the tracking of evacuees, patients, pets, and associated property and equipment using triage tags or disposable bar-coded wristbands. The intuitive and secure design supports a common operating picture to facilitate interoperable communications among different agencies and organizations. Response and support teams can effectively track, coordinate, and manage patient movements throughout the continuum of care including at the scene, during transport, at the destination, at discharge, and during promotion of the family reunification process. With its unique scan-and-go technology, EMTrack provides the effective management of individual and associated asset data collected that efficiently assists EMS, hospital, and healthcare organizations in managing critical resources, patient care, and valuable time. EMTrack is configured for each site to support local policies and nomenclature, and to reflect any unique state or local needs in patient tracking processes. The goal is to provide real time tracking of patients in an immunization POD and allocate appropriate resources to reduce bottlenecks and increase operating efficiency during DOH- Broward back to school immunization POD campaign. The objectives are: adequately train staff on proper use of the EMTrack system; monitoring client service and wait times; reallocating resources to areas of need based on volume; and provide real time tracking reports to the Incident Management Team (IMT). The practice was implemented through the activation of Incident Command System (ICS) in March, 2015.  Staff received training on the EMTrack hand held scanners in August, 2015. From August 10-25, 2015, DOH Broward held its annual back to school immunization Point of Dispensing (POD) campaign in which the EMTrack system was used.  During the 2015 back to school immunization POD campaign, DOH staff provided 6,283 vaccines to 2,160 children, which was an increase of 3% for the number of children vaccinated and an increase of 25% for the number of vaccines provided. Factors that led to the success of this process were staff training, willingness to implement new technologies, and DOH-Broward staff experience working within an Incident Command System. The EM Track system enabled POD managers to allocate resources where necessary, provide real time data reporting, and increase the number of clients served. The Public Health impact of practice was a more effective use of existing resources (POD staff, supplies, and technology) to manage client flow. As a result of implementing this practice, it increased the number of clients that could be served and the number of vaccines provided. Website: http://broward.floridahealth.gov/    
To address the public health issue of enforcing laws and regulations that protect health and ensure safety by ensuring all children entering, attending, or transferring to a Florida school have completed school appropriate vaccines that are based on The Centers for Disease Control (CDC) Immunization Schedule guidelines. Broward County public schools system is the sixth largest public school system in the nation with a total of 343 schools that includes 105 charter schools and has over 268,000 enrolled students. Additionally there are 207 private schools with approximately 40,000 students in Broward County. All students, grades pre-kindergarten through 12, in public and non-public schools, are required to have a Florida Certification of Immunization, DH 680 Form on file at their school as outlined in Section 1003.22, Florida Statutes, and Rule 64D-3.046, Florida Administrative Code Requirements for Admittance and Attendance. DOH-Broward promotes and protects the public’s health through the reduction and eventual elimination of vaccine-preventable diseases by providing vaccine administration, education on receiving timely immunizations, surveillance, and monitoring. Vaccines prevent infectious disease and save lives in the people who receive them and protect those who come into contact with unvaccinated individuals. DOH- Broward’s goal is 95% of kindergarten students and 7th graders to be up to date on immunizations. The model used for the POD is an evidence based intervention recommended by “Guide to Community Preventive Services.” Historically, the weeks prior to back to school, DOH-Broward service sites have experienced a surge of children who are in need of back to school immunizations.  To accommodate community needs, DOH-Broward operated community-based immunization points of dispensing (PODs) to alleviate overcrowding at its clinical sites and provide immunizations in a convenient community setting in Broward County.  Prior to implementing this practice, a manual system was in place. The DOH Incident Management Team determined that the manual tracking system was inefficient and a queuing, real time patient count tracking system would be a more effective means to monitor client throughput.  DOH-Broward determined that EMTrack, a hospital evacuation software program that enables emergency response teams to effectively track, plan, coordinate, and manage progressive and spontaneous evacuations could be effectively utilized in a POD setting as a creative use of an existing tool. The use of EMTrack tracking application enabled POD managers and the DOH-Broward Incident Management Team to view real time data flow of client movement throughout the POD stations.  Any stagnation of client movement was identified electronically and reallocation of appropriate resources took place to address client needs. Each client is assigned a unique barcode upon entry to the POD. The barcode is scanned at each service station to permit real-time tracking of clients. Client back-logs are easily identified and monitored by the POD Manager using EMTrack real time reports.  Client wait times are minimized to increase throughput.  Electronic scanning of client unique barcodes eliminated the need for manual client tracking and also reduced typographical errors. Real-time, on-site, tracking of all clients at any POD location improved the process by managing bottlenecks and allocating staff to highest areas of need. Children grades K-12, entering, attending or transferring into Broward County schools, targeting rising Kindergarten and 7th grade students are the targeted populations. 93.5% of children entering kindergarten and 95.9% of children entering 7th grade was reached for school year 2014-2015. Daily results were compared to daily results from the previous year for changes in utilization and costs. Scanning technology improved the efficiency of POD operations by identifying bottlenecks and allowing the POD manager to reallocate resources in real time. Test use of technology previously utilized for mass casualty incidents and pre-hospital tracking in a new setting to monitor flow, increase client throughput, and decrease bottlenecks in a Point of Dispensing (POD) setting. This is an evidence-based practice and the use of this technology is a modification of existing technology.  
