Appendix B. HAvBED Advisory Group Meetings
Meeting Minutes
Thursday, July 15,
2004
Secretary's
Conference Room
Office of the
Assistant Secretary for Public Health Emergency Preparedness
Hubert Humphrey
Bldg., 200 Independence Ave., Washington, D.C. 20201
Attendees
Lt. Col. James Baxter
Rhonda Earls, M.S.N., C.N.M.
Matthew Payne, M.P.A.
Robert Blitzer
Capt. Ann Knebel, R.N., D.N.Sc.
Sally Phillips, R.N., Ph.D.
LCDR Sumner Bossler
Lt. Col. William Kormos
Peter T. Pons, M.D.
Shayne Brannman, M.S., M.A.
Sheri Eisert, Ph.D.
Dean Ross
Stephen Cantrill, M.D.
Capt. F. Christy Music, M.Sc., U.S.N.
Kevin Yeskey, M.D.
Robert Claypool, M.D.
Michael Nugent
Office of the Assistant Secretary for Public Health Emergency Preparedness (OASPHEP) Considerations
Mr. Blitzer
Attributes Mr. Blitzer would like this effort to include
are:
- Utilize existing systems.
Capitalize on existing systems that are currently
in use and working. Should not be intrusive.
- Inter-operability.
Should be interoperable with existing systems such
as HARTS and the National Disaster Medical System (NDMS).
- Adaptable.
Data should be made available by Region and have
the ability to reconfigure information to meet the event at hand.
- Real Time. Timely, accurate data should be available within
2-4 hours of an event.
- Bed Definition. Not just bed count; need number of available
staffed beds, specialty beds (i.e., burn, neonatal, coronary care unit [CCU], intensive care unit [ICU), ventilators while
not being intrusive. Want all beds to be accounted for, including public,
private, Veterans Health Administration (VA) and Department of Defense (DOD) beds. Divide into pre-hospital assets, hospital assets and
alternative care sites. Build on HARTs.
- Utility to the Department of Health & Human Services (HHS). This system needs to help HHS make sound and timely
decisions on how the Federal government can best help local and State resources
respond to an emergency, based on verifiable sound data. This data will drive
policy decisions like redirecting resources (staff, equipment, supplies) to a
region in need from other regions, pre-positioned resources, NDMS, etc. Data
from this system could drive aero-medical evacuations from one region to
another.
Mr. Ross
System needs to be dynamic, bi-directional, scalable,
relational and spatial. Attributes to address include:
- Legislation. Mr. Ross mentioned that the
federal government is currently prohibited from collecting "routine data" from
local agencies. This prohibition is outlined in existing OMB legislation. The
question was posed as to how NDMS is allowed to receive data from locals. Two
conditions allow NDMS to collect such data:
- The NDMS has a signed memorandum of understanding with each participating hospital giving permission for such collection.
- The NDMS collection of data is not considered "routine" (We were not provided a definition of what OMB defines as routine).
Dean also mentioned
that he has had several conversations with hospital executives in which he
discussed their willingness to provide bed availability data. He Stated that
they seemed to be resistant because of competitive concerns.
- Scalability. All meeting participants agreed
that the HAvBED system must be scalable. Hospitals should be able to determine
bed availability in close proximity to their institution and move out from
there as capacities are exceeded.
- "Disaster EGOV" Compliance.
HHS and Department of Homeland Security (DHS) initiative;
compliance will be developing uniform data standards.
- Geospatial Elements.
Mr. Ross commented that geographic information systems (GIS) and
geospatial analysis capabilities should be an essential component of the HAvBED
system.
- Erroneous Inputs. During the design phase of HARTS,
Mr. Ross visited several of the existing bed tracking systems including the Hospital Emergency Response Data System (HERDS)
and the Washington system. During these visits, he encountered instances in
which erroneous data had been entered into a system. Need to identify by
analyzing variation in trends and putting reasonable limits using capacity
numbers. This could be an objective of the HAvBED exercise, to validate via
site visit or internal confirmation that data entered has been accurately
entered. Dr. Phillips also suggested validating the numbers through the testing
component of this task order.
- Scope of Hospitals.
- Data Dictionaries.
