[Federal Register Volume 59, Number 144 (Thursday, July 28, 1994)]
[Unknown Section]
[Page ]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-18364]
[Federal Register: July 28, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[Announcement Number 101B]
Addendum to Announcement 101; Program Announcement and
Availability of Funds for FY 1994 Demonstration Projects for the
Development of State Immunization Information Systems
Introduction
The Centers for Disease Control and Prevention (CDC), through the
National Immunization Program (NIP) and the CDC Information Network for
Public Health Officials (CDC INPHO), announces the availability of
fiscal year (FY) 1994 supplemental grant funds to implement pilot
demonstrations of statewide immunization information systems. Funds
provided by this announcement will be divided into two parts or
components. This is an addendum to Program Announcement Number 101.
Component One will provide funds for the development of the core or
central operating system for the State Immunization Information System
(SIIS). While grantees should plan for the eventual implementation of a
total statewide system, this announcement provides funding only for the
acquisition and installation of hardware and software for centralized
data storage, linkages, and interfaces to other systems from the State
office. If a grantee already has an immunization information system,
they may apply for funds to expand or enhance their system. The level
of funding, however, will be predetermined and based upon the hardware
and software needed to manage a specific number of new patient records
as indicated by the number of live births occurring in a State each
year.
Component Two will provide funds for developing, acquiring,
installing, and maintaining statewide information systems and
communications networks that support the goals of the SIIS and of the
CDC Information Network for Public Health Officials (CDC INPHO). When
implemented, these statewide networks will enable public health
personnel to communicate with each other and with CDC by exchanging
electronic mail, accessing CDC information databases, and exchanging
public health data. The networks will be fully integrated into and
supportive of statewide immunization information systems. These
integrated networks and systems will serve to ensure the highest
possible vaccination levels of children by recording individual
immunization events, prompting follow-up of those children who missed
their scheduled vaccinations, and allowing for the confidential
exchange of immunization information between States to ensure
continuity of care.
The Public Health Service (PHS) is committed to achieving the
health promotion and disease prevention objectives of ``Healthy People
2000,'' a PHS-led national activity to reduce morbidity and mortality
and improve the quality of life. This announcement is related to the
priority area of Immunization and Infectious Diseases. (To order a copy
of ``Healthy People 2000,'' see the section entitled WHERE TO OBTAIN
ADDITIONAL INFORMATION.)
Authority
This program is authorized under Section 317 of the Public Health
Service Act, 42 U.S.C. 247b, as amended. Applicable program regulations
are found in 42 CFR Part 51b, Subparts A and B.
Smoke-Free Workplace
The Public Health Service strongly encourages all grant recipients
to provide a smoke-free workplace and promote the non-use of all
tobacco products. This is consistent with the PHS mission to protect
and advance the physical and mental health of the American people.
Eligible Applicants
Assistance will be provided only to departments of public health in
each State; New York, New York; District of Columbia; Puerto Rico;
Virgin Islands and U.S. territories located in the Pacific Basin;
hereafter referred to as grantees. This eligibility limitation is based
on the governmental entity responsible for legislation on disseminating
birth certificate data. Grantees with no immunization information
system in place are encouraged to apply. Grantees with immunization
information systems in place are encouraged to apply with the intent of
upgrading, enhancing, or expanding their current system to the
conditions set forth in this announcement.
Availability of Funds
Approximately $7,000,000 is available in FY 1994 to fund two
separate components of this Announcement. Of the $7 million,
approximately $5 million (Component One) will be available for grantees
to implement the central or core portion of a statewide immunization
information system (SIIS) database. This will include hardware and
software that will eventually be required for interstate and intrastate
transfer of immunization data. The average award is expected to be
$200,000, ranging from $100,000 to $400,000. The awards will be
provided to approximately 20 grantees. The supplemental awards will be
made on or about September 15, 1994. Based on availability of funds, it
is anticipated that additional projects, if their applications are
approved, will be awarded grants early in FY 1995 to install the core
or centralized portion of the SIIS.
The remaining $2 million (Component Two) will be available for
funding two to four grantees to develop wide-area telecommunication
networks. The average award is expected to be between $500,000 and
$1,000,000 per year for up to three years and will be made for a 12-
month activity period within a three year period of performance,
beginning in FY 1994. These awards will be made on or about September
30, 1994.
Note: Funding estimates may vary and are subject to change.
Additional awards for Component Two only, will be made based on
satisfactory progress of developing and maintaining statewide
informational systems and communication networks that support the goals
of State immunization information systems and of the CDC INPHO, and the
availability of funds.