Global Immunization
The goal is to increase the number of children who receive immunizations during DOH- Broward back to school immunization POD campaign. The objectives are: Training of staff on how to properly use the EMTrack system; Tracking clients by each individual station as they pass through; and Monitoring clients per station in order to allocate the necessary resources. The use of the “EMTrack” tracking application and handheld scanners enables POD managers and the DOH-Broward Incident Management Team to view real time data showing the flow of client movement throughout the POD stations.  Any stagnation of client movement would be identified electronically and intervention can then take place. The system increased the rate of immunizations from 4,544 in 2013 (when scanners were not in use at the PODS)  to  6,283 in 2015 resulting in an increase of 38%.  The number of clients served also increased from 2,012 in 2013 to 2,160 in 2015 which is a 7% increase. Before the operational POD started, employees were provided a training opportunity to practice POD operations with test clients.  Just-in-time training was provided to staff that were identified as those who would be using the EMTrack scanners.  The training included hands-on use of the tracking software and hand held devices under simulated stressful conditions.    Upon entry to the POD,  simulated clients were provided barcodes and registration forms to complete.  Once the paperwork was returned to registration, the bar code was scanned into the EMTrack system which follows the client through the process. The system identified the patient as a unique identification number, electronically in real-time.  At each identified station (registration, screening, vaccination, and exit processing/proof of vaccination forms), the client was scanned.  Upon completion at the station, the client was scanned out to the waiting area.  The process was repeated through the various stations within the POD.  The system identified how many clients were assigned to each station and waiting area at any given time.  The POD manager monitored the client flow throughout the POD and was able to reassign resources to areas that were experiencing high client utilization.  Incident Management was also able to access real time status reports from an off-site location.   The system enabled the POD Manager to run reports by vaccinators to determine, on average, the time it  took per client to receive vaccination(s). Once this information was provided, a determination could be made to bring additional clients into the POD.  Reducing bottlenecks and increasing client flow assisted in  increasing the number of clients able to be served in the POD, and ultimately increased overall immunization rates.  The timeframe for this practice began on March 2015 with the activation of the Incident Command System (ICS) and ended on the last day of the immunization campaign. DOH-Broward back to school immunization PODS were operational from  August 10, 2015 through August 25, 2015. DOH-Broward worked with Broward County public and private schools, 31 local municipalities, local television and print media, Broward County government, and community and faith based organizations.  Local businesses assisted DOH-Broward to advertise the event and participate in the health fair that was held in conjunction with the POD. DOH-Broward continually fosters collaboration with community stakeholders.  Staff participates on community-based committees including Broward County Comprehensive School Health Advisory Committee and Broward County Schools Educational Conferences.  DOH-Broward is in routine communication with the Broward County School Board, Broward County Superintendent of Schools, President of the Charter Schools Association, and Childcare Licensing Office.  DOH-Broward maintains relationships with the Broward County Administrator and local public health officials.  DOH-Broward leads an outreach workgroup that provides ongoing informational materials to community stakeholders. Prior to POD operations, informational literature was disseminated to all local pediatricians within the county. The Lauderhill Mall Management furnished space for the vaccination POD without cost to DOH-Broward. POD operations also occurred during tax-free week (August 7-16, 2015) which increased the number of clients utilizing the mall, exposure for DOH-Broward, and was beneficial for both the vendors and DOH-Broward. Additional vendors came to the mall and setup booths promoting the Back to School Family Health Fair. The POD was convenient for clients to receive immunizations, and allowed DOH-Broward to reach the immunization goal.  Startup costs: The Wireless scanners were previously purchased and no additional capital was needed to support the scanners.    
The use of the “EMTrack” tracking application and handheld scanners enables POD managers and the DOH-Broward Incident Management Team to view real time data showing the flow of client movement throughout the POD stations.  Any stagnation of client movement would be identified electronically and intervention can then take place. The system increased the rate of immunizations from 4,544 in 2013 (when scanners were not in use at the PODS)  to  6,283 in 2015 resulting in an increase of 38%.  The number of clients served also increased from 2,012 in 2013 to 2,160 in 2015 which is a 7% increase. During the POD operations and at the end of each day, reports were generated in real-time by the EMTrack system administrator that included the total number of clients served at each station and the cumulative total of all clients fully served. The reports were provided to the POD manager and Incident Management Team. Paper records for each client were compared to the electronic report to ensure accuracy of the EMTrack generated reports.  The EMTrack system produced time-study reports per station/per POD staff.  The POD operations manager utilized this function as a performance improvement tool and a tool to increase the number of clients receiving vaccinations in the POD.  Daily utilization reports were compared to daily utilization reports from the previous year to identify changes in utilization patterns and costs. Resource reallocations  were easily incorporated into the EMTrack system and reports were seamlessly revised ot incorporate personnel changes.  For example, a vaccination screener was assigned to the registration area to assist the data entry registrars in interpreting vaccination documents from other counties. An exit staff person was assigned to process requests from clients who did not require vaccinations, but simply needed completion of a form stating that they had received all required immunization (form 680). K    
The lessons learned in relation to practice were that scanning technology improved the efficiency of POD operations by identifying bottlenecks and allowing the POD manager to reallocate resources in real time. The time-study reports per the vaccination station allowed the POD manager to know when daily capacity has been reached and project when the last patient would be served.  This allowed better management of POD capacity to the number of clients needing services.  Clients in line who would not be able to be served, were prioritized to the next business day.  Analysis of capacity earlier in the day reduced people waiting in line who would not able to be served, but were prioritized until the next day.  There was sufficient stakeholder commitment to sustain the practice.  All acute care hospitals and EMS providers have access to this scanning technology in Broward County.  DOH-Broward maintains a cache for use in Broward County and the region. The EMTrack system will be used in future PODs.  
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