- Diversity of Data Locations. Mr. Ross described the HHS' "Hug
the Box" policy. In order for HHS to integrate a technology system into their
operations they must own and operate the server. Existing systems used by HHS
contain redundant and secure data centers located in 5 different sites around
the country. In the next two weeks, Office of Management and Budget (OMB) legislation will be approved requiring
federal systems to demonstrate this type of "diversity."
- Cannot be totally Web dependent. Both Dr. Cantrill and Mr. Ross cautioned the group
about our increased dependence on Web-based and IP systems and tools. This
infrastructure could be damaged during a natural or manmade disaster; Mr. Ross
suggested the HAvBED system should consider telephonic inputs. Data entry
considerations include the use of telephone data entry using automated prompts
and the use of stand alone alert equipment in EDs that prompts hospitals to
enter data. Ideally will have single device system-no email or phone calls.
- Data-Field Flexibility. Must include flexibility to add or
delete fields.
- Permissions. Who should have access to what?
Definitions: Beds
Available Beds: Licensed, Staffed and Equipped
Using number of licensed beds in defining capacity is
dangerous; hospitals may have entire wings shut down and still have those beds
on record. DAS Blitzer prefers to have beds distinguished by staffed beds and
other non-staffed beds.
Dr. Yeskey is concerned that bed definition/categories do
not reflect the services needed (i.e., food, isolation etc). The definition needs
to reflect more than just staffed and licensed. It is important to understand
service capability or what type of care can be provided and how the beds will
be used. The HAvBED system may not be able to define standardized definitions
for bed classifications. Ideally, the tool would enable a facility to respond
to services needed. Defining beds based on level of care needed by the patient
will help limit the variance in reporting definitions amongst clinicians and
facilities. A ventilated bed category might be more explicit than a critical
care category such as NDMS uses, again terminology should reflect patient need.
Capt. Music wants to follow patients through the continuum of
care and therefore prefers categories that include rehabilitation, nursing
home, etc. She also feels the categories should include civilian and Federal
(DOD, VA, military).
The HAvBED system should include what an institution's
adjusted bed capacity could be if augmentation was provided. E.g. Staff,
equipment and external support.
Current NDMS Categories
Mr. Ross mentioned the need to look at psych beds since
there is a need based on expected hysteria of population. Dr. Yeskey does not
believe that lumping medical and surgical beds is a good idea and they should
be separated. There is a need to add isolation beds.
Dr. Yeskey also thought it was important to include a
hospital evacuation category so that we know when a bed is about to be
available. Civilian clinicians need to think about the concept of evacuation
upon entry to the medical facility. In a military context, the term evacuation
is used to describe patient movement out of a medical facility to another
environment such as specialty services or rehabilitation. Dr. Yeskey believes
that civilian clinicians currently consider this concept upon discharging
patients; however given a rapid influx of acutely ill or injured patients some
decisions will have to be made early as to whether the hospital can provide the
continuum of care required by the patient. Dr. Cantrill questioned whether
civilian health care providers could make such decisions.
Comments were presented regarding medical disaster
management, specifically as to whether it is more effective to evacuate
patients in a disaster area or to deploy medical resources to the affected
area. In the cases of specialty care, it may be more beneficial to move these
patients to a site with this capability. However, in a large-scale medical
disaster, patient movement out of the affected area is too resource intensive.
There was consensus amongst the participants that the NDMS patient evacuation
resources would be quickly diminished in a medical disaster scenario.
There seemed to be a consensus among the Advisory Board that
the project should not limit its data elements to those currently used by NDMS
and that these are not meeting the HHS regions' needs. This is another reason
why it is important to look at the others systems that have been developed,
since other people have been looking at these same issues for a while.
HAvBED Data Elements
LCDR Bossler stressed the need for simplicity and proposed
focus on a few categories of beds. This project should review the other
systems to see what they collect and interface with what they currently collect
to the best of our ability. Most of the project effort should be spent on
creating data and reporting uniformity among the already existing system. Then
we could develop categories/definitions and data elements that would be most
appropriate and provide them in the form of recommendations in the final
report. Adding additional data elements could decrease the utility of the
HAvBED concept.
