[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