Transcript Health Emergency Response Data System (HERDS)

Health Emergency Response Data System (HERDS)
NY State Health Commerce
Enterprise-wide Integrated Information Systems
Public Health Preparedness, Planning, Response
HERDS operates within the NY State
Health
Commerce System (HCS)
A Secure, Standards-based , Integrated
Infrastructure for Enterprise-wide Health
Information Interchange.
NY State Health
Commerce System(HCS)
• Operational Since 1995
• Web Based and Accessible via the Internet
• Requires Id and Password
• An integrated architecture supporting a wide array of
information exchange applications
health
–Routine Information interchange
– Preparedness and response. Examples
•Disease surveillance and Lab reporting
•Health Alerting
•Volunteer data base
•HERDS ( Health Care preparedness and Response )
•Used by ALL local health departments, health facilities, health
providers and practitioners.
Other Participants
Federal: DHHS
NYState: OHS, CSCIC (CyberSecurity), Dept. of
Agriculture & Markets, State Police, SEMO, Insurance
Dept., Mental Health, Environmental Conservation
NYC: FDNY, OEM
Other States: NJ DOH; CT DOH
A Natural Platform for Public Health
Preparedness
Leverages Existing Infrastructure
• Security
• Availability
• Identity Management and Access control
• Application Development Environment
• Core Integration Applications
Leverages Existing Presence of Needed Partners on HCS
Presents common user interface and identification system to
users
One stop shopping for data and data reporting
Presents opportunity for integration of data systems
HERDS Evolved in Response to Information
issues during 911 and Anthrax Letter
Attacks.
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Developed: at the request of Greater NY Hospital Association and Emergency
Planning Coordination Counsel.
Issues: Health care deluged with information requests during the events.
o Competing, conflicting and disparate requests from multiple sources (Federal
Agencies, Law Enforcement, State/local health, media/Press)
o No formal process existed for collecting information
o Multiple requests were disruptive to providers’ and State’s response to event
o No clear authority for collection and dissemination of data
Requires: centralized integrated system maintained by State Health Regulatory
Authority for monitoring and reporting of facility resource information:
available and needed for response or capacity planning. Resource needs for
events can vary significantly with type of event and change as event evolves.
Post 9/11 Response (2001-2002)
Define Requirements from Ground-upwards
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Coordination by Greater NY Hospital Association
Establish Emergency Preparedness Coordinating
Council (EPCC)
Regional planning and response (NY, NJ, CT)
– Establish ongoing dialogue: meetings, briefings, and drills
– Establish Framework for communicating regarding
emergencies, alerts, advisories, and protocols
EPCC composition:
– Providers of all types (hospitals, nursing homes, home care, physician
organizations)
– Local, state, and federal agencies (health, emergency management,
and law enforcement)
EPCC Outcome
Mandate for A Statewide Health Emergency Response Data System
• Develop
system to meet information exchange
needs based on 9/11 and extend to Public Health
Events in general
– Facility resources, surge
– Event-related visits
– Event Patient locator/tracking system
• Goals:
– Develop agreed-upon needs for the data system
– Protect confidential, Competitive and proprietary data:
Use Central authoritative source:
State Health Department Regulatory authority
– Use Existing Infrastructure
Beyond Events such as 9/11
Other Public Health Events of More Common Origin Frequently Emerge.
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They have different and varying information needs, origin, duration,
surveillance/response requirements and rate of emergence.
o Outbreaks: E. Coli ( 0157 Washington fairground), Cryptosporidia ( Seneca Lake
Spray Park), West Nile Virus, Monkey Pox, SARS
o Preparedness
o Disease Surveillance / response : Influenza , Pandemic Flu. ( Ongoing )
o Natural Disasters: Hurricanes: Hurricane Isabel: September 2003
o High Profile Events: Republican National Convention Aug-Sept 2004
o Elevated Threat Levels: Threat level Orange
o State Emergencies: NorthEast Blackout: August 2003
o Critical Health Resource Shortages: Blood Supply Shortage ( Summer 2004),
Influenza Vaccine Shortage ( Fall 2004 )
Information must be shared in real-time between: state/regional/local health,
health facilities and response organizations.
The underlying information collection/distribution system must mutable,
changing to respond to event.
HERDS Generic Preparedness Functions
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Planning and Preparedness
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Surveys
Surveillance
Asset tracking
Response
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Electronic Incidents
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Surge
bed and resource availability
resource requirements
Event Patient/Victim tracking
Integrated Data Visualization: Situational Awareness
Automated Alerting based on Central Communications Directory ( Role
and Contact Information )
Secure Collaboration
Data Exchange Inclusive of Key Response Organizations
Health Facilities
Public Health (State, Regional and Local )
Emergency Management
Other ( Fire EMS, Facility Networks and Organizations )
NYS HEALTH COMMERCE Architecture
Health providers,
Response partners,
Agencies
Local Health
Departments
Clinical Labs
Health
facilities
Automated live exchange
Clinical data
Alerts
Other State/Federal Systems
E-mail Fax
Phone (cell,pager)
Secure Web Posting
Secure Web Access
! Alerting
Electronic Disease
Surveillance/OM
Lab Reporting
HERDS
Secure
Collaboration Forum
Integrated Alert
System
Integrated Voice Response
Integrated Data
Repositories
Secure Automated
Messaging (EbXML/XML/HL7)
Other Commerce
Information
Systems
Communications
Directory
Data Visualization
& Analysis
GIS
Spatial Data
Warehouse
SECURITY, Availability, Continuity
Health Emergency Response Data System
(HERDS)
• HERDS Deployments
Hospitals (4500 users 540,000 user transactions /yr )
Nursing Homes
Local Health
Adult and Home Care
Clinics
Other facilities: e.g. Schools
Examples of HERDS Use
• Drills( 16 )
– NYCity Metro Area ( 14 Counties 75 hospitals, 3 states: NY,CT ,NJ ) –
SARS, Dirty Bomb, BT-Agents, subway explosions
– Upstate Metropolitan Areas ( 8-10 Counties , 10-30 hospitals ) – SNS
activations, Disease outbreak, natural disaster.