Dr. Yeskey thought we should develop the ideal list of
categories and augment the systems to the best of our ability to capture this
data, particularly since this is a national system. This project should
identify an all-encompassing, best-practice data set that would be used in the
ideal bed tracking system. It would be disappointing if the threat of
"pushback" from private industry vendors or current system participants limited
identification of these data elements. These ideal elements should be based on
federal, State and local needs.
Total Number of Data Elements
Originally, the NDMS tracked 16 different bed categories;
this number was decreased to 6 and increased reporting compliance. HARTS
collects 10 different bed categories including the number of isolation rooms
available. TRAC2ES collects bed information based on snapshot.
Other
Some discussion on defining capacity as what you can do with
your current resources with minimal augmentation.
Definitions: Time
"Real-Time": Data Input Frequency
"Real time" data entry and display was not really defined in
this meeting. Most in the meeting agreed that a snapshot of data such as that
collected by NDMS is insufficient and limited. Bed and resource availability
is too dynamic.
Comments were made about the frequency of data input in an
ideal system. HARTS data can be updated every four hours. The question was
posed regarding whether day to day data input is necessary; instead, could an
effective bed tracking system only include data entry during a large-scale
emergency? The group favored the ability to obtain data at a variable rate
based on the type and scale of an event. The system would have to be extremely
simple and intuitive for a user.
HHS has developed system that uses satellite band for
medical warnings like the weather service.
Maximum: Available in 72 Hours
The NDMS system provides a data collection field called
"maximum beds." This is defined as the number of potentially available beds
within a 72 hours time period. Most users agree that this number is a "best
guess," but Dr. Claypool believes that the current threat climate necessitates
some similar attribute in the HAvBED system. The existing snapshots of bed
availability provided by many of the systems are helpful, however prolonged
incidents spanning weeks or months will require projections of bed
availability.
Patient Tracking
Capt. Music emphasized the need for patient tracking. Capt
Knebel cautioned with the need to either focus on the tracking of assets or the
tracking of patients. Lt Col Baxter explained that TRAC2ES tracks
the patient while in transit. Once they are discharged, other systems capture
the data. As part of this task order, Dr. Phillips explained that patient
tracking can be part of the asset bed tracking component such as developing the
fields, while not necessarily collecting actual data. FEMA is expected to have
10 emergency coordinators among the 10 regions to assist with patient movement.
The only existing system that seems to track from time of
injury to hospital destination is the St. Louis system with involves a
cooperative relationship between Raytheon and EMsystems. Patients are bar
coded for patient tracking and destination is provided using EMsystems.
The Advisory Board approved of the concept of when moving
patients, priority should be to move them to local area hospitals, even if this
requires minimal hospital augmentation. It would be preferable to move the
assets to where the patients are located rather than move the patient to the
part of the country where there are assets. This is particularly applicable to
a communicable event.
HARTS System Overview
Mr. Ross presented an overview of the HARTS system and
gave a handout that Dr. Eisert collected. He described HARTS as a
comprehensive system that tracks numerous different attributes including blood,
equipment, etc. Can add fields, GIS component, has event log that can be used
by participating hospitals. Once hospitals are "opened up" (those medical
centers that are affected by an event) they are given an opportunity to enter
data. If hospital is a hub for both blood distribution and medical care, the
facility can have access to both HARTS components. HARTS has a chat function
and derives its facility data from the American Hospital Association. During
events, HARTS can specify the frequency in which users must enter data and then
track hospital compliance via colorimetric scales such as red, yellow, and
green. Looking at TRAC2ES system to incorporate patient movement.
HARTS activates hospitals and other medical facilities by placing a phone call
and deploying emergency response teams to the affected area. HARTS can be
updated every four hours. HARTS has admin section, hospital section and blood
section.
National Health Alert and Warning System
Mr. Ross provided a brief description of the
National Health Alert and Warning System. This non-terrestrial system is
currently in testing and production; in summary, it includes an inexpensive
alert device that can be placed in a public health center or hospital and has
the capability to transmit voice, text, and data when activated by HHS. Staff
will receive an audible tone to alert them of an incoming message.
Choice of Tracking Systems To Review
- Illinois—HHAN system.
- St. Louis—hybrid system with Raytheon patient tracking function and EMSystems patient destination.
