在这节课中查理竖琴与洛丽·摩尔, Public Health Analyst and Stuart Myerburg, Informatics Team Lead with the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD) group, as they discuss what it’s like managing data around vaccines, the challenges they faced and opportunities they discovered while going through the COVID-19 crisis.

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Transcript

Charlie Harp:

Hi, I’m Charlie Harp, and this is the Informonster Podcast, and today on the Informonster Podcast, I’m going to be talking with Stuart Myerburg and Laurie Moore about the CDC and the NCIRD group. Why don’t we start? If you guys go ahead and introduce yourselves. Lori, why don’t you go first?

Lori Moore:

Hi there. My name is Lori Moore, and I’m a pharmacist by trade and I work for CDC. I’ve been with CDC now for actually coming up on five years in just a few weeks. Before I started in CDC, I actually worked with Indian Health Service for close to 15 years, actually, and I’ve been supporting public health informatics projects for most of that time.

Charlie Harp:

Thanks, Lori. Stuart?

Stuart Myerburg:

Hi, I’m Stuart Myerburg. I am the informatics team lead in what is currently the Immunization Information Services Support Branch. I’ve been with CDC since 2010 with the same branch and before that, I worked at Emory University School of Public Health, and I also went to undergrad and law school there.

Charlie Harp:

Great. Thank you guys so much. What we were hoping to do today was we’re going to tell us a story of the process that you guys went through going through COVID and managing the vaccines and that data, but I think it’d be great to start out with you guys talking a little bit about your branch and what your branch does at the CDC.

Stuart Myerburg:

Sure. I can start that and, Lori, please feel free to jump in. So our branch, like I said, is currently called the Immunization Information System Support Branch. We are going through a process of reorganization with the whole division and our new name will be the Informatics and Data Analytics Branch. So it will be IDAB, which is much easier to say is an acronym than IISSB. So that’s the reason we picked it, but it does flow off the tongue better.

So we are part of the National Center for Immunization and Respiratory Diseases, and the mission of the center is to deal with preventing disease and disability through immunization and by controlling respiratory and related diseases. Our division is the Immunization Services Division, and it’s specifically focused on immunization, obviously, and protecting individuals and communities from vaccine-preventable diseases.

So the division deals with a lot of different things from purchasing vaccine to providing technical financial support to immunization programs, doing education to providers and the public, and doing evaluation and research. Our branch really focuses on supporting the immunization information systems, otherwise known as IISS, IISS’s population-based systems where all immunization doses are recorded within jurisdictions, and because it’s jurisdiction-based, it’s a little bit different from some other programs within CDC where they may have a central repository or central system that CDC controls. Everything with the IISS is done locally within jurisdictions.

So our branch supports those systems by facilitating development, implementation, providing standards, and doing evaluation, but we really are in a support role because we don’t control the systems. So that’s the very high-level overview of where we sit in CDC and what we do. I don’t know if, Lori, you want to add anything?

Lori Moore:

No, I think you did a great job.

Stuart Myerburg:

Thanks.

Charlie Harp:

好吧。对于the listeners at home, do you guys want to give a high-level picture of what your roles are within the group?

Stuart Myerburg:

Sure. I’ll start. So I am the informatics team lead in the branch, and the informatics team is focused on a lot of the standards work I mentioned. So we are the ones that maintain our health level seven implementation guide to allow for the electronic exchange of data between providers and IISS or between IISS themselves. We also support the code sets and vocabulary, which we’ll be talking about later, 2D barcodes, and clinical decision support for immunization. We support vaccine ordering and inventory, but we don’t maintain that system per se. So we really are supporting the broad spectrum of standards that influence everywhere from where the shot is given all the way to getting into the IIS, and then sometimes coming to CDC.

Lori Moore:

Then I’ll add, I am actually on Stuart’s team. When I first came to CDC before COVID hit, I was really specifically focused in on our supply chain systems and working with the vaccine system, we call it VTrckS, and basically working across 64 jurisdictions to help them with the ordering and inventory, provider master data that we exchange between their local systems and CDC. That’s specifically to order routine vaccines and to report on their inventory before they can order more.

