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A Model for Leveraging EHRs in Large Scale Disasters

A Model for Leveraging EHRs in Large Scale Disasters. Acknowledgements. Some of the material in this presentation is taken from “HIE in the Context of Emergency Preparedness and Response” developed by Samuel Schaffzin, MPA, LCDR, U.S. Public Health Service

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A Model for Leveraging EHRs in Large Scale Disasters

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  1. A Model for Leveraging EHRs in Large Scale Disasters LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  2. Acknowledgements • Some of the material in this presentation is taken from “HIE in the Context of Emergency Preparedness and Response” developed by Samuel Schaffzin, MPA, LCDR, U.S. Public Health Service • Member of SERCH (Southeast Regional HIT-HIE Collaboration) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  3. Goal • To demonstrate the opportunities to enhance the value of EHRs and HIEs for a larger audience while improving response outcomes during and after a disasters • Basics of Emergency Preparedness (EP) • Public Health and Medical Responsibilities • Louisiana’s EP IT Infrastructure • Opportunities • Next Steps LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  4. Basics of Emergency Preparedness Another World LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  5. Disaster Recovery • “Disaster Recovery” means something entirely different in Emergency Preparedness than it does in the EHR/HIE world. • 3 Basic Phases: • Planning and Preparedness • Response • Recovery LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  6. All Disasters Are Local

  7. Preparedness Source: Citizen Corps http://www.citizencorps.gov/ready/2009findings.shtm • Key Findings of “Personal Preparedness in America”: • 29% of Americans have not prepared at all • Others…over confident? • of those who perceived themselves to be prepared: • 35% - no plans • 77% - no drills • 73% - did not know evacuation routes • How will this factor into accessing and navigating the healthcare system? LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  8. National Response Framework Single, All-discipline, all-hazards framework for Federal response in domestic incident management Successor to the NRP and FRP Links all levels of Government, private sector and non-governmental organizations in a unified emergency response. Supports State, Tribal, territorial and local incident managers

  9. Emergency Support Functions • A grouping of government and certain private sector capabilities into an organizational structure to provide support, resources, and services • Primary operational level mechanism to provide assistance to State, Tribal, and local governments of Federal Departments and agencies . • Each ESF has a primary (or lead) agency identified • Authorities, resources, capabilities • ESF’s are expected to support each other in carrying out their respective roles and responsibilities • Not all ESF’s are activated during an incident or event

  10. Louisiana ESF Structure Emergency Support Function (ESF) Primary State Agency ESF 1 - Transportation DOTD ESF 2 – Telecommunications GOHSEP ESF 3 - Public Works and Engineering DOTD ESF 4 - Firefighting Agriculture & Forestry ESF 5 - Emergency Management GOHSEP ESF 6 - Mass Care, Housing & Human Services Department of Children/Family Services ESF 7 - Resource Management GOHSEP ESF 8 - Public Health & Medical Services DHH ESF 9 - Search and Rescue Wildlife & Fisheries ESF 10 - Oil Spill, HazMat & Radiological DEQ/ Oil Spill Office/ LSP ESF 11- Agriculture Agriculture & Forestry ESF 12 – Energy Natural Resources/ Public Service Comm. ESF 13 - Public Safety & Security DOJ/ LSP ESF 14 - Community Recovery, Mitigation Economic Development ESF 15 – PIO ESF 16 – Military/ LNG

  11. Public Health and Medical Emergency Preparedness and Response (ESF-8) is: • ESF-8 is a network of care during state declared disasters. • Components • Incident Command • GOHSEP Coordination • Logistics and Response • Regional Structures

  12. Regionalized Approach Designated Regional Coordinators • For planning purposes, the state is divided up into 9 regions. • ALL units (hospitals, EMS services, nursing homes, etc.) are actors. • Designated Regional Coordinators (DRC) • Hospitals • EMS • Nursing Homes • Mass Fatality • Home Health • Governmental Structure • DHH/Office of Public Health Regional leadership

  13. GOHSEP EOC Layout LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  14. ESF 8 GOHSEP Presence • Executive Leadership • Bruce Greenstein, Secretary (UCG) • Dr. Jimmy Guidry, ESF 8 Incident Commander (UCG) • Rosanne Prats, ESF 8 Deputy Incident Commander • GOHSEP ESF 8 Team (2 shifts, 24-hour ops) • Small team of task managers, phone operators, and support staff • Hospital Association, Nursing Home Association, and LSU • Data Cell • 8 to 10 staff monitoring facility statuses and preparing briefings LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  15. ESF 8 Responsibilities Bruce D. Greenstein Secretary