- FREDs Pennsylvania State?
- California—Capt Music refers to Jeff Rubin (Reddinet?).
- North Carolina?
Additional Participants
- DHS/NDMS—Contact Bob Jevec.
- American Red Cross—should have representative although Capt. Knebel Stated that Dr. Claypool could represent this group.
- American Hospital Association representative.
Next Meeting Date
The group agreed on the week of October 11. HAvBED project
team is looking at October 14 or 15 for the next meeting and will solicit
votes.
HAvBED Advisory Group Meeting Minutes
Thursday, October 14, 2004
Deputy Secretary's
Conference Room
Office of the Assistant Secretary for Public Health Emergency Preparedness
Hubert Humphrey Building, 200 Independence Ave.
Washington,
D.C. 20201
Attendees
Lt. Col. James Baxter
Ivan Gotham
Sally Phillips, R.N., Ph.D.
LCDR Sumner Bossler
Nathaniel Hupert, M.D., M.P.H.
Peter Pons, M.D.
Shayne Brannman, M.S., M.A.
Jeffrey Lowell, M.D.
Dean Ross
Stephen Cantrill, M.D.
Duane Mariotti
Daniel Salazar
Robert Claypool, M.D.
Capt. F. Christy Music, M.Sc., U.S.N.
Maj. Wayne Surratt
Rhonda Earls, MSN, CNM
Dawn Myscofski, Ph.D.
Carrie Vinci, Sc.M.
Sheri Eisert, Ph.D.
Andrew Nunemaker
Elaine Wolff, M.H.S.
Michael Feeser
Hospital Beds Definition
Staffed and Unstaffed Beds
The project team proposed that unstaffed bed count is a
useful data element reflecting an open bed that a patient could be regulated to
if staff were supplied as an asset. The advisory group felt that contractual
pools of staff may allow quick staffing of unstaffed beds. The question becomes
whether these beds are "staffed" or not and what is the time frame? Other
members noted that many new staff may not be familiar with the hospital
equipment and procedures and need orientation.
Vacant Beds
The term "vacant" beds may not be as intuitive to users as
"available" beds used by NDMS. Most hospitals are familiar with the term "available,"
but may not understand "vacant."
Data Elements: Current Capacity
We must collect information that is actionable, not just
collect for collecting sake. This project needs to separate things that are
"nice" to know versus things that are "need" to know. This project should
also beware of mission creep and this first look through should be concise as
to what we "need" to know.
This system should contain the bare essentials but other
data besides bed count is crucial. Dr. Claypool is very interested in other
data elements and suggests tailoring data collection to nature of events.
Beginning with bed availability for simplicity sake to demonstrate the proof of
concept may lead to a more refined dataset once the feasibility has been
proven. This project should also be aware of looking at things at an academic
level but not necessarily paying attention to what assets could actually be
moved based on this information. This project needs to address the daily trip
wires and attributes.
Bed Types
If the hospitals are given no definitions they can make
different beds into different types and the counting is inconsistent.
Suggestions include making sure burn beds are ABA certified. ED diversion
status is a more useful data element than number of ED beds since these beds
can be turned over quickly.
Ventilators and ICU Beds
The Washington system collects ventilator status but not
blood supply information. Ventilator status is located on the resource page and
every two months requests a total number of ventilators from each hospital.
Most of these ventilators are attached to a patient and are not available. This
project may want to differentiate between "vacant" and "used" ventilators.
A concern from the last meeting referred to throughput and
that additional resources beyond beds will be necessary to count. Counting
ventilators addresses the issue of bed functionality because utilizing
ventilators available and ICU bed count provides the necessary information for
encompassing services needed for critical care. If other resource data elements
are included this will address the issue of noting bed service capability.
Since there is a lack of respiratory therapists, some
suggested including the staff in the ventilator definition. Another note of
caution arose in that an ICU bed count may identify ICU beds that meet all
other ancillary needs such as nurses, but do not include a ventilator. Implicit
in that idea is that every ICU has to have the capability to do everything to
every patient, which does not hold true for most hospitals. A new frontier is
going to be using ventilators in non-traditional settings. Oxygen is also
important to address.
