National Hospital Available Beds for Emergencies and Disasters (HAvBED) System

I. Summary

Purpose: The primary purpose of this study was to develop, implement and evaluate a real-time electronic hospital bed tracking/monitoring system that will serve as a demonstration management tool to assist in a system/region's ability to care for a surge of patients in the event of a mass casualty incident. In addition, existing patient tracking systems were to be reviewed and recommendations made for the future development of a national patient tracking system. The overarching purpose of this project was to develop an exportable model of a hospital bed tracking system for the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Public Health Emergency Preparedness (OASPHEP) Secretary Command Center (SCC) and other Federal, Regional, State or Local Command Centers to access standardized information across the entire nation.

Background: Denver Health established Advisory and Working Groups of entities (private sector, hospitals, States and federal government) that have already developed and utilize bed availability and patient tracking systems to design, implement and test a standardized "real-time" national bed availability demonstration system. These pre-existing stand-alone systems were developed to monitor varying objectives including: hospital divert status, the status of hospital resources during a mass casualty incident, and the status of a voluntary network of non-Federal acute care hospitals that have agreed to accept patients in the event of a national emergency. Some of these systems are Web-based where as others require the reporting of data in response to a telephone request. Each of these systems collects various data elements, some are as simple as yes/no for bed availability and others record actual bed numbers. The definition of various data points such as "available hospital bed" also varies between these systems and even between hospitals.

Methodology: The Advisory Group met four times at the Office of the Assistant Secretary for Public Health Emergency Preparedness (OASPHEP) at the Department of Health and Human Services (HHS) in Washington, D.C., and once during the National Disaster Medical System (NDMS) Conference in Orlando, Florida. Under the direction of the team at Denver Health, the Development and Implementation Working Group conducted the following activities:

• Review and analysis of pre-existing hospital bed reporting systems including:
  • NDMS.
  • OASPHEP Secretary's Command Center (SCC) Hospital Asset Reporting System.
  • Hospital Emergency Response Data System (HERDS) (New York Department of Health, Greater NY Hospital Association).
  • EMSystem® (Milwaukee, Wisconsin).
  • State Hospital Capacity Web System (Seattle, Washington).
  • (Other systems were invited to participate but chose to decline).
• Development of a consensus agreement of standardized definitions for bed types and capacity.
• Development, implementation and testing of a data interface that receives and reports hospital bed availability data from:
  • Hospitals that participate in existing reporting systems.
  • Individual hospitals that do not currently participate in such systems.
• Implementation of geo-coding and spatial display of hospital bed availability data from the developed data interface Web site.
• Evaluation of existing systems for transporting, tracking, and reporting patient status and location including TRAC²ES and the St. Louis Metropolitan Medical Response System (MMRS)—Raytheon system.

Results: The demonstration hospital bed availability reporting system illustrated in Figure 1 was implemented and operated in a demonstration/production mode from June 26 through July 31, 2005. The results of this operational period were presented to the Advisory Group on July 12, 2005, in Washington, D.C.

Recommendations:

The HAvBED Project Group, after testing, evaluation and review of the demonstration system, recommends the following:

Conceptual Recommendations:

• The HAvBED demonstration system should be implemented on a national level and expanded to interface with all other existing bed capacity systems currently in operation.
• The HAvBED system should not replace any existing systems, but rather it should acquire and amalgamate data already being gathered by these pre-existing systems.
• Hospitals not participating in a multi-institutional bed capacity system should provide necessary data via the HAvBED manual data entry Web interface.
• The reporting structure and framework of the HAvBED system was developed by a national representation consensus. If modification is deemed necessary, it should occur only after very careful deliberation.
• The concepts and operation of the expanded HAvBED system should remain simple and user friendly. Major expansion of the scope of the system will put the potential for success at risk.
• Incentives for hospital participation in the HAvBED system should be developed and implemented. This could include such management tools as capacity trend reports for hospitals as well as regions.
• HHS should work with State and local departments of health, emergency medical services (EMS) agencies and emergency managers to inform and educate them of the utility of this system. These groups, in turn, will be instrumental in encouraging participation at the local level. This could be done via a series of conferences or meetings. Additional partners in this effort may include the Department of Homeland Security, the American Hospital Association, State hospital associations, emergency management professional organizations and selected medical specialty professional organizations. This approach will offer and provide collaborative efforts at multiple levels as well as the greatest opportunity for acceptance and widespread implementation of such a system.
• HHS, in concert with potential State, local and national users, should develop a mechanism for testing the utility of the HAvBED system at these different levels of operation.
• Concerns raised regarding the legality of ongoing collection of bed capacity data by the federal government should be investigated and addressed.
• As currently designed, the HAvBED system provides limited utility for use by field personnel in their day-to-day operations as the HAvBED data structure may not include some bed types felt to be of local importance for these operations.
• The implementation of the expanded HAvBED system should be done by an impartial organization or contractee working with HHS (such as achieved by the Booz Allen Hamilton collaboration with the Department of Defense in the creation of TRAC2ES).
• A national patient tracking system may be of help during a time of national emergency but supplying data to such a system may prove too burdensome to make it efficacious. A patient locating system may be easier to successfully implement.

Technical Recommendations:

• The HAvBED hospital data base (based upon the American Hospital Association (AHA) hospital data) should be edited and updated to:
  1. Remove non-acute care institutions.
  2. Correct errors in institutional location (longitude/latitude) and AHA bed numbers.
  3. Add institutions that are not AHA members (such as some military installations).
  4. Indicate those institutions that are NDMS and/or TRICARE participants.
• The Web interface for data entry and retrieval should be refined to be more intuitive and to be ADA and eGov compliant. Additional specific search and data retrieval modalities should be implemented, such as:
  1. NDMS/TRICARE institutions only.
  2. Time specific criteria, i.e., all data that are less than "X" hours old.
  3. Geographic specific criteria, i.e., all hospitals within a specified number of miles of a specific location.
  4. Data point specific criteria, i.e., all available ventilators or all institutions with available mass decontamination units.
• The symbology of the geographic information systems (GIS) maps should be improved and extended, including providing detailed institutional data on mouse-over of the institution's icon.
• The system should be reconfigured in a more robust manner to provide improved responsiveness.
• An extensive acceptance test procedure should be implemented to verify system operation and data reliability.

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