After COVID, that expanded quite drastically, and so that’s where I also expanded into code set work, as Stuart mentioned we’ll be talking more about. Also worked a little bit on the administration pieces that as systems that we were working with throughout COVID. So I’ve done just a little bit of everything throughout COVID.

Charlie Harp:

I bet. How many people are on the informatics team?

Stuart Myerburg:

That’s a great question. It changes so often. We also have some public health informatics fellows. I think we’re at nine. Does that sound right, Lori? I think we have six FTEs, full-time employees, and then we have three fellows.

Lori Moore:

Yes. We are actively trying to expand. So that’s why it’s hard to track these days.

Stuart Myerburg:

Exactly. Well, also, we’re reorganizing and so our team is pretty much staying intact, but a couple of people on the team are moving to a new team that doesn’t exist yet. So the number changes in my head based on whether are we talking about soon or currently. So anyway, we’re somewhere around nine I’d say right now.

Charlie Harp:

Lori told me offline that she’s totally happy to work weekends, so there you have it.

Lori Moore:

Charlie, he knows this. I think everybody knows it. I love it.

Charlie Harp:

I think those of us in the data world and the healthcare, public health data world, you have to love it-

Lori Moore:

You do.

Charlie Harp:

… because of what it is, its speed, and its relevance of it. So here you were minding your own business, doing your work, and then COVID hits. I would imagine COVID was a lot for all of us, for the entire nation, the entire world, but for you guys, my guess is that it had quite a bit of impact and demand on what you were doing. Before we get into that, I mean, what were the cadence and the nature of what you guys did before COVID?

Stuart Myerburg:

It was a lot calmer. Well, I guess I can explain where we started with our vocab code set project and where we were at before 2020 or maybe even into the very early months of 2020. So this project, which we call VCSMS, even though most people don’t use that acronym because it’s another one that does not flow very well, but it’s the Vaccine Code Set Management Service. Prior to 2016, we were maintaining all of these codes very much by hand.

So we create the CVX and MVX at CDC, which are used to record vaccines, and then the NDC and CPT also exist out there to record vaccine administration, which were maintained by other entities, the NDC, by FDA, CPT, by the AMA. Prior to starting this project and using Symedical, we would basically source these codes as best we could.

So there was no systematic way to pull in the codes from AMA or from FDA. We also weren’t really using any tooling that allowed us to standardize workflows or do any data research, capture, and curation. So we had an access database and we had one person who did a very great job of diligently going out there and looking to see when a new code was created, but there was nothing automated about it and, obviously, it wasn’t really sustainable and also could lead to data quality issues.

So in 2016, the idea of shared services was being talked about within our division to try to reduce the burden on our stakeholders and enhance their ability for them to get to data sources. So this seemed like a really good project to use pilot for shared services.

So we’re looking for something that would obviously do more than just an access database. So we really wanted a commercial off-the-shelf product that we knew had proven ability to manage codes and do these mappings. So that’s how we ended up using Symedical, and we put out a contract to not only obtain and provision the software but also to take everything that we had from this historical, quote, unquote, “database”. I was in an access database, but it wasn’t really very robust and moved it into the tool and come up with a process to really be much more methodical and systematic in the way that we dealt with codes.

Charlie Harp:

I’m familiar with CVX and MVX because cause my long history at First Databank and the Zincs and places like that, but for people that aren’t super familiar or don’t have something that intersects with that, can you briefly explain how people utilize the CVX and MVX code systems?

Stuart Myerburg:

Yeah. So the CVX really came about because it was being used when there were a lot of historical vaccines, so, especially in the early days of these systems when you might not have been recording things live. So CVX, it describes the vaccine in a different way than an NDC does. So they serve the same purpose ultimately because they identify the product, but CVX is a lot more flexible when you don’t really know exactly what was given but you just know they got Hep A vaccine but you don’t know anything else about it. Then it’s paired with the MVX, which specifically describes the manufacturer.

So going forward, we’re encouraging the use of NDC, but there are still a lot of systems that really live by CVX because, historically, that’s the way they’ve been recording things and that’s what they use internally. Even if they accept the NDC, they might be mapping internally, but many, many systems still really live by that CVX.

Charlie Harp:

Is it fair to say that the CVX is essentially like a value set that rolls up NDC and immunization codes into an immunization group?