  16. Managing Resource Requests Know Your RESOURCES. Don’t Pass the Buck. • SWH (Stuff We Have) • Pre-identified • Pre-allocated • Pre-planned • SWDH (Stuff We Don’t Have) • Takes Time • May Never Get it

  17. ESF 8 Responsibilities: Sheltering LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  18. CRITICAL TRANSPORTATION NEEDS SHELTERSSTATE and PARISH RUN Minden (Storage) Cp Minden Bastrop Madison (1,500) Orleans Parish Shreveport Jewella (2,000) Jefferson Parish Monroe Accent (2,000) Orleans Parish Shreveport Westpark (2,000) Jefferson Parish Alexandria LSU-A (2,000) Orleans Parish Shreveport Hirsch (1,600) Calcasieu Parish Shreveport Riverview (500) Cameron Parish Total:11,600 Confidential Data Enclosed: Not for wide-spread/public distribution

  19. MEDICAL SPECIAL NEEDS SHELTERS (MSNS) and Federal Medical Stations (FMS) Bossier City 90 Bossier Civic Center Monroe –ULM 150 Ewing Coliseum Grambling (FMS) 200 Intramural Sports Center Baton Rouge – LSU (FMS) 500 Field House Alexandria (FMS) 300 Riverfront Baton Rouge – LSU 300 Maravich Center LSU Alexandria 220 State Shelter Hammond – SLU 220 Kinesiology Bldg. Lake Charles – McNeese 150 Recreation Complex Thibodeaux – Nicholls 200 Ayo Hall Lafayette 160 Heymann Center Confidential Data Enclosed: Not for wide-spread/public distribution Total:2,490

  20. SEX OFFENDER SHELTER HOMER Wade Correctional Center Confidential Data Enclosed: Not for wide-spread/public distribution Total:120

  21. Major Wrap- Around Items for MSNS: Generator Hygiene Kits Cots Blankets Food/water O2 - 50 E cylinders per shelter Bariatric beds

  22. ESF 8 Responsibilities: EMS LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  23. Basic Requirement • Acquire sufficient transportation resources to support: • Patient evacuations • Sheltering support • 911 and local augmentation • Track inventories and forecast need • Life support for EMS personnel LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  24. Processing Sites Chennault International Airport 3650 J. Bennett Johnston Ave. Lake Charles, Louisiana, 70615 National EMS Academy 2916 North University Avenue Lafayette, LA 70507 LAMAR DIXON CENTER 9039 S Saint Landry AveGonzales, LA 70737-8044 SHERWOOD FOREST Baton Rouge, LA

  25. Regional Forward Staging Locations Covington Fair Grounds 600 N. Us-190, Covington, LA. PMAC North Stadium RoadBaton Rouge, LA 70803 Chennault Airport 4500 Cennault Parkway Lake Charles La. 70615 First Baptist Church 100 Lee Avenue Lafayette La. 70501 Lakefront Airport 6001 Stars &Stars and Stripes Blvd, New Orleans, LA 70126 Assumption Parish High School 4880 Hwy 308 Napoleonville La. 70390 Zephyr Field 6000 Airline Dr. Metairie, LA 70003

  26. ESF 8 Responsibilities: Facility Evacuation and Support LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  27. Scope: Catastrophic Planning • Problems: • How do you RELOCATE entire hospitals? • How would you evacuate MULTIPLE hospitals concurrently? • How many ambulances and aircraft are needed to relocate and successfully transfer patients to other hospitals in the nation? • Answers: • Medical Institution Evacuation Plan (MIEP) • Patients tracked through the At Risk Registry

  28. MIEP Planning Assumptions MIEP Planning Assumptions Number of Parishes: 12 Number of Hospitals: 60+ Regions 4,5: 624 patients Regions 3,4: 343 patients Regions 1,3,9: 1063 patients Anticipated Planning Range: low - high 343 - 1,063 (reasonable “worst case” planning scenarios)