Operating Rooms
This project should look at defining what an available OR is
(i.e., canceling elective surgeries) including requiring staffing with a surgeon,
anesthesiologist, and nurses. The reporting of available operating rooms may
be more meaningful in binary form such as "capable" and "not capable."
Federal Assets
Federal beds are a community resource. There are DOD
memorandums of understanding that will provide mutual support. The VA will be
told that they can make beds available to the public. DOD and VA resources
should be listed but flagged until authorized to participate and accept
civilian casualties. NDMS and Tricare hospitals should be tagged in this
system as well.
For civilian facilities, there are no formal agreements and
sharing of assets will be up to the locals. With NDMS, the DOD coordinates the
patient transportation component. The largest issues arise from reimbursement.
Data Elements: Surge Capacity
The question was posed: should this system forecast data or
is it beyond the scope of this project? The committee agrees this project
should use NDMS bed availability type surge counts, instead of the proposed
"unstaffed" beds category. When discussing surge, we should address not only
what will become available but also what you may need in the 1-3 day range.
There are two types of surge capacity and capability that should be counted: Hospital
and Alternative Care Facility (ACF).
Hospital Bed Capacity
There are many different suggested hourly projections
necessary for planning and responding to a mass casualty incident (MCI) such as 8-, 24-, 48-, 72-hour
estimates. Each different stakeholder requires a different length projection
and this group agrees that a lowest common denominator minimizes the burden on
the hospital, for example 12-18 hour shifts.
NDMS surge bed counts (or deliberate planning beds) are
requested at minimum (24 hour) and maximum (72 hour) projections, which are a
guess for the civilian hospitals reporting. The 24-hour estimate becomes a
48-hour projection when done every 24 hours.
Local and regional planners rely on and value the smaller
hour projection where as multi-State regional and federal planners find the
longer projections helpful. The focus of your view is based on who you are and
what you need. The hospitals may not know what they need and DHS will just
start sending assets. The hospitals need to get better at knowing how many of what
they need. They also need to think about sustainment. The 24-hour estimate
becomes what from a planning perspective could be asked for in a 72-hour
window.
Providing a 24-hour NDMS type bed capacity projection will
be very useful in the buffer zone of the event, but not the cross hairs. The
incident will move out to overwhelm the next hospital. It provides an increased
depth of information to the areas that haven't been affected. State or county
managers could also use this information to decide where to place casualties in
the next 24 hours. The 72-hour projection gives a regional idea of where to
place casualties.
The Washington System notes that multiple hour projections
are too intuitively difficult and cumbersome for hospitals to provide before an
incident occurs. From their experience, they feel most hospitals can and would
be willing to supply a 24-hour estimate. These estimates should be at minimum
provided daily, during an event, every 24 hours.
In conclusion, the board advised a 24-hour forecast with a
definition if you cancel elective surgeries and discharge patients what is best
guess of how many beds could be opened in 24 hours. The project will need to
address in detail defining hospital surge capacity beds in a standardized way. For
example, cancel elective surgeries and discharging patients. For a chemical, biological, radiological, nuclear, or explosive (CBRNE) incident, there is a need to decide the requirements for acceptable standards
of care. The question that the hospitals need to ask themselves is: What do we
have over and above what we are running right now? What could we make
available to accept an active case? Surge capacity requires a common
understandable definition; potential capacity can change every ten minutes and
depends on how frequently the polling occurs. The number of operating rooms and
recovery beds will change with every operation therefore a binary capability
may be more relevant.
Alternate Care Facility (ACF) Bed Capacity
The project should contain a placeholder for ACFs so that
ACF bed counts do not co-mingle with the current hospital capacity information.
These surge beds off-site could be entered early if known, before an incident,
minimizing data entry burden and assisting in planning. For this system, a
bimonthly or quarterly question of what could be made available may suffice.
This information should be shared locally, to address how quickly you could
move the patient between facilities locally. This would also require local
memorandums of understanding and emergency medical services (EMS) integration. In addition, this project
could graph capability to project needs and capabilities out or graph
availability of beds over time to follow trends.
ACF bed count should be built in to this system, but would
require ownership of this feature. The committee agrees there are two main
organizational levels that deal with ACFs and could report capabilities:
hospitals and State (regional) planners. Hospitals could track and count
according to their mandated Joint Commission (JCAHO) hospital plan for an alternative care site
(ACS). This is the planning phase number associated with each hospital ACS or
planned capacity.