Stuart Myerburg:

It’s definitely a value set. It’s not necessarily rolling the NDCs up. I mean, we do mapping, which we were doing, again, manually before, but now we’re able to do this much better using a tool that allows us to do these things, but it’s really a list of codes, much like exactly like the NDC, describes things in a slightly different way and allows for that more generic code.

Then we map to the NDC and to the CPT, which also describes more of an encounter in a clinical setting versus an actual product, but we know that many systems use that, especially for billing purposes. So we have to be able to make all of those connections between the different codes because different systems are looking at a vaccine encounter in different ways.

So that project started in 2016, and then from 2016 to 2019, it was really getting everything into Symedical and then going live. We were fully live and transitioned by early 2019. 2018 was really the transitional phase. 2017, we were piloting to make sure this was actually going to work. By 2019, everything was in place. Our end users were using this. They had different ways to access the codes through web services and content cloud that are just pulling them off of our website, which they can still do, but it gave them a lot more options. So we were really at the point in early 2020 where we were just looking at, “What’s next? How can we refine this?” and then COVID came along.

Lori Moore:

It’s your fault. You had to say, “What’s next?”

Stuart Myerburg:

I mean, really, we were literally having those conversations. We were like, “Okay. Well, we can start thinking about some of these more wishlist things. We’re in a great position.” Should never say that.

Lori Moore:

I would say I came in to CDC around 2018 and I spent the first part just trying to orient myself to the systems and what we were using and how different codes impacted all the different systems, and specifically at the time looking at the supply chain systems for ordering. One of the things that I was researching before COVID really kicked off was the fact that we had a gap and some challenges in the inventory space due to the way we were tracking lot numbers.

I know we’re going to touch on that a little bit later in the conversation, but there really was a lot of work happening before COVID that helped to guide us as we got into COVID and really allowed us to work in ways we weren’t able to do so before COVID, at least not as quickly as we had with the opportunities I want to say of COVID. I know people don’t look at that as an opportunity or COVID as an opportunity, I should say, but we really did have some great collaboration and opportunities that we were able to leverage during COVID to expand on what Stuart had already put into place.

Charlie Harp:

Well, there’s nothing like a crisis to increase your sense of urgency and put you in a room where you have to figure out, “How are we going to creatively deal with this because the normal course of business is not going to work?” I would imagine that during the early phases of the COVID crisis and as the new vaccines started to come out, you guys were probably asked to scramble quite a bit to figure out how to make things work.

Lori Moore:

What’s interesting in that aspect is we had a lot of the foundational pieces that we needed for the response. We had an established ordering system, and there were definitely some gaps that we had to work on. So I think what’s really interesting, at least for me, is knowing that we had a lot of foundational pieces in place for COVID, and then it allowed us to quickly expand on those areas so that we could really tie everything together so that it came together as well as it did for reporting of products. As COVID went out, we were quickly able to receive information back, which would not have happened outside of COVID. That’s not what it looks like today in the routine vaccine space.

Charlie Harp:

So what were some of the challenges that you guys had to deal with? It sounds like you had already built out and planned out a solid foundation, and I remember those early days working with you guys and we were very, very grateful for the relationship that we at Clinical Architecture have with the CDC. Not only has it been good to work with you guys, but you guys have pushed us in ways that made our products better, made our services better, and we really appreciate that, but when things were happening around that time, were there specific challenges that come to mind that you guys had to do something to address?

Stuart Myerburg:

Lori, do you want to start or you want me to?

Lori Moore:

You can go first and I’ll jump in. How’s that?

Stuart Myerburg:

Okay. Well, I would say the timing was probably the biggest challenge that we had across the board, and that included dealing with code sets because, really, immunizations tend to be pretty predictable in the sense that there’s a long lead-up time, clinical trials, and you know very well in advance when you know FDA is reviewing it and then when ACIP is going to be voting on recommendations.

So we were very much in the habit of being passive about it because we would wait until we knew that there was a new product out and you knew well in advance, and so you didn’t have to rush ever to get something out in general. So I think the biggest challenge we faced at the beginning was just the speed of how everything was being approved because we were in the EUA space, the emergency use, and so things moved much quicker. The time between a product going through clinical trials and getting to FDA and getting approved by ACIP was very much abbreviated.

