CHAPTER 25- Informatics Solutions for Emergency Preparedness and Respo

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Presented by: Elvin Valentine P. Arao Informatics Solutions for Emergency Preparedness and Response Elizabeth Weiner Sally Phillips

INTRODUCTION: 

INTRODUCTION Impetus for informatics solutions for emergency preparedness and response: September 11, 2001- catapulted US into realization that the country was not adequately protected for terrorism. Anthrax outbreaks- stressed the public health infrastructure to the point that bioterrorism arose as an additional threat.

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A new definition of Community Community health (US) – provision of healthcare outside the hospital infrastructure. As such, the public health departments have been viewed as the major delivery system of healthcare. Federal funds were channeled through the Centers for Disease Control and Prevention (CDC) to the states in order to strengthen the public health infrastructure. Changes in Federal System Affecting Emergency Preparedness and Response

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Challenges for hospital and public health : reporting systems lacked standardization no central place for accessing information Informatics solutions : Healthcare members in St. Louis developed a bar code system to log and track victims. East Carolina university tested the in-place telehealth networks

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Inability to access electronic heath data creates barriers to continuity of care , quality of care , cost analysis , and vulnerabilities to exposures during bioterrorism events . The development of National Health Information Infrastructure (NHII) will come an improved public health information network (PHIN). At the same time, data sharing has to be carefully planned in order to stay in compliance with the HIPPA.

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Department of Health and Human Services (DHHS) – is responsible for the education of healthcare professionals in preparedness for emergencies, including potential terrorism Three units focusing on emergency planning and response: CDC - Centers for Disease Control and Prevention AHRQ - Agency for Healthcare Research and Quality HRSA - Health Resources and Services Administration Federal Responsibilities for Healthcare Providers

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Presidential Directive #8 - the definition of first responder was expanded to include healthcare providers. Thus, allowing healthcare community to be eligible for funding from the DHS. CDC - Centers for Disease Control and Prevention - recognized as the lead federal agency for protecting the health and safety of people-at home and abroad, providing credible information to enhance health decisions, and promoting health through strong partnerships. - Dr. Julie Gerberding (the director), called for changes that would strengthen the organization, particularly in the area of risk communication.

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National Electronic Disease Surveillance System (NEDSS) - is an initiative that promotes the use of data and information system standards to advance the development of efficient, integrated, interoperable surveillance systems at federal, state, and local levels. Purposes of NEDSS: To detect outbreaks rapidly and to monitor the health of the nation Facilitate the electronic transfer of a appropriate information from CIS in the healthcare system to public health departments. Reduce provider burden in the provision of information Enhance both the timeliness and quality of information provided

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Health Alert Network (HAN) – funded to develop capacity at the state and local levels for continuous, high-speed access to public health information, and to broadcast information in support of emergency communications.

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«--OR--» Local health officer suspects that cases of illness may be due to a bioterrorist incident2 First: Inform & involve State Health Department. Health Department notifies CDC. Conduct investigation. Yes Is BT incident confirmed or thought to be probable? No Notify FBI. Notify other pre-determined response partners. Continue investigation Local Health Officer is informed of a bioterrorist incident or threat1 First: • Notify FBI • Notify local law enforcement Next: Notify & involve State Health Department and other response partners, per a pre-established notification list State Health Department notifies CDC Protocols: Interim Recommended Notification Procedures for Local and State Public Health Department Leaders in the Event of a Bioterrorist Incident

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Laboratory Response Network (LRN) – is charged with the task of maintaining an integrated network of state and local public health, federal, military, and international laboratories that can respond to both bioterrorism and chemical terrorism.

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Division of Public Health Surveillance and Informatics – their purpose is to provide and improve access to and use of public health information. A wide variety of resources can be found on their Web site, including performance criteria for public health disease reporting systems , phone triage protocols , and guidance for public health alerts and advisories.

AHRQ - Agency for Healthcare Research and Quality: 

AHRQ - Agency for Healthcare Research and Quality Decision Support Systems – assist in rapid diagnosis and management of disease; facilitate clinician reporting of trends that will be used to diagnose possible bioterrorist attacks; speed up the reporting process and enhance dissemination of relevant information.

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(IDSRN) Integrated delivery system research network- to develop a computer simulation model for citywide response planning for mass prophylaxis and vaccination during bioterrorist attacks and other public health emergencies. Researchers at the Children’s Hospital of Boston building decision support models for information systems of linked healthcare data

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Univ. of California at San Francisco examined the role of information technologies and decision support systems to assist in rapid diagnosis and management of disease. Boston Children’s Hospital and Harvard University develop a prototype database and Web site to facilitate clinician reporting of trends that will be used to diagnose possible bioterrorist attacks.