Alternatively, States have been forced to look at the
regionalization of off-site care and have allocated certain areas as an ACF.
These are pre-designated in areas like New Hampshire and New York stadiums
according to The Concept of Operations for the Acute Care Center, U.S.
Army Soldier and Biological Chemical Command (SBCCOM), 2003. Colorado has
equipment but has not pre-designated ACFs yet. In order to obtain this type of
planning data, the State commissioners may be. In addition, most regions have
benchmarks. The regional plans are based on certain projections such as the
ability to handle 500 victims per million population or to accommodate a 20%
surge. This information could aid in estimating what the ACFs in area can
provide.
EMSystem has already added ACFs such as shelters during
incidents like the hurricanes in Florida. With this feature they can track
availability of shelters for DHS, HHS and the Red Cross.
In conclusion, hospitals should enter 24-hour projections
daily and an ACS planning projection quarterly. Regional/State planning
information should be entered for an area's ACF planning projection quarterly.
The data enterer is still unidentified and may be a long-term goal.
Systems Interface
The interface will be with each distributed hospital
resource tracking system, not centralized. For the regions of the country that
are not covered by each of the existing systems, the project will develop an
individual hospital interface.
The Health Resources and Services Administration (HRSA) suggested that operational test cases for the
individual hospital interface represent a diverse group of health facilities
across the country. For example, these could include a health care system in a mid-level city such as Intermountain healthcare or a smaller metropolitan
area that does not utilize one of the existing systems.
Crossing National Borders
Regarding crossing borders and sharing resources with Canada, Detroit and Ontario have been doing this for many years. 3,000 nurses move every week from Canada to the U.S. (? or vice versa) for better pay and have apartments in Detroit. They work for 3
days and then cross the border back to Canada. One third of nurses are "border
crossers" in that area. We lose care providers this way. Sharing of resources
with Canada has already begun. The ministry of health runs the Ontario bed tracking system and Dr. Claypool may be able to provide a link to the person he
has been working with related to cross border issues. Dr. Claypool suggests
pursuing the Ontario system. LCDR Bossler questions if the Ontario system is a
provincial system vs. Health Canada.
Redundancy
Mr. Ross mentioned 50% of hospitals had no data capability
after the earthquakes in Japan. The network and internet NCS experienced T1
shutdown. Redundancy issues, although a valid concern, will not be addressed in
this study.
Data Collection: Routine and Incident Dependent
The data should be able to communicate "I am becoming
saturated, these are my needs." The Federal government cannot poll the
hospitals regularly. This project should not only collect what hospitals are
normally gathering and reporting, but should be able to be expanded during an
event to address incident dependent data collection. EMSystem® collects this
information as an event. HERDS activates certain data fields based on the event
type. Routine data must be separated from an open and closed event, not a
day-to-day usage. This project may want to think about scalable data entry
based on nature of event and if there is an event.
HARTS System
Mr. Ross brought up HARTS which collects real time data
during an incident. Each hospital has been given a log in and a password. Illinois has a similar system. A portal sends information to HARTS and sub populates
additional fields. This system will port data one way but may want to look at
porting data the other way. HARTS was created Federally and is not proprietary.
HARTS has been used real time, for example during the
hurricanes in Florida. The project team requested an offline discussion of
exactly which data has been collected at what time. The granularity of the
data is of concern. For example, during the hurricanes HARTS collected
information on hospital structural damage, power sources either commercial or
generator and information was sent to the States and power companies.
System Users
The end-users of this system need to be clearly defined. It
is important to look at how this system will be used and in what time frame.
Different levels of planning and response require different data sets. The
required datasets vary for emergency departments (EDs), regional and State needs. A concept of
operations for this product should also need to be developed for all the
anticipated users. This type of operational discussion is larger than the
technical discussion. This system is collecting data for the local EMS responders all the way to Federal planners.
Some of the issues regarding the users of this system
include operational versus planning usage. Responders utilize different
information than planners. In addition, the complexity of each of these users
is also an issue. Both operational and planning users may service the local,
regional or national level. There are different data elements and time
sensitivities required for local or regional planners and responders.