所以我们绝对挑战想弄啊ut how to deal with that because we didn’t have established relationships with a lot of these entities to know what was happening that far in advance because we never needed to. By the time ACIP voted, that’s all we need to know about beforehand, but COVID changed all that.

Lori Moore:

Absolutely. Charlie, I think you really touched on this at the beginning. The partnerships were one of the most critical pieces of all of this. Knowing who to talk to and how to get everybody moving in the same direction was really the key to success in everything that we’ve accomplished with COVID.

The timing of things, as Stuart said, before COVID is we were waiting until it was approved and then it could be anywhere from four to six weeks before CDC and other data partners such as AMA or drug compendiums like First Databank would actually publish their information. Then we know that outside of COVID, once the publications are posted, it could take anywhere from six weeks, if not longer, for our EHR vendors and other system vendors to actually pick those codes up.

When we’re talking COVID and really accelerating the timeline, the key to success for it was as soon as the product was authorized, it would ship, and as soon as it arrived, we had the expectation of providers administering shots in arms right away. Based on the way we were doing business before COVID, that whole process wasn’t going to be suitable for what we needed for COVID.

So we did have to change our timelines and expand our partnerships, and we really could not have done it without the manufacturers. We partnered with them in ways we had not done before. We had partnered with other federal agencies in ways we had never done before, and we learned a lot that we did not know about, I think, before product actually gets approved by the FDA. So it’s been very educational along the way.

此外,我们有一个工作关系with AMA, but not as extensive as what was required for us to do code set publications that we had during COVID and at the rate that we were asked to produce so. We also had to expand more into the drug file or the formulary compendium space. So we had just started working with First Databank, and then we had to rapidly expand into some of the other compendiums. Really, in my mind, these guys did such an amazing job of coming together to support the rapid development and publication of all of the codes and variations that we’ve seen throughout this last few years.

然后我们也密切合作了National Council for Prescription Drug Program, NCPDP, who also oversees the compendiums to help us maintain that one standard. Then other partners, and I have to really promote all these partners because it was really all of these people coming together that made this a success. We had existing relationships with our immunization information or IIS vendors, but there were other ones out there that we really didn’t have a working relationship with.

So we had to establish new partnerships with the Electronic Health Record Association or EHRA vendors, and it was amazing to watch all of those EHR vendors come together and talk about where their challenges were so we could learn from that and help to remove as many roadblocks as we could in order to achieve rapid delivery and administration in arms.

Also, with data exchange vendors, essentially it covers every aspect from end to end of the interoperability data exchange process that one can imagine, not to mention all of the jurisdictions we worked with, 64 in total. We also had some new provider partners that came to the table to work with us that were administering, and that includes federal agencies, national commercial partners such as pharmacies and dialysis.

Then one that we really hadn’t put at the beginning but we did as we moved along COVID were our payer partners. Really, it took all of these guys to make this work. It’s really amazing when you take a step back to understand how it works from end to end, but if any one of these guys would’ve been missing, we wouldn’t have been able to achieve I think what we did in such a rapid time.

Charlie Harp:

鼓励当这样的事情发生了and people roll up their sleeves and get to work, and healthcare sometimes gets a bad rap because the healthcare system in this country and frankly in every country I’ve ever intersected with, they all have their issues because of the nature of what they’re doing and how they’re doing it, but when something like this happens, you can tell the people are very earnest about wanting to do something that helps people.

We tried to do a number of things during the process because we felt a little bit on the sidelines at Clinical Architecture because we have all these partners that are providers and folks like you guys and payers, and as a vendor that built systems, we really didn’t feel like we could have a direct impact to help what was happening with COVID. So we did a couple of things like the COVID-19 Interoperability Alliance, where we were building value sets with folks, and then, of course, the work that we did with you guys we felt was very important, but yeah, it’s very encouraging and amazing when you think about everything that people did to help us get through that process, get through that crisis. I think we learned a lot in the process too as a industry and as a nation.

Lori Moore:

Absolutely.

