Preparation for Epidemic Requires a Speedy Vaccination Process

Digital pen and paper technology increase speed, accuracy of information gathered in simulated pandemic exercise.

by News Staff / April 18, 2008

Written by Michael Frenn, Administrator of the Solano County Emergency Medical Services Agency, a bureau in the Public Health Department.

The Solano County, California, Public Health and Social Services Department takes the health and quality of life of its community seriously and is preparing ahead of time to safeguard them from any emerging health threats such as a flu pandemic. They organized a large preparedness drill in the Fall, just prior to the typical flu season, and utilized digital pen and paper technology to streamline the process of treating thousands of people quickly.

In the event of an actual emerging flu pandemic, the Solano County Public Health and Social Services knew it would need to be able to treat as many of its inhabitants as possible in as short a time as possible. In order to achieve this, they used digital pen and paper technology, invented by Anoto Group AB, to assist in a practice drill involving volunteer participants from the public to receive real doses of the year's seasonal flu vaccine.

The ultimate goal of the exercise was to achieve a vaccination rate established by the Centers for Disease Control and Prevention (CDC). This rate was possible based on the process rate from the county's exercise in which the digital pen and paper system was tested. The general public, a total of 267 patients, filled out their personal health surveys with these special pens, a new technology being increasingly used in hospitals and nursing homes around the country. The details from each survey determined whether the patient should be seen by a nurse for further screening prior to receiving the vaccine, and the pen was able to capture their information, process it immediately, and alert a nurse.

Any size pandemic has the potential of changing our lives, which is why Solano County Public Health and Social Services provided the public with free flu shots, thereby realistically dispensing mass numbers of doses of vaccine in a simulated pandemic situation. Using the innovative digital pen and paper technology, they achieved the speed, easy of use, and efficiency needed to safely process patients.

"Solano County Public Health is constantly working to prepare for public health emergencies, including the very real possibility of a pandemic flu," said Robin Cox, Health Education Manager for Solano County Public Health. "This technology gave the county healthcare professionals the critical patient information in real time to ensure that they were able to administer the flu vaccine to patients who would not have an adverse reaction. They were also able to assess the geographic locations that need additional communications of the US. Dept. of Health's message," Cox continued.

Setting up the system

The Solano County team spent weeks preparing for this flu vaccination event, which utilized the services of 101 county employees, including doctors, nurses, health educators, the Public Information Officer, and numerous county line staff. Arthur James, president of IS2BE who developed digital pen and paper technology for the program, provided approximately 100 pens in addition to the development of the survey templates. In the event 267 members of the public participated and were screened, with 265 receiving vaccinations. Two patients were deemed potentially allergic to the vaccine and therefore were not administered with it.

The data collected by the system was critical to the screening process by helping non-medical staff determine whether the patient would need to be seen in a second screening process by a nurse. In this landmark trial, speed was a paramount component to achieving Solano County's objective of vaccination. The contributing factor of success was the digital pen and paper system ability to immediately collect and process the health history and contact details of each patient in real time.

Key Objectives

Solano County Public Health's key objective was threefold: promotion of receiving a flu vaccine, promotion of attendance to the health community event, and promotion of safety while offering and administering free vaccines to the county's inhabitants. As part of their safety goal, a survey was formulated to capture a patient's medical history and contact information as well as guide the patient in a workflow question and answer process. In the end the Public Health Department was able to evaluate how well it marketed the event while also determining how well it's targeted marketing messages reached the community.

Getting Started

The event was held at the Solano County fair grounds in order to provide enough room for its elaborate operations which involved a lot of planning, technology and processes.

A proper screening protocol was established that entailed two screening processes. The first involved non-medical screening personnel who would distribute to the public approximately 100 digital pens and health surveys printed on digitally encoded paper. The survey was developed in a way that would guide the patient through a series of comprehensive workflow questions and answers. These questions need to be answered and documented prior to anyone being given the vaccine. Thanks to the digital pen and paper, the participants themselves could supply important details of their own medical history such as allergies as well their addresses and contact details. The staff noted that fewer data errors occurred when participants filled out their own surveys.

Additionally, the use of digital pen and paper reduced the need for data entry and hastened the speed at which survey data could be processed. The patient's data could be immediately downloaded from the digital pen and utilized by non-medical screeners in order to decide whether to send the patient for further screening by a nurse. Nurses conducted the second screening process because they are better qualified to determine whether or not a patient could have an adverse reaction to the vaccine.

The final process entailed another check in with the participant before the actual administering of the vaccine by the nurses.

Goals Achieved

The goal to see 250 patients an hour was exceeded using the digital pen and paper. The use of digital pen and paper technology allowed for the easy collection of data that could be used and processed immediately.

  • Solano County Public Health department uncovered that the digital pen and paper caught errors by non-medical screeners who may have not correctly directed patients to see a nurse due to their answers on the digital form in real time. As the digital pen's data was downloaded onsite, the nurse would be immediately alerted that the patient would need further screening prior to receiving the flu vaccination.
  • The data collected was able to be analyzed immediately and helpful medical intelligence ascertained such as the fact that approximately 15 percent of the public would need to go through a secondary screening. Equipped with this knowledge, the health department could staff accordingly.
  • An Important goal for the Public Health Department was the ability to emulate the process of giving the vaccine out in a fast and easy manner -- such as seeing 250+ patients an hour. In the event that the county did experience a flu pandemic, such as bird flu or a tuberculosis outbreak, the department would have confidence of reacting fast.
  • The Public Health Department found it crucial to be able to seamlessly integrate participant addresses captured from the pen with a Google Maps program to see how effectively they promoted the event in each city and area within the county. Insights into future marketing and promotional efforts were gained by identifying the areas of the county where residents did or did not show up to receive the free flu vaccine.