Purpose
The purpose of this grant program is to ensure that the following
automated systems are in place for each State by October 1, 1996:
A system that ensures the adequate immunization of at
least 90 percent of all children born on or after October 1, 1994.
A system that ensures the follow-up of children who miss
scheduled vaccinations.
A secure and confidential system that enables appropriate
health care providers within States to access a child's vaccination
record to determine their status.
A system that monitors adverse reactions to immunizing
agents.
A system that monitors vaccine distribution and usage.
The distribution of grant funds has been systematic. Funds were
provided in FY 1993 for each project area to conduct a needs
assessment. In FY 1994, funds were available to each grantee to develop
short- and long-range plans using the data acquired from the needs
assessment. Funds are now available for the next step--the installation
of the core or central portion of the SIIS.
This grant announcement is divided into two components:
(1) To implement a core or central computerized immunization
information system and communications interfaces that will allow
transfer of immunization information on an intra- and interstate
network between heterogenous systems (Component One).
(2) To develop and implement statewide telecommunications networks
that will eventually connect CDC, State, and local health agencies.
These networks (local area networks and wide area networks) will
directly link with and support the National Immunization Program (NIP)
immunization information system goals and objectives (Component Two).
Therefore, applicants may apply for funding for one of the
following:
1. Component One only.
2. Component Two only.
3. Components One and Two.
Program Requirements
To receive funds, each applicant must satisfactorily address the
following program elements for funding Component One.
1. Complete and submit a satisfactory needs assessment and plan for
implementing an immunization information system(s).
2. Develop and implement an initial immunization record in the SIIS
database using an electronic birth registry interface or an appropriate
alternative method which would capture all infants in the State's
annual birth cohort.
3. Provide evidence of cooperation, coordination, and collaboration
between the State health department and the various local public and
private health care agencies that will be involved in the planning,
development, and implementation of SIIS.
4. Demonstrate the capability to expand the number of other systems
that are able to interface effectively with SIIS.
5. Provide assistance and the physical space for the installation
of the communications lines, hardware and software.
6. Prepare to coordinate demonstration activities among State and
local data processing units, State immunization program, and major
immunization health care providers, e.g., health department clinics,
health maintenance organizations, hospital outpatient clinics,
community health centers.
7. Seek support from the health community and professional
organizations in promoting acceptance and participation in the SIIS
activities.
8. Demonstrate the use of other funding resources to include
redirecting existing funds, unobligated funds, IAP funds, funds from
other Federal, State, or private sources and the like.
9. Provide an estimate of State, local, or other funds spent to
date on the development of a statewide immunization system or an
integrated system of which immunization is a part. Also provide an
estimate of the amount of State, local, or other funds that will be
needed to complete the statewide system.
10. Describe hardware and software requirements and estimated
costs. Growth and flexibility of the system must be considered in the
purchase of hardware and software.
Note: State immunization information systems must meet or exceed
the System Fault Tolerance Level II standard described in Novell
operating systems manuals, including disk mirroring, differential
backups, off-site storage of backups, continuous and non-interrupted
power and power surge protection. The system(s) should potentially
be capable of 24-hour operation. Downtime episodes must not exceed
30 minutes and must not occur more than once a month.
11. Describe personnel requirements and estimated costs. There will
not be enough funds from this grant to support all the personnel the
grantee may believe are required. If additional personnel are needed,
the grantee can apply for funds under the Immunization Action Plan or
through local or State funds.
12. Describe training requirements and estimated costs. Personnel
will receive support for technical and programmatic training. The
development of an automated system of this magnitude with the number of
interfaces that will be necessary will require close collaboration with
CDC staff in conjunction with appropriate training. Training may occur
within the State, at CDC in Atlanta, or at a designated conference
site. Project personnel may obtain training on- or off-site from
private vendors.
13. Describe travel requirements and estimated costs. Close
collaboration with CDC and other applicants is essential for the
development of SIIS. Funds for periodic training and CDC meetings for
the purpose of information sharing will be supported.
To receive funds for Component Two, grantees must satisfactorily
address the following program elements:
1. The grantee should develop a plan that addresses three phases:
(1) electronic linkage via computer networks among State and local
public health agencies, (2) rapid and efficient access to local, State
and Federal information needed by public health practitioners, and (3)
electronic data exchange. The plan addressing each of these three
phases should address planning, implementation, and evaluation.