Charlie Harp:

So one of the things that we have on our talking points here, and this is really for people that aren’t super aware of some of these concepts, but would you mind talking a little bit about lot numbers because when the new vaccines were coming out and they’re trying to get them administered, I’ve even had friends of mine, we would talk about some of the work we were doing, they’d say, “Well, why is that a big deal? What’s so important about the lot numbers?” Would you mind giving a primer on lot numbers?

Stuart Myerburg:

Lori, I think you’re probably the best one to do that.

Lori Moore:

Okay. Sure, yeah. I think before we dive into lot numbers, I think where we should start is the NDC. I think most people feel like NDC is one of the most important pieces of the vaccine-related codes, and it truly is critical, but that lot number goes out of sight, out of mind when people don’t see it or talk about it a lot.

The way the labeling works is you’ve got a carton or an outer package and then you’ve got a label that goes on the actual syringe or the vial, and we call that the inner package or the unit of use is the inner package and the outer package is unit of sale. You can have a lot number that is supporting your unit of sale and you can have a lot number that supports your unit of use. Hopefully that’s not too complicated.

Essentially, what happens when you take a step back from the labels is you have to think about how the systems are using each of those numbers. What we see are the supply chain systems are dependent on the NDC, the unit of sale NDC and the unit of sale lot number, whereas our administration systems are basically dependent on the unit of use.

So when I’m going to order a vaccine, I am usually ordering from the unit of sale vaccine-related codes. When I receive those, depending on which system I’m using to track and how I’m tracking, I’m usually just tracking the outer carton information, that unit of sale, when my patient comes in for an appointment and I administer it through, I pull the information off of the vial or that syringe, and that’s what I’m putting into my EHR.

One of the things we’ve noticed even before COVID was that some of our manufacturers would use the same standard for the lot number on both packagings, outer and inner, and then we had manufacturers that would change it. So there essentially wasn’t a standard out there to really get one standard way of doing it.

The other thing we knew is we had gaps and we didn’t have crosswalks, essentially, that gave us an NDC for unit of sale and a lot number for unit of sale, and we didn’t have on the same table, essentially, we didn’t have that corresponding inner packaging labeling tied to it. So for systems, they could not connect the dots between the unit of use and unit of sale lot numbers.

It becomes really important, again, in terms of when you’re trying to tie systems together, make them interoperable. In each individual setting, the system can operate with its own specific code needs, but when we don’t have crosswalks and we don’t have a way of reconciling that, we have challenges when it comes to decrementing inventory, meaning it can’t automatically reduce the number of doses as they’re administered, and that has to be manually accounted for, and sometimes it’s really hard to do, especially if someone is not using the 2D barcode scanning functionality, where it’s getting us our highest data quality.

If I am a provider in clinic and I don’t have 2D barcoding and I just manually key in that lot number from the vial or the syringe, there’s a lot of room for errors in that space. So when we try to tie all of those together, it can be quite complicated. What we found before COVID and even more so in COVID is that we needed a solution that would allow us to have a crosswalk so that we could reference the lot numbers.

Charlie Harp:

So the lot number is actually tying it back to when it was manufactured so that if there are any problems or expiration information, that lot number groups all the NDCs that were produced in that lot together. Is that fair?

Lori Moore:

That is fair. Absolutely. It becomes one of the most critical pieces, especially if there’s a recall and you need to pull a batch back. Not having the ability to do that is essentially what we are up against. I normally have visuals to show this so I can step people through it. So it’s so hard to do it here. I see it in my mind, but trying to explain it without those visuals is so challenging.

Charlie Harp:

I know.

Stuart Myerburg:

I mean, I know that I am a already knowledgeable audience, but I think you did a great job of explaining it. It makes sense.

Charlie Harp:

If anybody listening to the podcast wants to get a visual primer, just let us know.

Lori Moore:

Exactly. We can definitely do that.

Charlie Harp:

底线是当你们面对moving all these vaccines around the country, being able to track what’s being administered where, when those vaccines lose viability, those ties between the outer pack identifier, the identifier on the vial itself, and what actual batch when it was produced and who produced it was obviously very important for you to be able to know what’s going on from a supply chain perspective.