Operational users may use this tool to aid in regulating staff from another
community to an event or to regulate patients from an event to
another area.
The staff movement concept of sending staffing resources to
an event, instead of moving patients away, was proposed to aid in containment
for a biological incident. Eric Tolbert of DHS is working on some of these
issues including volunteer credentialing.
The Trac2es team noted that they have a synopsis of patient
regulating procedures as part of the Global Patient Movement Requirement Center
(GPMRC) that they will review with the project team during the site visit.
In terms of usage incentives, this project may want to
provide links to other disaster response information and systems such as HAN.
This tie adds every day value to have extra information available for users.
Common practices augment information and minimize additional data entry. You
can ask people to populate the fields but they won't do it unless it benefits
them.
Next Meeting Date
The next HAvBED Advisory Group meeting will be January 27,
2004, in Washington, DC.
HAvBED Advisory Group Meeting Minutes
Thursday, January 27, 2005
Deputy Secretary's
Conference Room
Office of the Assistant Secretary for Public Health Emergency Preparedness
Hubert Humphrey Building, 200 Independence Ave.
Washington,
D.C. 20201
Attendees
Lt. Col. James Baxter
Michael Feeser
Sally Phillips, R.N., Ph.D.
LCDR Sumner Bossler
Nathaniel Hupert, M.D., M.P.H.
Peter Pons, M.D.
Shayne Brannman, M.S., M.A.
Jeffrey Lowell, M.D.
Col. Anthony Rizzo, M.C., S.F.S.
Stephen Cantrill, M.D.
Duane Mariotti
Daniel Salazar
Robert Claypool, M.D.
Capt. F. Christy Music, M.Sc., U.S.N.
Christopher Felton, M.D.
Rhonda Earls, M.S.N., C.N.M.
Andrew Nunemaker
Jacob Dye, M.S.
Sheri Eisert, Ph.D.
Kevin Yeskey, M.D.
Padmini Jagadish
Deborah Levy, Ph.D.
Introduction
Dr. Cantrill
AHRQ Bioterrorism Research Overview
Sally Phillips
- Project interface:
- Surge capacity requirements for tracking.
- Mass causality movement of patients.
- Strategic national stockpile.
- Cross training.
- Interface with other projects like HAvBED.
Software Specifications Summary/Definitions/Screen
Shots—Frames
Dr. Cantrill
- ABA Certified is limited, not including the 43 ABA verified, there are 132 ABA certified hospitals nationwide. Change to "Burn Unit
Bed in a Burn Center" or "Burn ICU beds in Burn Centers"
- Overstating capabilities.
- If not ABA certified, pulling from same certified critical
care nurses for ICU beds.
- Add comment that staff for beds should not draw each other
individual hospitals.
- Negative air flow?
- Beds must be mutually exclusive.
- Need to have a dialog with ABA to potentially expand the
burn bed data field.
Dr. Claypool
- What is it meant by "currently not in use"?
- Change to "can be made available in 2 hours"
Col. Rizzo
- Virtually every operating room available for immediate
receipt of patients.
- Change to "available for prompt receival of
patients." or "Staffed ORs"
- Ventilators—total #
- Delete ventilators—"not in use"
- Change "Decontamination" to "Mass
Decontamination"
- Emergent Department Status—change to:
EDXL Group Discussions
- XML schema EDXL.
- XML: Data tagged and organized allowing the receiving
system to know where to place the data. Snapshot of the data available
and how often does it change.
Presidential Inauguration Bed Tracking Report
Lt. Colonel Baxter
Discussion
- NDMS does not include all hospitals, but includes the
majority.
- Show NDMS to another level—go to other system.
- "Throughput" is the limiting factor for the
ultimate number of available beds.
- Tracking hospital resources to calculate throughput.
- HAvBED does not have throughput capabilities; hospitals do
not have technology to make this judgement.
Feeser
- Need to have hospitals regulate operations during tests of
HAvBED.
- Set conference call for the April meeting.
- Change the date for the April meeting? NDMS conference.
Next Meeting Date
HAvBED project team will have a phone conference sometime in
April for the next meeting and will solicit votes.
