CDC tracking system streamlines vaccine supply chain

In April 2012, the Centers for Disease Control and Prevention will launch the final deployment of a system that is expected to transform the way the agency distributes vaccines to more than 100,000 U.S. doctors and clinicians. As the body responsible for providing almost 60 percent of the pediatric vaccines used in the country each year, it’s a vital task.

But you might be forgiven for wondering just how that managed to happen in the past. Before the new system was developed, distribution was handled through 64 different state, local and territorial health departments. Each of these CDC “grantees” handled its own inventories, had its own methods of tracking those supplies (many of them manual and paper-based), and each had its own way of getting the vaccines to the health providers.

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It was, frankly, a bit of a mess.

“You’re basically talking about 64 grantees doing business their way,” said Anjella Vargas-Rosales, management officer for the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD). “Of course, with more touches you increase the likelihood of wasted product, of wasted vaccine. And there was no visibility into the amount of vaccine that was in the pipeline at any one time.”

As the vaccine programs it administered expanded and grew more complex, the NCIRD knew it had to change the system. In 2003 it began the Vaccine Management Business Improvement Project (VMBIP) as an umbrella program for a series of initiatives that would make that change happen, beginning with one to replace the existing fractured distribution with a centralized system.

The Vaccine Tracking System (VTrckS), which went live with six grantee pilot programs in December 2010, is the second initiative. The first attempt by the NCIRD at a comprehensive IT program for vaccine ordering and distribution, it’s also considered the most critical initiative within the VMBIP.

It will integrate all of the pieces of the vaccine supply chain, from the CDC’s purchase of vaccine from its manufacturers, through the ordering by the grantees and the final distribution of the vaccine to health providers. 

Supply pipeline 

“When I explain it to people, I say that VTrckS completes the vaccine life cycle,” said Vargas-Rosales, who is also the VTrckS project manager.

In addition to simplifying the way vaccines are ordered and distributed, VTrckS provides NCIRD more visibility into the process and enables it to use more controls and apply business rules. All grantees will be required to report the levels of inventory they have on hand through VTrckS and that, together with the ordering data, will give the NCIRD a continual update on the state of the supply pipeline.

One thing Vargas-Rosales did when she took on the management of the VTrckS program early in 2010 was to set up an executive steering committee composed of all of the business leaders in CDC, including both the CIO and chief financial officers. And she made sure she kept them all regularly engaged with the project.

That proved invaluable when the inevitable problems arose, or when issues developed that needed to be clearly communicated. Having early buy-in from the business leaders meant they could be depended on to address and mitigate risks to the project before they could have a real impact.

It was especially useful in introducing SAP’s enterprise resource planning (ERP) system, which was the first time the technology had been used within CDC. That was a “huge knowledge gap” that had to be overcome, Vargas-Rosales said, and it proved to be an on-the-job learning experience for everyone.

“Because it was a new technology for us, there were some times when we needed extra support,” said Agha Nabeel Khan, acting director of the NCIRD’s office of informatics. “This project is just one part of the CDC portfolio, but with the help of [the business leaders] we were able to prioritize things to get our needs met very quickly.”

Blueprint and design

That inclusiveness certainly helped with security issues surrounding the SAP technology. Because SAP has a very particular methodology that needs to be followed for implementing its technology, there were a number of challenges that needed a very close collaboration with CDC security people.

“That was a huge task for us,” Khan said. “We worked very closely with the CDC security team to make sure that all of the security controls would be in place, and that we would still have that capability moving forward.”

It was not really about the technology, he said, but more about building a tight relationship with the security team, and of its members having a good understanding of what the NCIRD's needs were and what was being asked of them. 

All together, the VTrckS development process has been relatively smooth because these relationships were developed early. However, one thing Vargas-Rosales said she would have done differently would have been to bring blueprinting the project into the actual contracting and development of the project. As it was, SAP had to follow a blueprint that was developed by another contractor.

“SAP did not walk through that blueprinting with us; they were just the recipients of the documents,” Vargas-Rosales said. “And because it was a firm fixed-price contract, they had to deliver in a very short period of time. So, if I had anything I could do over, I’d definitely not disconnect the blueprinting from the actual design. I’d have a continuous process.”

The fact that SAP nevertheless managed to get its hands around all of this and still deliver on time speaks highly of its own commitment to the project, she said. High-level executives made themselves available daily and even hourly, if needed, and Vargas-Rosales had a standing weekly meeting with them to go over outstanding issues.

However, despite all of the efforts at team building, both Vargas-Rosales and Khan understood that they have been fortunate in the people they inherited at CDC. The team had been involved with vaccine and immunization projects for some time, knew the value of what it was doing with VTrckS, and was committed from the start to do whatever was needed — and even go beyond that.

“I knew from the get-go, because I came from immunization programs myself, about the critical need" for VTrckS, Vargas-Rosales said. “What became clearer to me, as the leader, was the role it will have in truly transforming the way that we manage vaccines at the CDC.”