Lori Moore:

Exactly. The thing about COVID too that was even more challenging in this space is that we had non-standard labels that we were up against. The EUA labels were not the same as what we would see under the BLA or Biological License Application. So because this product was coming out and we didn’t have all the stability data on it, some of them did not have even expiration numbers on them, and it made it harder for people to track that information, especially when they’re administering and trying to log it into their EHR. So COVID even put more challenges on us than we initially had to, that we initially have to do with the routine vaccines.

Charlie Harp:

Well, I remember being in a call with you guys when we were talking about the lot numbers and the challenge that you guys were having getting the data from the manufacturers, and we said, “Well, we’d like to help you with that.” Us being able to help wrangle the lot numbers from the manufacturers and get them all normalized together so they could be delivered to a place where they could be put to use is something that we as an organization are very proud to have been a part of, and we appreciated you guys letting us contribute to that effort.

Lori Moore:

Well, you guys have just been amazing. I mean, ideally, it was a proof of concept with we knew that there were gaps with lot numbers, and we knew where the technical challenges existed, but finding a solution that we could put into place at such a rapid turnaround time and make it available to people that need it was such an amazing accomplishment. So again, another key partnership out there where we’ve really made improvements in public health.

Charlie Harp:

Well, a lot of people did a lot of really good work to make it all happen, but we’re super proud to be a part of it. So now that we are where we are, I mean, how would you characterize where we are today relative to pre-COVID? Do you feel like we’re in a good place? Do you feel like the systems, the foundations are all pretty solid?

Lori Moore:

Stuart, I’ll take the first stab here and then I’ll turn it over to you. Does that sound fair?

Stuart Myerburg:

Yeah, sure, sure.

Lori Moore:

I think over the course of COVID, we’ve really made significant advances to the entire ecosystem. The partners continue to meet routinely. Everyone is engaging on ways to improve, and a lot of the things we’ve stood up were either proof of concepts or pilots. Those things are really having a significant impact even today. So as we continue to move forward, I think that we’ll continue to expand on a lot of the new areas that were established under COVID.

我认为这些关系我们已经落实到位,I don’t see those going away. We’re building on those as key. You can’t do any of this without having all the partners at the table. Now that we know what it takes to make this work, I think it’s going to get better. We’re already seeing improvements in data quality because of these activities, which is essentially why we’ve focused and worked so hard on the terminology side and making sure that everybody’s readying systems in advance, and then monitoring the data as it comes in and working with these partners to continue their improvements. Stuart, I’ll turn it over to you.

Stuart Myerburg:

Yeah, I mean, I would agree with all of that. I mean, I think the learning experience alone was invaluable because we thought we understood the process pretty well, but COVID and that accelerated process really forced us to dig in deeper and really understand how a product gets from clinical trials all the way to distribution and into an arm. So that in and of itself was really helpful for us to understand not just for the code sets, but across the board everything that we do.

Then that really came about because of the partnerships. Like Lori said, those partnerships are not going to go away. If anything, they’re going to be strengthened, and it’s really helpful now to be able to talk with these groups who know about the vaccine a lot of times well before we do just so we know what’s on the horizon and we can really try to work out issues well in advance so something doesn’t get approved and come to market and then we have to scramble to figure out because there’s some thing that we’d never encountered before with it or whatever may happen.

Then I think also the lot number work going to hopefully expand. I know we are toying with the idea of, “We did this work with COVID, but how do we leverage this work and expand the scope to look at routine vaccines as well?” which obviously will take a lot more resources and time, and it’s a lot, well, not that COVID was predictable, but COVID was only predictable in that we would know about things very quickly, but yeah, I mean, I think it’s a great opportunity to start considering that and see what we can do.

Charlie Harp:

Can I ask you guy guys an informatics nerd question? I’m the informatics nerd in this scenario, by the way. Does the nature of the new vaccines, the mRNA vaccines, does it change how you model the CVX codes from a information perspective?

Lori Moore:

It can. If the formulation changes, we do have to go back and reevaluate whether new codes are needed or not. So there are several different aspects that we look at in terms of modeling a vaccine code that come into play as each new presentation comes up.

Stuart Myerburg:

I think it forced us to dive even deeper into that very non-informatics world of formulation and truly trying to understand what the difference was between these products because the mRNA vaccines are so very similar, hence why they can be used interchangeably that in a non-COVID world we probably would’ve considered them the same vaccine ultimately. So it was very difficult for us to tease out exactly what the difference was. So when we were creating that CVX, we had something that made it different from the other product. Thankfully, we do have people like Lori who are pharmacists who can understand that thing because it really has gotten a lot more into that world than we ever had to think about previously.