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Syndromic Surveillance – is loosely defined as detection of a disease outbreak before the actual disease or mechanism of transmission is identified. “real-time outbreak and disease surveillance” (RODS) system – a project undertaken by MPC Corporation, University of Pittsburgh and Carnegie Mellon University. This system provides early warning of possible infectious disease outbreaks caused by bioterrorism or other public health emergencies.

Helping Clinicians Respond: 

Helping Clinicians Respond Univ. of Alabama @ Birmingham – developed a continuing medical education training modules to teach healthcare professionals to identify various biologic agents. Research Triangle Institute (RTI) – developed two prototype simulations to aid medical providers in responding to bioterrorist attacks and other public health emergencies.

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Practice-based research network (PBRN) @ children’s Hospital Center in Cincinnati – developed a system to allow for electronic solicitation of data using handheld devices and wireless communications. Researchers @ Vanderbilt University Medical Center – have undertaken a study to determine the effectiveness and efficiency of learning programs to educate nurses volunteering in their local community Medical Reserve Corps.

HRSA - Health Resources and Services Administration: 

HRSA - Health Resources and Services Administration Two grant management programs: National Bioterrorist Hospital Preparedness Program - its purpose is to aid state, territory, and selected entities in improving the capacity of the healthcare system, including hospitals, emergency departments, outpatient facilities, emergency medical services systems, and poison control centers, to respond to incidents requiring mass immunization, isolation, decontamination, diagnosis, and treatment, in the aftermath of terrorism or other public health emergencies.

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Bioterrorism Training and Curriculum Development (BTCD) Program – provides continuing education and curricular enhancement for practicing healthcare providers and current students.

Other Changes Affecting Emergency Preparedness and Response: 

Other Changes Affecting Emergency Preparedness and Response Competency-Based Learning and Informatics Needs Nuclear, Biologic, Chemical (NBC) Task Force – formed by ACEP to evaluate the status of bioterrorism training in the US, identify barriers to this training and offer recommendations for effective education. Nurse representatives to the task force: Cheryl Peterson – ANA Claudia Niersbach and Bettina Stopford – Emergency Nurses Association

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Kristine M. Gebbie, RN, DrPH – led an initiative funded by the CDC; published her work “Center for Health Policy”. Her work was recently expanded to encompass specific bioterrorism competencies for more job categories. - Gebbie went on to develop a “competency-to-curriculum toolkit” that is a resource for those planning a curriculum in emergency preparedness and response. Int’l Nursing Coalition for Mass Casualty Education (INCMCE) – interested in promoting mass casualty education for nurses.

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John Hopkins University Evidence-based Practice Center concluded that there is a need for future research into the most effective way to train clinicians in areas that will improve their ability to respond to a bioterrorist attack or other public health event. An update of the literature review on training practice for bioterrorism, with new emphasis on disaster drills, and best practices to accomplish successful drills was made.

Informatics and Emergency Operations Center: 

Informatics and Emergency Operations Center Incident management system (IMS) – first used by firefighters to control disaster scenes in a multijurisdictional and interdepartmental manner. Later on it was adapted for hospital use and is called the Hospital Emergency Incident Command System (HEICS). Information Management Emergency Operations Center (IMEOC)

Informatics and Volunteerism: 

Informatics and Volunteerism Disaster Medical Assistance Teams (DMAT) – teams that are willing to travel to other regions of the country in the event of an emergency. Medical Reserve Corps initiative – was designed to assemble healthcare volunteers who are willing to respond at their local levels. National Nurses Response Team (NNRT) – comprise 10 regionally-based teams of 200 registered nurses who could be called on to assist in chemoprophylaxis or vaccination. American Red Cross - has a long history of volunteerism during disasters, and has education requirements for nurses depending on what roles they will play in disaster relief.

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Characteristics of national volunteer nurses’ database: Verification of licensure (can be multiple states) Records of continuing education Records of certifications Organization(s) volunteering for (will need to decide how to only count individual once during an event) Activation instructions Prior emergency response experience (including dates of service) Security clearance level

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The National Health Information Infrastructure (NHII) in Fighting National Threats David J. Brailer, MD, PhD – appointed as the first national coordinator for Health Information Technology; charged with directing health IT within DHHS and coordinating them with those of other relevant executive branch agencies.

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“Computers are incredibly fast , accurate and stupid . Human beings are incredibly slow , inaccurate and brilliant . Together they are powerful beyond imagination.” -Albert Einstein SUKRAN!!!