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Health Emergency Assistance Line and Triage Hub (HEALTH) Model

Chapter 2. Planning

The DHMIC seeks to develop the Rocky Mountain Regional Health Emergency Assistance Line and Triage Hub (HEALTH) model, a 21st-century contact center providing medical information and triage advice, through expanded communications pathways including voice, E-mail, fax, video, and Internet Web site. In planning the development of this model, our goals, strategies, and objectives were established. Roles and responsibilities were determined and a work plan was developed. Finally, methods for systems development were chosen. An overview of these tasks is included in this section of the report.

Goals, Strategies, and Objectives

Goal

To determine the requirements, specifications, and resources needed for developing Rocky Mountain Regional HEALTH. Rocky Mountain Regional HEALTH is a public health emergency contact center that is highly integrated with public health agencies. It is designed to minimize surges in patient demand on the health care delivery system during a bioterrorist event or other public health emergency.

Strategies

Incorporate the lessons learned for bioterrorism preparedness from other regional models of care and DHMIC experiences in developing a model for emergency response.
Determine what linkages with local public health and emergency preparedness infrastructure are required for the model.
Create a model for surge capacity, including facilities, equipment, and personnel.

Objectives

Eleven objectives were identified in conjunction with the three strategies listed above:

Determine best practices for, challenges to, and shortfalls of public health agency communications during past public health emergencies.
Determine the types of information and the communication pathways used or requested by the public and healthcare providers; determine how recipients perceived the information provided; determine how delivery could be improved; and determine which communication pathways were most effective or convenient for recipients.
Determine which special populations were encountered in past events, and whether their needs were adequately addressed (i.e., elderly, children, and the disabled).
Determine the specifications and requirements of data storage and retrieval systems for information provided by and to public health agencies.
Determine the needs for infrastructure integration between HEALTH and existing State and local public health agencies.
Develop criteria for electronic data collection as required by data users (health departments) and for program evaluation that is integrated with current data collection systems and can relay information to public health agencies in real time.
Determine call metrics and reporting requirements for the public health agencies and the HEALTH model.
Determine the facility specifications for the HEALTH model.
Determine the technical and equipment requirements for communication modalities for HEALTH, incorporating lessons learned from other public health emergencies.
Determine the most effective, efficient, and feasible technical solutions; design a technology implementation strategy accordingly.
Develop methods for the rapid ramping-up of health care personnel for surge staffing.

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Resources

Committees and Project Team

Core Project Team

The Core Project Team included DHMIC personnel charged with developing the HEALTH model. The team included a Project Manager, staff with disaster planning and emergency response experience, and staff with information systems and call center experience.

Name	Title
Gregory M Bogdan, Ph.D.	Principal Investigator, Research Director and Medical Toxicology Coordinator
Deb Scherger, R.N., M.S.	Information Systems and Telecommunications Manager
Deborah Keller	Project Manager
Kathleen M. Wruk, R.N.,M.H.S.	Administrative Director
David W. Daley	Information Systems Manager
Jim Peterson, R.N., B.S.N.	Program Manager, Rocky Mountain Poison Center
Diane Swanson	Business Manager, Denver Health NurseLine
Kurt Ammon	Business Manager, Rocky Mountain Drug Consultation Center
Shireen Brady	Researcher and Technical Writer

Export Committee

An export committee was created to guide the process toward development of a model that could easily be exported for use by other agencies in other parts of the Nation. Members of the export committee were drawn from public health agencies in Colorado, Hawaii, Utah, Nevada, Montana, Idaho, Wyoming, North Dakota, and South Dakota. The American Association of Poison Control Centers designates the Rocky Mountain Poison & Drug Center as the Regional Poison Control Center for Colorado, Hawaii, Montana, Idaho, and Clark County, Nevada. Utah, Wyoming, North Dakota, and South Dakota are within Federal Region VIII and were included to allow for feedback on use of the model in their service areas. A full list of the members and their contact information is included in Appendix A.

Steering Committee

A steering committee was created to periodically monitor the progress of the project, to consider the challenges facing public health and health care agencies, and to determine their requirements for using the HEALTH model to improve surge capacity to accommodate the public and healthcare providers. A full list of members and their contact information is provided in Appendix A. The committee includes representatives of the following agencies:

Colorado Department of Public Health and Environment
Colorado Health and Hospital Association
Colorado Rural Health Center
Denver Public Health Department
Tri-County Health Department
Jefferson County Department of Health and Environment
Denver Office of Emergency Management
Hawaii State Department of Health

Capabilities of the DHMIC and Denver Health

The DHMIC includes components of the Denver Health and Hospital Authority (Denver Health). The DHMIC comprises three specialized call centers—the Denver Health NurseLine, the Rocky Mountain Poison Center, and the Rocky Mountain Drug Consultation Center—and two support departments, Consulting & Research, and Medical Toxicology.

Poison Center

The Rocky Mountain Poison Center (RMPC) has been in operation since 1956. The center provides poison information and emergency treatment recommendations. The American Association of Poison Control Centers (AAPCC) certifies the RMPC as a regional poison center. Its service area encompasses Colorado, Montana, Idaho, Hawaii, and Clark County, Nevada. Physician telephone consultations can extend nationwide.

Drug Center

The Rocky Mountain Drug Consultation Center (RMDCC) is a drug information and safety center that provides medical information, adverse event reporting, and product complaint services. Pharmacists and nurses specializing in drug information staff the RMDCC. RMDCC currently provides its services to a number of pharmaceutical companies.

NurseLine

The Denver Health NurseLine provides telephone triage, medical advice, workplace injury reporting, after-hours healthcare services, call back service, provider notification, and eligibility verification to State agencies, hospitals, clinics, and worker's compensation programs. It was established in 1997 to provide 24-hour information to the public and contract clients regarding medical triage of health concerns, and recommendations for further medical evaluation as appropriate.

Consulting & Research and Medical Toxicology

Our Consulting & Research and Medical Toxicology Departments provide a wide range of consulting and research services to drug companies, biotechnology companies, legal firms, local/State/Federal governmental agencies, chemical manufacturers, pharmaceutical companies, and other organizations. In addition to conducting research for individual clients, we also conduct research for the benefit of the medical community. Consulting & Research currently manages over 30 research projects, including three clinical trials. There is a 10-person staff, headed by a Ph.D. in pharmacology and toxicology. In addition, our Director (M.D., Ph.D.) and Medical Director (M.D.), and physicians in our Accreditation Council for Graduate Medical Education (ACGME), an accredited Medical Toxicology Fellowship program, participate in research activities as well as provide physician support to our call centers.

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Organizational Feasibility

Denver Health is committed to developing readiness for public health emergency events. Denver Health has committed human resources to determining the requirements for producing a model that efficiently manages call surges and is exportable for use by other States and agencies. The States of Colorado and Hawaii have already designated a portion of their Centers for Disease Control and Prevention bio-terrorism supplemental monies to fund technological improvements needed for developing of the HEALTH model. Our technology partners, Avaya and Expanets, want to continue their partnerships with us through in-kind equipment and programming assistance.

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