  29. Hangar 3 ASF (50 bed/42 medical staff) Hangar 4 ASF (50 bed/42 medical staff) Aero-Medical Marshaling Point (AMP) Planning Assumptions: 50 patients per C-130 Air Medical Staging Facility Teams: ROLE: “man” hangars and prepare patients for air transport RESPONSIBILITY: DOD/NDMS Airhead: Belle Chase* Hangar 1 – ASF (50 bed/42 medical staff) Federal Coordinating Center (FCC)/ Airport NDMS Facility Hangar 2 - ASF (50 bed/42 medical staff) NDMS Facility Airhead: Lakefront * * Proposed sites; additional sites for airheads include Houma Airport ?(Region 3) Iberia Regional Airport(Region 4), Chenault Industrial Airport (Region 5)

  30. Abbreviated Timeline H-hour: • 120: Lean Forward! Email alerts, notifications distributed, communications check • 72 : Flag goes up! All levels of government (local, state, federal) must watch this storm and be ready to mobilize an AMP.Form 1 is used to identify potential volume of patients so that number of aircraft can be estimated and organized for potential activation. • 72- 54 Continuous updates to Form 1. Refinement of data as threat becomes more imminent. Based on the direction and threat of the storm, AMP(s) are activated. • 54: “No-kidding” numbers are ascertained. • 48: Wheels-up! The first load of patients should be enroute to FCC • 18: Clearing the Battlefield. A meter-check is determined to see how many patients still require evacuation. This is the last chance to make any corrective actions. SMART listing identified. • 12: AMPs CLOSED

  31. NDMS Repatriation • Based on Gustav/ Ike 2008

  32. Nursing Home Evacuations • Point-to-Point evacuation • No air movement • Private ground transport • Support from DOTD and BEMS • No intermediate stops (no AMP concept) • No repatriation managed by ESF 8 • Patient movement tracked in EMSTAT LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  33. ESF 8 Responsibilities: Mass Fatality Response Bruce D. Greenstein Secretary

  34. Basic Worse Case Plan For Official Use Only - Do Not Distribute

  35. State-wide Storage Capacity For Official Use Only - Do Not Distribute

  36. Basic Worse Case Plan • Requirement for a Family Assistance Center (FAC) or similar operation • Interface between families, fatality management system/temporary interment sites, and funeral providers (when system reaches a recovery point) • Central data repository from all points • Expertise in release procedures • With proper technology, the FAC can be “virtual” • Potential tie-in with other State Call Center operations For Official Use Only - Do Not Distribute

  37. Louisiana EP IT Infrastructure 2011 Concept of Operations

  38. ESF 8 Growing Pains After hurricanes Gustav and Ike in 2008, ESF 8 determined that it’s current systems infrastructure was not able to meet the emerging needs of ESF 8 An information systems strategy was executed that involved a core suite of applications Had to be in place for the 2009 hurricane season

  39. 2009 Architecture

  40. 2009 to 2010: The Basics SILOS SILOS

  41. A New Strategy for 2011 and Beyond Acquire a module that could serve as a secure web portal for end users, with “single sign-on” access to all the applications they need Acquire a module that offered robust incident management and notification capabilities Acquire a comprehensive resource management module that could expand as needed. Develop more advanced analytics, connected to the databases in real-time

  42. The Guiding Principles • These modules had to meet the following criteria: • Had to connect to the EMSTAT database for facility data and person/contact data • Had to provide as much “1-stop shopping” as possible for the end users • Had to have potential for real-time analytics, dynamically driven by changes in the source databases – without technical intervention • Had to be affordable and able to be implemented quickly

  43. Our Roadmap: Acquire The Capability • Security Module • This would serve as the single sign-on portal with self-service features for user account information • Resource Management Module • This would serve as the core resource reporting tool, designed to meet ESF 8’s and LERN’s strategic needs • Incident Management and Messaging Module • This would allow rapid communication to facilities and other stakeholders, using a variety of methods. • It would form the basis for the “early warning” role of the LERN Call Center • Basic GIS platform • Connected initially to EMSTAT to display real-time status of critical healthcare facilities

  44. Two Major Stages Planned • Stage 1 • Acquire the basic functionality to cover the spectrum of needs • Target Date: November 1, 2011 • Stage 2 • Complete standardization and security integration • Target Date: June 1, 2012

  45. 2011 Progress To Date: Stage 1 Stage 1

  46. Stage 1 Timelines

  47. Completing the Plan: Stage 2 Stage 2

  48. Stage 2 Timelines

  49. Opportunities for EHRs and HIE Near and Long Term Bruce D. Greenstein Secretary

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