Tag Archives: Oregon

Planning for the worst: Emergency preparedness at its best

By Erin Corrigan

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Over three days in May, 2013, the Oregon Immunization Program participated in an exercise in emergency preparedness called PACESetter. It began in Atlanta and reached all the way up to Washington State, involving federal, state, tribal, county, city and private agencies. We were presented with the simulated scenario that bioterrorism and other attacks were made against citizens in five Oregon counties as well as Clark County in southern Washington. The intent was to respond to these simulated attacks exactly as we would in real life and to test our ability to share information not only across jurisdictions in Oregon but also across state lines with Washington.

In response, the Centers for Disease Control and Prevention (CDC) shipped medical supplies that we received at Oregon’s Receipt, Stage and Storage (RSS) area. Our team helped unpack and redistribute the supplies to Oregon’s impacted counties. We also activated our Agency Operations Center (AOC), which acts as the command center where planning, operations and logistics such as requests for federally funded medical supplies are coordinated and documented.

The RSS area works as a well-oiled machine with staff efficiently breaking down large pallets of material, including items from our Strategic National Stockpile (SNS), into smaller lots to be distributed where they’re needed. The AOC, on the other hand, is more like carefully controlled chaos with information coming in constantly that changes the scenario and the required response. In addition, the exercise planners always throw in unexpected events or additional threats that change the game to make sure participants are nimble and able to switch gears as needed, which is exactly what would be likely to happen in a real attack.

This exercise was a full-scale exercise (FSE), meaning that we used all aspects of the state and local agencies’ planning and response resources, from immunization program staff to emergency management staff to medical response teams, state partners and even the governor, who had to declare a state of emergency (a fake one, of course). We are required by our CDC federal emergency preparedness grant to conduct an FSE every five years. The purpose of any emergency preparedness exercise is to ensure that the state’s public health and medical services can respond to a complex public health incident quickly and effectively, mobilizing teams that are prepared and well-trained.

Our goal in these exercises is just as it is in our everyday work: to improve the lifelong health of Oregonians through our vision of a healthy Oregon. 

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Isabel Bickle: A life dedicated to public health

 By Jody Anderson

“Never a Dull Moment” is the title of the book Isabel Bickle plans to write now that she’s retired from the State of Oregon’s Division of Human Services Office of Medical Assistance Programs (DMAP).  While “policy” may not be a word that causes most of our hearts to flutter, Isabel seems delighted to have lived and breathed policy for most of the last 28 years. Her enthusiasm for policy shines through when asked about what stands out in her career. She says, “I believe in rules—you can’t function without rules.” She notes that you that you can’t run a household without rules, you can’t raise kids without rules and you can’t have a health care system without rules.

Isabel’s career has been far from dull. In her role as a medical policy analyst, she has been a part of making history over and over again. When the Oregon Health Plan (OHP) came into being, Isabel was instrumental in creating the first ‘Prioritized List of Health Services’ where diagnoses and procedures were paired. Isabel assisted the medical director in final decision making of the diagnoses on the List. She knew at the time how revolutionary the OHP was in health care provision. “This was totally new,” she says, “and nothing like it in the world. I didn’t even know if it was even going to work. But it did. This allowed coverage of the most appropriate treatment.”

Isabel seems to have touched every area of Public Health. According to Lorraine Duncan, Oregon Immunization Program (OIP) manager, Isabel “made our working relationship with DMAP an outstanding experience. She ­was always buried with work but she always made time for immunization. We should thank her from the bottom of our heart!” Isabel’s contributions to OIP included making sure the immunization coding was accurate and up-to-date with the Advisory Committee on Immunization Practices (ACIP), driving to Portland to attend the quarterly ALERT Advisory Committee and Immunization Policy Advisory Team (IPAT) meetings where her input was invaluable, and processing the S-Chip bills (an essential revenue source for the OIP). But most of all, Isabel was always available to help OIP troubleshoot problem areas.

Isabel recalls working with OIP on the ALERT Registry “for many years before it was implemented,” helping with the flu vaccine shortage and working with coding issues during the H1N1 epidemic. She says that the Public Health Division “was the driver, but we [DMAP] were there in supporting them, and answered questions for our providers too.”

Karol Almroth of Oregon Reproductive Health Program says that Isabel “has been an ally to our program for many years, particularly around contraceptive meds and supplies.  She participated on the original work group that developed and implemented the Medicaid Family Planning waiver program (currently known as CCare), contributing her extensive knowledge of Medicaid reimbursement of medications.  She is our resident expert to this day.”