A. Linkage
The goal of this element is to establish computer network linkages
with and among the various component agencies within the State public
health system and also to investigate or establish linkages with
primary care providers, especially large organizations, such as managed
care organizations. The plan for this element should include:
i. Planning Phase
Comprehensive assessment of current communications and
telecommunications environment throughout all components of the public
health structure within the State.
Creation of a Network Design and Technology and
Implementation Plan that emphasizes a WAN using modern, personal
computer-based client server architecture.
Creation of a Hardware and Software Implementation Plan.
ii. Implementation Phase
Strategy for the integration of the State communications
network and the immunization information system, allowing access to all
providers of immunization and other public health services.
Implement local area network connectivity (including
cabling, hardware and software installation, and user training) between
local and State health departments and CDC, including an Internet
interface.
User applications, including support and training.
iii. Evaluation Phase
Demonstrate that there has been an adequate inclusion of
all agencies and organizations that will be critical to successful
implementation of elements B and C below (i.e., Information Access and
Data Exchange).
Thorough specification of existing public health related
systems infrastructure and current plans for and funding sources for
expanding this infrastructure.
B. Information Access
i. Planning Phase
Grantee should specify the types of immunization
information needed to assist public health personnel to more
effectively improve and protect the health of the public. For example,
directories of training resources, guidelines for disease prevention,
operational guidelines for prevention programs, State information
databases, etc., to which online access would be desirable.
Grantee should specify the process through which these
information resources will be determined and developed.
ii. Implementation Phase
Grantee must present an implementation strategy and
timeline for placing these information resources into electronic
access.
iii. Evaluation Phase
Grantee should present an evaluation plan that provides a
basis for determining the impact that access to the immunization
information databases (item B.i.) above has on changing the practice of
public health and potentially the outcomes as measured by health status
indicators.
C. Data Exchange
Future public health information systems should provide for
efficient capture, transmission and exchange of the universe of data
relevant to the practice of public health.
i. Planning Phase
Grantee must describe the State's approach to state-wide
public health data system integration, the goal of which is to provide
efficient capture, transmission and exchange of public health data
(e.g., patient specific data, immunization events, vital records,
disease surveillance and reporting data, population based assessments,
etc.).
The plan should specify how the State is proceeding or
will proceed to develop an integrated data system to meet the future
needs of public health. Where appropriate, the plan should discuss
plans for electronic interaction with non-government health care
organizations, such as managed care organizations, private
practitioners, etc.
ii. Implementation Phase
The grantee should present a data system implementation
plan and system design with timeliness and development schedules.
iii. Evaluation Phase
The grantee's evaluation plan should correspond to the
goals (as identified in the PURPOSE section of this announcement) of
the integrated State system and include an inventory of existing
health-related information systems.
2. Hardware and software requirements and estimated costs.
3. Personnel requirements and estimated costs.
4. Training requirements and estimated costs.
5. Travel requirements and estimated costs.
6. Other funding sources, if any, supporting project activities.
In formulating an approach, grantees are strongly encouraged to use
the structure, technical descriptions, core data set, etc., which are
included in the application kit.
CDC supports the concept of comprehensive health information
systems which give priority to the immunization information function.
Documentation must be provided (amount of dollars and source) by the
project if funds from other sources will also be used to support the
development of a comprehensive health information systems. CDC will
also support, in concept, the use of limited grant funds, if approved,
for the development of some hardware or software interfaces that will
ensure that key linkages can be made, such as to State offices of vital
statistics and managed health care organizations.
Review and Evaluation Criteria
Applications for funds for the State Immunization Information
System will be evaluated by a CDC-appointed Objective Review Committee
(ORC) whose members have expertise in disease prevention and service
delivery. These reviewers will be persons representing a variety of
disciplines and may or may not have specific expertise with
immunization programs or automated data processing systems. Grantees,
therefore, should consider the clarity of presentation and the use of
terms that are widely understood or clearly defined. The ranking of
scores made by the committee and program need will determine which
grantees will be funded in FY 1994 and FY 1995 for Component One, as
well as which grantees will be funded for Component Two.
