Using Patient Tracking Technology in a Point of Dispensing Vaccination Operation to improve client flow

State: FL Type: Promising Practice Year: 2015

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 2013 population estimate of 1,838,844, 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).  Its diverse population includes residents representing more than 200 different countries and speaking more than 130 different languages.  31.4% of the residents are foreign-born.   Broward County is a minority/majority county demonstrated by its 2013 population by race (Black 28.5%, Asian 3.6%, Hispanic 26.9%, other races 4.1%, more than one race .2%, for a total of 59.5% and White 40.8%). 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. It is part of the Integrated Florida Department of Health (DOH) and operates in cooperation with the Broward County Commission under Florida Statute 154. 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 ensuring a minimum of 95% of kindergarten students and 7th graders be up-to-date on immunizations which is also DOH-Broward’s goal. Goals and objectives of proposed practice:  1.  Provide back-to-school immunizations to school aged children 2.  Organize immunization community PODS for back to school for August 4-19, 2014 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. The Improvement Plan for 2013 back-to-school PODs identified a corrective action to "develop a better mechanism to track clients through the POD".    For the 2014 POD activities, electronic patient tracking technology was deployed.  This technology has been successfully utilized in mass casualty incident and hurricane special medical needs sheltering exercises as well as by local emergency medical services providers in some municipalities in Broward County.   The technology had not previously been tested in mass prophylaxis PODs. The practice was implemented through the activation of Incident Command System (ICS) and implementation of a back-to-school community immunization POD held from 08/04/14 – 08/19/14 and all stated objectives were met. Factors that led to the sucess of this process were staffs willingness to implement new technologies and DOH-Broward staff experience with Incident Command System. The Public Health impact of practice was a more effective use of existing resources (human capital and technology) to manage client flow. As a result, increased number of clients that can be served.
Florida Department of Health in Broward County 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.  Vaccine-preventable diseases can be very serious, may require hospitalization, or even be deadly – especially in infants and young children. According to Chapter 10D.3.088, Florida Administrative Code, Public/Non-Public Schools K-12 (children entering, attending, or transferring to Florida schools) shall have on file a Florida Certification of Immunization, DH 680, documenting the following:• 4 or 5 doses of Diphtheria-Tetanus-Pertussis (DTaP) vaccine• 2 or 3 doses of Hepatitis B (hep B) vaccine• 3 or 4 doses of Polio vaccine• 2 doses of Measles-Mumps-Rubella (MMR) vaccine• 2 doses of Varicella vaccine for kindergarten and grade one*• 1 dose of Varicella vaccine for grades two through eight**Varicella vaccine is not required if there is a history of Chicken Pox documented by the healthcare provider DOH-Broward’s goal is 95% of kindergarten and 7th grade students be up-to-date on immunizations.  The week prior to and the week of back to school the DOH-Broward Health Centers have historically been overwhelmed with children who are in need of back to school immunizations.  For the past several years, DOH-Broward has operated community-based immunization points of dispensing (PODs) to alleviate overcrowding at its clinical sites and provide immunizations in a community setting targeting populations at greatest need within Broward County. Children grades K-12, entering, attending or transferring into Broward County schools, targeting rising K and 7th grade students are the targeted populations. 93.6% of children entering kindergarten and 96.6% if children entering 7th grade was reached for school year 2014-2015. Manually tracking clients through the POD stations was done in the past to address the problem.Electronic scanning of client unique barcode reduces tracking and typographical errors and provides real-time/on-site/all-site tracking of all clients who are currently being served at the POD improved the process.Scanning/bar code technology is currently being utilized in mass care and pre-hospital triage and tracking of patients.  A manual clip board system was utilized at the DOH-Broward PODs in prior years to track clients through the POD stations.  By assigning each client a unique barcode upon entry to the POD and scanning the barcode in and out of each station as a service is received, real-time tracking of clients and client back-logs was visually monitored by the POD Manager.  Client wait times could quickly be minimized by reallocating POD resources in a real time environment to increase throughput and reduce wait times. Use of this technology is new and DOH-Broward was unable to locate any current users of this technology in this manner.  
Global Immunization
The goal is to provide back to school immunizations to school aged children in partnership with community based providers and municipalities. 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. Steps taken to implement the program:Before the operational POD started, a practice pre-POD was setup and exercised with test clients simulating a real POD.  Just-in-time training was provided to staff that were identified as those who would be using the EMTrack scanners.  The training included setting the correct capture screen and scanning of each unique barcode as identified from the vaccination paperwork.  Once a client was greeted, they were given a barcode and registration forms to complete.  Once the paperwork is returned to registration, the bar code is scanned into the EMTrack system which will follow the client through the process. The system identified the patient as a numeric number electronically in real-time.  At each identified station (registration, screening, vaccination, and exit processing/proof of vaccination forms), the client would be scanned.  Upon completion at the station, the client would be scanned out to the waiting area.  The process was repeated through the various stations within the POD.  The system identified how many clients are 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.  The timeframe for the practice: 8/4/14 – 8/19/14. DOH-Broward worked with Broward County Public and private schools, 31 local municipalities, local television and print media, Broward County government, 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. Start up costs: Wireless scanners purchased with preparedness funding at approximately $3,000 per scanner.
Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice. Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/ awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence). DOH-Broward’s goal is 95% of kindergarten students and 7th graders to be up-to-date on immunizations.  During the period August 4, 2014 – August 19, 2014, 93.6% of children entering kindergarten and 96.6% of children entering 7th grade.   The number of clients served increased from 2013 to 2014 by 3% with the number of vaccines given increasing by 10%.  Client and staff surveys conducted during the POD operation were very positive overall and extremely positive when evaluating the use of the new scanning technology. The use of the “EMTrack” tracking application and handheld scanners enabled 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 was identified electronically and intervention took place. At the end of each day, a report was generated 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 report was provided to the POD manager and Incident Management Team. Paper records for each client were compared to the electronic report to ensure accuracy. All clients registered were served by the POD staff.  The EMTrack system can also produce time-study reports per station/per POD staff.  Future POD operations will utilize this function as a performance improvement tool. Daily results were compared to daily results from the previous year for changes in utilization and costs. 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).  
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.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.
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