When asked what the most notable moment of her career was, Isabel doesn’t hesitate, “At Medicaid, the most notable was the denial of a liver/lung transplant. It was a difficult decision to make; but I denied it because of the rules. The rules just didn’t allow it.” The decision was widely covered by the media, and ultimately challenged, but upheld by the court. “Your heart goes out to approve a service but you have to make your decision based on the rules,” says Isabel when she talks about the decision, “Here I was a nurse just doing her job, and just doing it correctly, but I just got through that storm.” While the denial of the combination lung/liver transplant was criticized by many, Isabel remembers receiving a note from a woman afterwards and it read, “You saved the lives of two people: a lung recipient and a liver recipient.” The woman signed her name and the year she received her liver. Isabel took it as confirmation that she made the right decision.

What advice does Isabel have to offer to the rest of us? About work she says to “learn what you can, make the best decision on the knowledge at the time, always be open to new information, listen to a new opinion and weigh it, and change the policy if you need to.”

From a larger perspective, Isabel says, “There’s still life after work. You’re not finished, and it’s another adventure—I’m having the time of my life. I love what I do, I really do, but it’s just a change I was going to need to make. When I made the decision to retire it’s made me so happy. If you have 30 days to live, what would you do? Make amends, do the things you want to do—tell someone “I love you.”

There’s no doubt that that our state is losing a treasure, but we can look forward to hearing more from Isabel in her retirement. Besides baking and coding, Isabel still does have that book to write. “Never a Dull Moment” seems a fitting title.

 

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Benifits from Online VFC Recertification

 When it comes to processing forms, simple, easy and fast is better!  In 2010, the Oregon Immunization Program (OIP) took the annual recertification process for clinics enrolled in the Vaccines for Children (VFC) program online. In previous years recertification had been a paper process conducted through mail. But this method was difficult and time-consuming, so OIP purchased an electronic enrollment system with the aim of streamlining and standardizing the re-enrollment procedure. Providers now re-enroll clinics at a website online.

 “It’s much easier,” says Anona Gund, OIP health educator. “Health educators aren’t running around crazy now trying to get information from clinics.”The website is inactive until the recertification period. This fall, providers will first receive a memo about a month ahead of time reminding them to recertify, then a second memo informing them the day before the site is active. After two weeks, clinics that do not recertify are dropped from the program. They are deactivated and cannot order vaccine from VFC until they recertify online.

 The electronic system ensures enrollment forms are 100 percent complete before submission, a feature that helps drastically reduce the amount of time and energy spent on recertification. For example, after starting the online process, OIP saw  a 90 percent decrease in the amount of follow-up paperwork. Providers simply submit their completed forms online, so the electronic system also decreases the amount of time OIP health educators spent hand-entering information, making the process  less work-intensive. Previously, staff hand-entered clinics’ data into the computer and proofed all entries, which  took an estimated 259.75 hours. But with the new process, the Oregon Information System (OIS) simply downloads data from the web server, and then staff cleans and loads data into the system. Only an estimated 23.5 hours are required for data cleaning and import.

 The switch to online recertification caused 92 percent decrease in processing time. In 2009, with the paper procedure still in use, it took 25 weeks (about 6 months) to recertify 87 percent of providers. But in 2010, with the new online system, it took only two weeks to recertify the same number of providers. The number of providers who recertified increased by 8.4 percent as well. Ninety-one percent of providers also reported a higher satisfaction rate and thought that the new online process was easier to complete than the old paper method.

 

 

 

 

 

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Oregon shines at the 2011 National Immunization Conference

The 45th annual National Immunization Conference was held earlier this spring. Several of the Oregon Immunization staff were fortunate enough to attend and present. Our state program is regarded highly for the innovate approaches we take towards immunization practice. We’re so proud of Oregon’s team and the hard work done by our public and private clinics! We thought you might like to hear/see what Oregon staff presented at this year’s conference. 

 To view/listen to all of the presentations, click on the following link:  http://cdc.confex.com/cdc/nic2011/webprogram/meeting.html

Kick-off Award Ceremony:

Our very own Lorraine Duncan (she is the black dot in the middle) presents the 2011 Natalie Smith Award to Susan Lett, MD, MPH, Medical Director, Immunization Program, Massachusetts Department of Public Health. The award is the highest form of recognition for Immunization Program Managers and recognizes contributions and accomplishments in the area of vaccine-preventable disease prevention.