HAvBED Advisory Group Meeting Minutes
Thursday, October 14, 2004
Monday, May 2,
2005
Hotel Caribe
Royale
Orlando, Florida
Attendees
Lt. Col. James Baxter
Mark Roupas
Sally Phillips, R.N., Ph.D.
Stephen Cantrill, M.D.
Duane Mariotti
Jacob Dye
LCDR Cipriano Pineda
Capt. F. Christy Music, M.Sc., U.S.N.
Shayne Brannman
Chris Felton
Andrew Nunemaker
PowerPoint® Presentation
Dr. Cantrill presented the HAvBED project progress leading
up to data delivery by system partners and hospitals using the manual data
entry Web interface:
- Secured Server online.
- Database ready to receive data.
- System partners testing Web services interface.
- GIS interface progress.
- Requested matrices for final report.
Data Points
EMSystem®,
represented by Andy Nunemaker and Chris Felton, explained how data is requested
from participating hospitals it covers. A data entry screen is dispersed to
the data entry person at each participating hospital as an HTML page. Data is
entered and sent to an EMSystem® database and on to the HAvBED database.
Hospitals participating through EMSystem® will include all the public and private hospitals in the State of Colorado, and potentially hospitals in Southeast Wisconsin and Virginia. State Hospital Capacity System, represented by Duane Mariotti, explained that a subset of data
already being requested from participating hospitals in Washington, Oregon, and South Carolina will be sent to the HAvBED database. Hospital data will
include public, private, and military hospitals.
Matrices for Final Report
Dr. Cantrill requested the advisory group discuss the final
report documentation and the project findings in the form of matrices.
- The one suggestion that dominated the discussion was the
need for a followup survey to determine the success of the HAvBED project
from the user's perspective. Many of the obstacles the HAvBED project has
met were not technological but administrative. Interfacing with hospital
data, which is considered
proprietary to the individual hospital, presents many challenges. To ensure
the continuance of the HAvBED project requires the documentation of the process
to construct the hospital database, GIS and Web interface. In addition, the
process each individual hospital went through administratively to approve or
disapprove the participation in the HAvBED pilot project will assist in a
full-scale national implementation. The survey would document both the
technological and administrative issues involved with participating in the
HAvBED project.
- It was suggested that HAvBED staff file for an extension
through AHRQ for the followup survey and documentation.
HAvBED Advisory Group Meeting Minutes
Thursday, Tuesday, July 12,
2005
Deputy Secretary's
Conference Room
Office of the Assistant Secretary for Public Health Emergency Preparedness
Hubert Humphrey Building, 200 Independence Ave., Rm. 305A
Washington,
D.C. 20201
Attendees
Sally Phillips, R.N., Ph.D.
Robert Claypool, M.D.
Padmini Jagadish
Stephen Cantrill, M.D.
Nathaniel Hupert, M.D., MPH
Peter Pons, M.D.
Jacob Dye, M.S.
Duane Mariotti
Daniel Salazar
Sheri Eisert, Ph.D.
Andrew Nunemaker
Michael Feeser
Kevin Yeskey, M.D.
Capt. F. Christy Music, M.Sc., U.S.N.
Introductions
HAvBED Presentation: Dr. Stephen Cantrill
Dr. Cantrill reviewed the steps involved in the development
of the HAvBED project including the development of bed definitions, the
designation of desired data elements and the development of the operational
HAvBED system including the specification of XML interface, the Emergency Data
Exchange Language. A review of the three testing periods was presented. The
functionality of the HAvBED system was demonstrated via an internet connection
to the HAvBED system. Operational issues and limitations were presented.
Recommendations for next steps were discussed. Advisory group members were
provided with a logon and password for the HAvBED system. They were encouraged
to review the system and provide any comments to Dr. Cantrill.
Discussion
- In general, the Advisory Group thought the HavBed System is a good tool that could be used by regional and local emergency planners and responders.
- Edward Gabriel expressed that the HavBEd system would be good tool for emergency planners, especially when dealing with interState issues of bed availability.
- There were discussions of next steps concerning ownership and sustainability of the HAvBED system. Dr. Claypool and Phillips expressed the need to have a followup meeting regarding how to proceed once the Final Report is completed and recommendations finalized.
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