4. Priorities for Subsequent Phases

The Phase I National System, as noted above, will be a platform on to which additional feeder systems and improved resource availability data can be linked.  At the end of Phase I, an assessment should be made regarding the future directions and priorities for the National System, in light of the implementation issues and obstacles that arose during Phase I, whether participation in the National System is voluntary or mandatory, and the likely future funding streams for the National System. 

Projecting ahead, however, we envision that the priorities for subsequent phases will be to link as many feeder systems to the National System as possible and improve the quality of resource availability information.  In addition, as was noted in Section 3.1, additional patient and evacuee data elements should be included that describe in more detail the patient/evacuee's medical condition and needs.

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4.1. Linking Additional Feeder Systems to the National System

The highest priority item for subsequent phases is linking as many feeder systems to the National System as possible, including institutional records systems and tracking systems used at the local or county level.  Exhibit 4.1 shows a recommended prioritization for linking feeder systems to the National System.  The extent to which items can be pursued in parallel depends, of course, on the funding available to continue expansion of the National System.

The number of feeder systems that can be certified over a given period of time is difficult to estimate, as it depends on the experiences and lessons learned from Phase I (and, in particular, from the certification and roll-out process with the to-be-identified Health Information Techology [Health IT] vendor) and on the level of resources available to support subsequent phases.  For this reason, Exhibit 4.1 is organized by high, moderate, and low priority, rather than by Phase I, II, and so on.

As noted in Exhibit 4.1, our general strategy for expanding the number of feeder systems is to work with the major Health IT vendors, starting with institutions affiliated with the vendor participating in Phase I and then with the other major vendors.  The rationale is that these vendors can make changes to their systems which, in turn, can be installed by their (large) customer base.  Fortunately, the Health IT market is dominated by a relatively small number of major vendors.  According to the 2005 annual report of the hospital IT market by Healthcare Information and Management Systems Society (HIMSS) Analytics, the top 10 vendors account for nearly 90 percent of the market. 

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4.2. Improving Health Care and Transportation Resource Availability Data

Subsequent phases should also focus on improving the quality of data describing the availability of health care and transportation resources that are critical for regulating, incident management, and resource management.  Exhibit 4.2 summarizes our recommendations, by phase, pertaining to resource availability data.  Recommendations for Phase I, which were outlined earlier in Section 3, are included for comparison purposes. 

The major recommended initiatives for Phase II include (1) improving the baseline inventory for the transportation resources by including mid-range, as well as major, owners of these assets and (2) assessing the feasibility (and, if appropriate, development of prototype systems) of resource availability reporting systems for nursing home beds and for the major owners of transportation resources. 

Subsequent phases should focus on incorporating additional health care and transportation resources in the National System. 

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