Presentations by Oregon Immunization Program Staff:

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How Vaccine-Seeking Factors Into Disparities in Adult Influenza Vaccination
Holly Groom, MPH, Research Analyst, Oregon Department of Human Services/CDC; Pascale Wortley, MD, MPH; Fan Zhang, MD, PhD, MPH

Background:  Racial/ethnic disparities in influenza vaccine uptake among adults are longstanding; research suggests they result from multiple factors. Previous studies suggest that influenza vaccine-seeking behavior may be an important aspect to consider when evaluating disparities in vaccination coverage.

Objectives:  To determine if there are differences—by race or ethnicity—in influenza vaccination-seeking behavior among adults 65+ years of age.

Follow this link to view/listen to this presentation: http://cdc.confex.com/cdc/nic2011/webprogram/Paper25415.html

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Continuous Temperature Tracking: The Secret Lives of Vaccines
Albert Koroloff, MPH, Public Health Educator, Oregon Health Authority

Background:  Vaccines for Children (VFC) is a federally funded program that provides no-cost vaccines to providers for children who might not otherwise be vaccinated because of inability to pay. The Section 317 program is a discretionary federal grant program that provides vaccines to providers for underinsured children and adolescents not served by the VFC program. Both programs depend on the safe transport and storage of vaccines: sensitive biologicals that require very specific storage conditions. To protect this federal investment, participating VFC/317 clinics are required to check and record their vaccine storage temperatures at least twice a day.

In 2007 the Oregon Immunization Program (with approval by CDC) initiated an enhanced temperature tracking requirement. This requirement states that Oregon VFC/317 clinics will “use calibrated and NIST or ASTM certified continuous-tracking thermometers or other OIP-approved devices in both refrigerator and freezer units used to store VFC vaccines.” 

Follow this link to view/listen to this presentation: http://cdc.confex.com/cdc/nic2011/webprogram/Paper25507.html

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IIS Data Migration: Cleaning House Before the Big Move
Mary Beth Kurilo, MPH, MSW, ALERT Director, Oregon Immunization Program; Deborah Rochat, BS; Don Dumont, PhD

Background:  In 2010, the Oregon ALERT Immunization Information System (IIS) migrated from a locally developed data warehouse platform to a customized public domain clinical records model IIS. Approximately 4.5 million demographic records and 31 million immunization records collected since 1996 were cleaned, standardized and migrated to Oregon’s new system. Oregon utilized this transition to implement stronger data standards and business rules, including those produced through MIROW (Modeling Immunization Registry Operations Workgroup).

Follow this link to view/listen to this presentation: http://cdc.confex.com/cdc/nic2011/webprogram/Paper25505.html

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Adolescent Vaccination Uptake Among Students Participating in Tdap-Only Clinics in Deschutes County, Oregon
Holly Groom, MPH, Research Analyst, Oregon Health Authority; Heather Kaisner, BA; R. Bryan Goodin, BS, MPH; Collette Young, PhD

Background:  In 2008, Tdap (tetanus toxoid, diphtheria toxoid, acellular pertussis) vaccine was added as a school entry requirement for children entering 7th and 8th grade in Oregon.  Many local health departments provided Tdap through school-located vaccination clinics in 2008, using vaccine provided at no cost by the Oregon Immunization Program.  A condition of receiving free vaccine was that all administered doses had to be entered in Oregon’s Immunization Information System (IIS).

Objectives:  To examine uptake of all adolescent- recommended vaccines among children who received Tdap in a school setting.

Follow this link to view/listen to this presentation: http://cdc.confex.com/cdc/nic2011/webprogram/Paper25251.html

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Adding up the Benefits of Billing for Influenza Vaccinations Administered in School-Located Clinics: Experiences From Two Oregon Counties
Holly Groom, MPH, Research Analyst, Oregon Department of Human Services/CDC; Suchita Lorick, DO, MPH; Kelly Martin, MPH; Robert Moore, MD; Julie O’Neil, MPH; Rosa Duran; Bo-Hyun Cho, PhD; Garrett Asay, PhD; Mark Messonier, PhD

Background:  Oregon’s Local Health Departments (LHD) have been coordinating with schools to provide influenza vaccination in school-located clinics at no cost to schools and parents since 2006. In 2010, after a 3-yr pilot to assist LHDs in developing partnerships, the Oregon Immunization Program ceased providing LHDs influenza vaccine at no cost for school-located clinics.  In an effort to develop more sustainable approaches for vaccine delivery to school-aged children, two counties piloted a project in the 2010-2011 influenza season to bill for influenza vaccine and/or vaccine administration in school clinics.  