– Rural Areas (1-6 Counties, 2-8 hospitals ) mass trauma/accidents, disease
outbreak, Mutual Aid
• On-going Surveillance
– Bed Availability and ED traffic - Hospitals Statewide
– Influenza Surveillance - Hospitals Statewide ( NH, Clinics, CHHAs and
Adult Homes Q1 ’06)
– Vaccine availability – statewide Hospitals and Nursing Homes
• Asset and capacity Surveys
– AIIR
– Critical assets and surge – statewide Hospitals and nursing homes.
• Surge( e.g. bed, ED, mortuary ), equipment ( vents ), staff, pharmaceutical
inventory, capacity ( decon., diagnostic/imaging, treatment) , transportation (e.g.
Helipad, ambulance ), Data/Voice Communications Infrastructure
Examples of HERDS Use
• Emergency Response - Public Health Response
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NorthEast Blackout August 2003
Blood shortage July-August 2004
Vaccine Shortage Fall 2004 – Winter 2005
Regional Flooding – Central NY State June 2006
Western Region Snow Emergency October 2006
• Public Health Preparedness
– Hurricane Isabel September 2003
– Elevated Threat Levels 2003 ( February,May,December )
– Republican National Convention August-September 2004
• Baseline and Public Health Surveys
– HRSA Baselines 2002,2003,2004,2005
– Public Health Surveys.
• Infection Control
• Antibiotic protocols
• Hospital Services inventory
HERDS Real Time Reports
AIIR Capacity
HERDS GIS: Hospital Admissions
Lab Confirmed Positive Influenza
HERDS GIS: Surge: AIIR and ED
Local Health Dept Outbreak Tracking – E. Coli Outbreak
Nursing HomesVaccine Survey
HERDS Usage During
Emergency Declarations
• NE Blackout August 2003
– 48% of 238 hospitals activated statewide were able to
access HERDS. Alternate communications capacity
was not available to facilities who did not access
HERDS.
• Regional Flooding Central NY State June 2006
– 100 % 20 counties 40 hospitals activated accessed
HERDS
• Western Region Snow Emergency October 2006
– 100% 4 counties 19 hospitals activated accessed
HERDS
HERDS Critical Asset Survey of Hospital
Communications Capacity/Preparedness
• 98-100 % have internet access in multiple locations (EOC,
pharmacy, laboratory)
• 72% have at least one satellite phone, most are fixed base
phones –ISSUE: CAPACITY OVER SOLD
• 45% have satellite phones also capable of data
transmission
• 80% have portable radios for intra and/or inter facility
communications, but local communications and not
standardized.
• 50% report radio connections with their respective office
of emergency management.
• 60% report a relationship with an Amateur Radio
Emergency Services (RACES).
Statement of the problem
• Sophisticated electronic Public Health preparedness and response systems are
evolving at the state and local level: designed to establish exchange of critical
data between response partners.
• The response systems are used in emergencies and their effectiveness is
dependent on efficient and timely accessibility by all health response partners
( state and local health, health facilities,etc.)
• Access to data or information exchange resources needed for clinical care for
both victims affected by the event and health consumers within the affected
health care region are also dependent on continuity and availability of
communications infrastructure during the event.
• All critical health functions are therefore dependent on the very
communications infrastructure( voice, data, video) that would be subject to
outage/disruption due to the emergency event itself.
• During an event the outage/disruption could be due to
– Physical damage related to the event
– Surge due to usage during the event
– Reallocation of communications resources to other sectors via national or regional
ICS decisions.
Needed
• The equivalent of an Office of National Coordinator NHIN initiative for
Nationwide Health Information communications Network
infrastructure. A national plan, standardization and funding process.
• Support for both urban and rural areas
• Diverse and redundant, multimodal , interoperable communications
modalities ( broadband, wireless, HF radio, Satellite ).
• Connect state,regional local public health, health care facilities, OEM,
tribal nations, clinicians and consumer needs as appropriate
• On demand priority access.
• Dual use: Routine and emergency
• Core interoperable low level application support for reliable,
continuous, secure voice, data, video communications
• High level application support for: e-mail ,web services, manual web
browsing, telemedicine.
• Interoperability with EMS and Public Safety
References and Background
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Gotham I, Sottolano D, Hennessy M, et al. An Integrated Information
System for All Hazards Health Preparedness and Response. NY State
Health Emergency Response Data System (HERDS). J Public Health
Management Practice, 2007, 13(5), 486–496
Gotham I, Eidson M, White D, et al. West Nile Virus: A Case Study in
How NY State Health Information Infrastructure Facilitates
Preparation and Response to Disease Outbreaks. Journal of Public
Health Management Practice. 2001, 7(5): 75-86.
Gotham I, Smith P, Birkhead G, Davisson M. Policy Issues in
Developing Information Systems for Public Health Surveillance of
Communicable Diseases. In: O’Carroll P, Yasnoff W, Ward E, Ripp L,
and Martin E, editors. Public Health Informatics and Information
Systems. New York: Springer-Verlag; 2003: 537-73.