Charlie Harp:

Those pharmacists come in handy, and I’m not just saying that because all my friends at First Databank. So one of the things that’s interesting, and this is just from the flip side because you guys were dealing with this problem from the perspective of vaccines and distribution of them, one of the weird things that we also saw, not necessarily weird, but when we were working with the providers and the labs and the folks on the other side of COVID testing, one of the things that really blindsided the industry was the fact that they didn’t have a common vocabulary for talking about COVID screening tests.

So one of the big challenges, and I brought this up at a high-tech meeting, is we need to have a group somewhere that when there’s some emerging crisis like COVID, we should sit down and decide what are the semantics that we’re going to use to describe this because at one point when we were working with different clients, there were 72 different ways to say that a patient was positive for COVID.

When you think about mapping results, lab results, the way that people characterized COVID, whether it was SARS, whether it was coronavirus, however they were doing it, that was another facet of COVID and how it blindsided the industry a little bit, and it took a lot of time for people to figure out just the nomenclature of how do we describe and how do we talk about the test results in a way where they’re somewhat compatible because we obviously really care about, from a public health perspective, to be able to monitor that and see who’s positive and who’s not. So that was another aspect of this that I thought was interesting to see how the industry responded and dealt with that.

Stuart Myerburg:

We definitely see that even with the non-COVID world, especially with clinical decision support when we’re trying to give a code to an underlying condition that might affect whether you vaccinate or not vaccinate. There are different ways to describe the same condition, and when it’s done in a narrative form and not in any structured code form, it’s very easy to use terms interchangeably, but when you’re actually trying to code it, you start realizing, “Wait. Is this the same condition? Do you actually mean these to be the same thing or are they different things?” So we’ve definitely encountered that a lot even before COVID.

Charlie Harp:

Well, and that’s one of those things that I think COVID, as a phenomenon, opened up a lot of people’s eyes. We’re seeing it now in the wake of COVID. We’re seeing a lot of people that are starting to say, “Yeah, we didn’t realize how unusable our data was,” and why data quality, which for a lot of these folks out in the provider space and other spaces, we use it for billing, we use it for certain types of tracking and management, we try to use it for quality measures, but one of the things that was I’m sure very frustrating for a lot of people was, “How do we do a better job of predicting who is really going to get hit hard by COVID and who is not?”

It’s one thing to say that somebody is elderly and has multiple comorbidities, but why is somebody who’s 30 years old and relatively healthy having this problem? I think that one of the things that I hope happens as a result of COVID is that healthcare as an industry starts to ramp up the quality of their discreet patient data so that when things like this happen, we can actually look to the data and see what’s going on and do a better job of making decisions based upon that data so we don’t have things like locked up in narratives and things that are being coded incorrectly. I’m optimistic that it was a little bit of a wake up call for us from a data quality perspective, but I am a data quality zealot.

Lori Moore:

I do think that the key to all of this is planning ahead for these types of things. As we mentioned in the beginning that we had a lot of the foundational pieces in place, but definitely taking a step back and looking at all the lessons learned are key as we move forward, and also talking about some of the gaps that still exist outside of what we’ve established for COVID, even in routine vaccine world, it’s going to be important. I think that what I can’t say enough is just what an amazing historic effort that we’ve actually accomplished here with vaccines alone. I think that that will help us to inform a lot of other areas as we continue to make progress in future pandemic planning exercises. Got to have standards.

Charlie Harp:

Absolutely. Like you said, I think that it’s amazing what we can do as an industry when we roll up our sleeves and we work together towards a common goal. So hopefully, we started a trend in that respect with the things that happened during the pandemic. So what do you guys see as the future for the program?

Stuart Myerburg:

So for our branch or for the vocab work in particular?

Charlie Harp:

For both. Let’s start small and go bigger. So for the vocab work that you’re doing, where do you see yourself going from here?