Follow this link to view/listen to this presentation: http://cdc.confex.com/cdc/nic2011/webprogram/Paper25253.html

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Poster presentations:

Maureen Cassidy presents her work on increased Tdap uptake to protect the most vulnerable: infants, and to assess and improve Tdap administration by Oregon birth centers.

Carlos Quintanilla presented a poster on the pharmacy internship partnership between Pacific University and the Oregon Immunization Program.

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How does your county measure up? Population-Based Rates for Oregon communities now available online

California is in the midst of a whooping cough epidemic; in 2010, 8,383 cases were reported and ten babies have died. Oregon’s whooping cough levels were average for 2010, but still a concern with over 283 cases. It’s easy to look at statistical reports and know where in the state whooping cases occur. But now the Oregon Immunization Program (OIP), or anyone for that matter, can find out where a community might need to beef up their pertussis booster shots simply by looking online.

 Most states use the annual National Immunization Survey (NIS) to gauge vaccination coverage. The Centers for Disease Control and Prevention conducts this phone survey of random residents, with followup calls to the participants’ health care providers. The NIS provides a snapshot of what’s going on in each state, but doesn’t include important details. What if you need to know how well children are protected in specific communities? Oregon is one of the only states in the union that can provide that information through Population-Based Rates (PBRs).

 For example, someone may wonder if children who receive WIC benefits are more likely than the general population to be fully protected from vaccine preventable diseases.  PBRs tell us that yes, since 2007 children receiving benefits from WIC have been better immunized than others. Although WIC programs do not offer immunizations, they can show parents what shots are currently due and refer them to an immunizer. This type of information conveys the knowledge that parents are commited to protecting their children’s health and WIC staff are offering them the resources they need.

 PBRs also help Oregon Public Health track health equity, making sure that a child’s race or ethnicity does not predict how well protected they are from vaccine-preventable diseases. If a problem is identified, the public health system can act swiftly to address the inequity.

 Anyone, such as local health departments or organizations like United Way, can access this data to use in a number of ways, from grant writing to evaluations to legislative issues. The public can check to see how one county stacks up against the rest of the state. And when it comes to a serious health concern, such as whooping cough, the Oregon Immunization Program can use PBRs to gauge community protection levels. Health officials can look at whooping cough vaccination rates and determine where to do interventions and outreach to keep Oregonians healthy.

PBRs can be accessed by visiting the Oregonian Immunization Program web site:

http://www.oregon.gov/DHS/ph/imm/Research/index.shtml

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Oregon Immunization Program wins award for innovative strategy

 Every year or two, an unusual scene emerges at the Oregon Immunization Program (OIP). In an ordinary conference room, representatives from vaccine manufacturers sit alongside each other like students listening to a teacher. They are attending a presentation on vaccine handling by an Immunization Program staff member. This school-like scene is the Field Partnership Training, a collaborative information exchange between vaccine manufacturer staff and OIP that just won a national award. It may seem unconventional to have the representatives of competing companies learning together, but according to OIP Provider Services Manager Mimi Luther, “We want them all in one room so we can tell them the same story.”

 Award-Winning: This innovative partnership between Public Health and the vaccine industry—Field Partnership Training—won the Association of Immunization Managers Bull’s Eye 2010 Award for Innovation and Excellence in Immunization, awarded at the November national meeting in Atlanta. This award recognizes immunization strategies that “hit their mark” by achieving goals and encouraging adaptation by other programs.

Progressive: The purpose of the training is to educate manufacturer representatives who work with providers and other stakeholders about Oregon’s immunization-related rules, policies and program directions, in order to reach Oregon vaccine providers. When visiting providers, vaccine reps who have attended OIP’s Field Partnership Training can share important up-to-date information and spot potential vaccine-related problems in clinics, such as mishandling, misadministration or improper storage, which they then help the clinic to solve, or quietly report to OIP.

Innovative: The Field Partnership Training does invoke controversy; some people fear that such frequent interaction between OIP and vaccine manufacturers creates a conflict of interest. To prevent any conflict of interest, OIP developed careful internal policies regarding interaction with manufacturer representatives, and Oregon is a ‘provider choice’ state, meaning OIP doesn’t mandate vaccine brands—providers can purchase any vaccine they choose. OIP believes that it is more beneficial to not have a wall between manufacturers and public health.

 Finding effective ways to work with vaccine manufacturers is a key factor in working toward the program’s mission of improving vaccine coverage across the lifespan.  As Luther says, “These folks carry our message and they carry it well.”

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