Applications will be reviewed and evaluated according to the
following criteria (Component One and Component Two will be reviewed
separately according to the criteria set forth below):
A. The applicant's understanding of the purpose of the program, the
appropriateness and feasibility of the stated activities to meet the
criteria set forth in the announcement, and the likelihood that the
activities conducted by the applicant will achieve the desired
outcomes. (Component One: 10 points); (Component Two: 25 points)
B. The extent to which background information and other data
demonstrate that the applicant has the appropriate organizational
structure, administrative and technical support, accessibility to birth
records, and accessibility to immunization records of the target
population to implement the project and produce statistically valid
results, evidence of support from public and private agencies and
providers, and the ability to accomplish project objectives. (Component
One: 15 points); (Component Two: N/A)
C. The degree to which long-term and short-term objectives are
consistent with the purpose of the demonstration project and are
realistic, specific, measurable, and time-phased. (Component One: 15
points); (Component Two: 15 points)
D. The quality of the plan of operation for developing and
implementing proposed activities and the degree to which the plan
specifies the what, who, where, how, and the timing for start and
completion of each activity. (Component One: 20 points); (Component
Two: 15 points)
E. The degree to which the evaluation plan can be used in measuring
achievement of each objective and the quality of methods and techniques
to be used. (Component One: 10 points); (Component Two: 15 points)
F. The extent to which methods and strategies proposed are
financially feasible and have a system capacity to link with the SIISs
in other States. (Component One: 15 points); (Component Two: 15 points)
G. The extent to which qualified and experienced personnel are
available to carry out the proposed activities of the project.
(Component One: 15 points); (Component Two: 15 points)
In addition, consideration will be given to the extent to which the
budget request is clearly explained, adequately justified, reasonable,
and consistent with the intended use of funds, and the extent to which
the applicant is contributing its own resources to childhood
immunization activities.
Executive Order 12372 Review
Applications are subject to review as governed by Executive Order
(E.O.) 12372, Intergovernmental Review of Federal Programs. E.O. 12372
sets up a system for State and local government review of processed
Federal assistance application. Applicants should contact their State
Single Point of Contact (SPOC) as early as possible to alert them to
the prospective applications and receive any necessary instructions on
the State process. A current SPOC list is included in the application
kit. The SPOC should send any State process recommendations to Ms.
Elizabeth M. Taylor, Grants Management Officer, Grants Management
Branch, Procurement and Grants Office, Centers for Disease Control and
Prevention (CDC), 255 East Paces Ferry Road, NE., Mailstop E-16, Room
300, Atlanta, GA 30305, no later than 60 days after the application due
date. CDC does not guarantee to accommodate or explain for State
process recommendations it receives after that date.
Public Health System Reporting Requirements
This program is not subject to the Public Health System Reporting
Requirements.
Catalog of Federal Domestic Assistance Number
The Catalog of Federal Domestic Assistance Number is 93.268,
Preventive Health Services--Immunization.
Application Submission and Deadline
The program announcement and application kit were mailed to all
eligible applicants in June 1994.
Where To Obtain Additional Information
A complete program description, information on application
procedures, an application package, and business management technical
assistance may be obtained from Mr. Eddie L. Wilder, Senior Grants
Management Specialist, Grants Management Branch, Procurement and Grants
Office, Centers for Disease Control and Prevention (CDC), 255 East
Paces Ferry Road NE., Room 300, Mailstop E-16, Atlanta, GA 30305,
telephone (404) 842-6805. Programmatic technical assistance for funding
Component One may be obtained from Mark V. Schrader, Division of Data
Management, National Immunization Program, Centers for Disease Control
and Prevention (CDC), 12 Corporate Square, Corporate Square Blvd.,
Mailstop E-62, Atlanta, GA 30333, telephone (404) 639-8245, fax (404)
639-8615. Programmatic technical assistance for funding Component Two
may be obtained from Thomas G. Lacher, Public Health Practice Program
Office, Centers for Disease Control and Prevention (CDC), 24 Executive
Park Drive, Mailstop E-20, Atlanta, GA 30333, telephone (404) 639-1938,
fax (404) 639-1920.
Announcement number 101B, ``Supplemental Funds for Demonstration
Projects for the Development of State Immunization Information
Systems,'' must be referenced in all requests for information for these
projects.
Potential applicants may obtain a copy of Healthy People 2000 (Full
Report, Stock No. 017-001-00474-0) or Healthy People 2000 (Summary
Report, Stock No. 017-001-00473-1) referenced in the INTRODUCTION
section through the Superintendent of Documents, Government Printing
Office, Washington, DC 20402-9325, telephone (202) 783-3238.
Dated: July 21, 1994.
Joseph R. Carter,
Acting Associate Director for Management and Operations Centers for
Disease Control and Prevention (CDC).
[FR Doc. 94-18364 Filed 7-27-94; 8:45 am]
BILLING CODE 4163-18-P