Stuart Myerburg:

So I think, like I said earlier, I’m definitely thinking about how we can grow the lot number work because it’s been so helpful with COVID, trying to figure out what we can do in the routine vaccine space. I think also leveraging all of these relationships and coming up with some ways to standardize our interactions. Right now, it really is keyed off of what’s going on with COVID, but I think now in a less COVID-centric world, we need to come up with cadences and ways to engage with manufacturers, especially because we don’t necessarily know what their timelines are or when their new products that might be in clinical trial or whatever. So I think just growing all of those pieces that cropped up in COVID and using them to make our routine vaccine work better.

对于the branch, what I was alluding to earlier, we’re growing a lot. We’re adding three new teams, really. Two of them are pieces of an existing team, but that’s, again, a result of all the work that we did with COVID, recognizing that we’ve taken on a lot of new initiatives that we never did before within the branch but are very important and proven to be very useful, but we need the resources to support all of that. So yeah, I mean, really, COVID has been an opportunity for better or worse, but in this case, for better to really expand our scope and to grow everything that we’ve been doing in the branch and take all the work that we did pre-COVID and take it to the next level.

Lori Moore:

I’d just add that we’re still collecting lessons learned. I feel like we have a lot that we’ve learned from our side, but also just having listening sessions with partners and really hearing more about their lessons learned, it will ensure success in the future. As Stuart said, we plan on looking at ways to expand some of the projects like the lot number project, but that also means expanding more into manufacturers and really getting people to understand why we need information in advance and not after something’s been approved. So a lot of strong communications and partnerships that we have to keep focusing on as we move forward.

Charlie Harp:

我认为还有一个消息阿布t, you said it earlier, Lori, about standards. Having a standard way of doing things streamlines our ability to move information when we have to in a hurry as opposed to everybody creating their own one-off thing and then giving it to other folks and having them work through it and normalize it. When these things happen, it’s usually a good opportunity to say, “Okay. How can we create a standard thing so when this type of thing happens again, it’s normal course of business and not a mad scramble.” Is that something that you guys are working with the manufacturers on as far? I know we did some of that with the COVID vaccines, but is that something you think will expand?

Lori Moore:

I believe it will, making sure the standards are well communicated, published. If there’s a challenge with them, making sure we understand what that is and if there’s ways around it. Also, just trying to optimize implementation. So if there’s something that hasn’t been adopted yet, we’re really trying to encourage people. For instance, 2D barcoding, if you’re not using it, you should be. It’s a gold standard. So really trying to encourage across the nation for people to optimize all their systems and tools in addition to adopting those standards is important at this point.

Charlie Harp:

2D barcoding’s been around a while, if I remember correctly.

Lori Moore:

It has, but in a situation like COVID where you don’t have standard labels, and unfortunately we did not have 2D barcoding available to us during COVID, it became a challenge. Even as we sit down with partners, though, we learned that they were still not implementing some of these tools or they hadn’t completely rolled them out. So I believe people now see the value there, but it’s really our responsibility to keep communicating the importance and to publish how important it is, making sure that everybody understands how critical it is to the success of the overarching country. I mean, it really does help us when we’re trying to exchange all the data that we’re exchanging and making sure it’s at the highest quality that it can be.

Charlie Harp:

Anything else you guys would like to add before we wrap up today?

Lori Moore:

Charlie, I would just want to say thank you for hosting this, and again, if anybody needs a visual, I’m much better with visuals. This is the first time I’ve tried a podcast, but very excited that we had the opportunity to do this. So thank you and to your team.

Stuart Myerburg:

Thank you as well. We’ve enjoyed working with you over, I guess it’s now six years, and it was really great to have this opportunity to talk about everything that we did during that time and then how much it changed shockingly during COVID.

Charlie Harp:

Well, and you guys gave a lot of kudos to a lot of folks out there. Let me take this opportunity to give you kudos. I don’t know that people realize how much work you guys did and how much of a difference it made in us as a country doing a better job of making sure people were getting vaccinated and getting the help that they need. So I would say thank you for everything that you did and continue to do to help keep people safe out there.

Stuart Myerburg:

Thank you.

Lori Moore:

Thank you.

Charlie Harp:

This has been the Informonster Podcast with Stuart Myerburg and Lori Moore from the CDC, and I’m Charlie Harp, your host, and I’ll see you all in the next Informonster Podcast.