NY State Health Commerce

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Health Emergency Response Data System (HERDS)
NY State Health Commerce Enterprise-wide
Integrated Information Systems Public Health
Preparedness, Planning, Response
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HERDS operates within the NY State Health
Commerce System (HCS)

• A Secure, Standards-based , Integrated
  Infrastructure for Enterprise-wide Health
  Information Interchange.

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NY State Health Commerce System(HCS)

• Operational Since 1995
• Web Based and Accessible via the Internet
• Requires Id and Password
• An integrated architecture supporting a wide
  array of health information exchange
  applications
• Routine Information interchange
• Preparedness and response. Examples
• Disease surveillance and Lab reporting
• Health Alerting
• Volunteer data base
• HERDS ( Health Care preparedness and Response )
• Used by ALL local health departments, health
  facilities, health providers and practitioners.

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A Natural Platform for Public Health Preparedness

• Leverages Existing Infrastructure
• Security
• Availability
• Identity Management and Access control
• Application Development Environment
• Core Integration Applications
• Leverages Existing Presence of Needed Partners on
  HCS
• Presents common user interface and identification
  system to users
• One stop shopping for data and data reporting
• Presents opportunity for integration of data
  systems

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HERDS Evolved in Response to Information issues
during 911 and Anthrax Letter Attacks.

• Developed at the request of Greater NY Hospital
  Association and Emergency Planning Coordination
  Counsel.
• Issues Health care deluged with information
  requests during the events.
• Competing, conflicting and disparate requests
  from multiple sources (Federal Agencies, Law
  Enforcement, State/local health, media/Press)
• No formal process existed for collecting
  information
• Multiple requests were disruptive to providers
  and States response to event
• No clear authority for collection and
  dissemination of data
• Requires centralized integrated system
  maintained by State Health Regulatory Authority
  for monitoring and reporting of facility resource
  information available and needed for response or
  capacity planning. Resource needs for events can
  vary significantly with type of event and change
  as event evolves.

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Post 9/11 Response (2001-2002) Define
Requirements from Ground-upwards

• Coordination by Greater NY Hospital Association
• Establish Emergency Preparedness Coordinating
  Council (EPCC)
• Regional planning and response (NY, NJ, CT)
• Establish ongoing dialogue meetings, briefings,
  and drills
• Establish Framework for communicating regarding
  emergencies, alerts, advisories, and protocols
• EPCC composition
• Providers of all types (hospitals, nursing homes,
  home care, physician organizations)
• Local, state, and federal agencies (health,
  emergency management, and law enforcement) 

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EPCC OutcomeMandate for A Statewide Health
Emergency Response Data System

• Develop system to meet information exchange
  needs based on 9/11 and extend to Public Health
  Events in general
• Facility resources, surge
• Event-related visits
• Event Patient locator/tracking system
• Goals
• Develop agreed-upon needs for the data system
• Protect confidential, Competitive and proprietary
  data Use Central authoritative source
• State Health Department Regulatory authority
• Use Existing Infrastructure

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Beyond Events such as 9/11 Other Public Health
Events of More Common Origin Frequently Emerge.

• They have different and varying information
  needs, origin, duration, surveillance/response
  requirements and rate of emergence.
• Outbreaks E. Coli ( 0157 Washington fairground),
  Cryptosporidia ( Seneca Lake Spray Park), West
  Nile Virus, Monkey Pox, SARS
• Preparedness
• Disease Surveillance / response Influenza ,
  Pandemic Flu. ( Ongoing )
• Natural Disasters Hurricanes Hurricane Isabel
  September 2003
• High Profile Events Republican National
  Convention Aug-Sept 2004
• Elevated Threat Levels Threat level Orange
• State Emergencies NorthEast Blackout August
  2003
• Critical Health Resource Shortages Blood Supply
  Shortage ( Summer 2004), Influenza Vaccine
  Shortage ( Fall 2004 )
• Information must be shared in real-time between
  state/regional/local health, health facilities
  and response organizations.
• The underlying information collection/distribution
  system must mutable, changing to respond to
  event.

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HERDS Generic Preparedness Functions

• Planning and Preparedness
• Surveys
• Surveillance
• Asset tracking
• Response
• Electronic Incidents
• Surge
• bed and resource availability
• resource requirements
• Event Patient/Victim tracking
• Integrated Data Visualization Situational
  Awareness
• Automated Alerting based on Central
  Communications Directory ( Role and Contact
  Information )
• Secure Collaboration
• Data Exchange Inclusive of Key Response
  Organizations
• Health Facilities
• Public Health (State, Regional and Local )
• Emergency Management
• Other ( Fire EMS, Facility Networks and
  Organizations )

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NYS HEALTH COMMERCE Architecture
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Health Emergency Response Data System (HERDS)

• HERDS Deployments
• Hospitals (4500 users 540,000 user transactions
  /yr )
• Nursing Homes
• Local Health
• Adult and Home Care
• Clinics
• Other facilities e.g. Schools

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Examples of HERDS Use

• Drills( 16 )
• NYCity Metro Area ( 14 Counties 75 hospitals, 3
  states NY,CT ,NJ ) SARS, Dirty Bomb,
  BT-Agents, subway explosions
• Upstate Metropolitan Areas ( 8-10 Counties ,
  10-30 hospitals ) SNS activations, Disease
  outbreak, natural disaster.
• Rural Areas (1-6 Counties, 2-8 hospitals ) mass
  trauma/accidents, disease outbreak, Mutual Aid
• On-going Surveillance
• Bed Availability and ED traffic - Hospitals
  Statewide
• Influenza Surveillance - Hospitals Statewide (
  NH, Clinics, CHHAs and Adult Homes Q1 06)
• Vaccine availability statewide Hospitals and
  Nursing Homes
• Asset and capacity Surveys
• AIIR
• Critical assets and surge statewide Hospitals
  and nursing homes.
• Surge( e.g. bed, ED, mortuary ), equipment (
  vents ), staff, pharmaceutical inventory,
  capacity ( decon., diagnostic/imaging, treatment)
  , transportation (e.g. Helipad, ambulance ),
  Data/Voice Communications Infrastructure

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Examples of HERDS Use

• Emergency Response - Public Health Response
• NorthEast Blackout August 2003
• Blood shortage July-August 2004
• Vaccine Shortage Fall 2004 Winter 2005
• Regional Flooding Central NY State June 2006
• Western Region Snow Emergency October 2006
• Public Health Preparedness
• Hurricane Isabel September 2003
• Elevated Threat Levels 2003 ( February,May,Decembe
  r )
• Republican National Convention August-September
  2004
• Baseline and Public Health Surveys
• HRSA Baselines 2002,2003,2004,2005
• Public Health Surveys.
• Infection Control
• Antibiotic protocols
• Hospital Services inventory

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HERDS Real Time Reports AIIR Capacity
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HERDS GIS Hospital Admissions Lab Confirmed
Positive Influenza
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HERDS GIS Surge AIIR and ED
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Local Health Dept Outbreak Tracking E. Coli
Outbreak
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Nursing Homes- Vaccine Survey
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HERDS Usage During Emergency Declarations

• NE Blackout August 2003
• 48 of 238 hospitals activated statewide were
  able to access HERDS. Alternate communications
  capacity was not available to facilities who did
  not access HERDS.
• Regional Flooding Central NY State June 2006
• 100 20 counties 40 hospitals activated accessed
  HERDS
• Western Region Snow Emergency October 2006
• 100 4 counties 19 hospitals activated accessed
  HERDS

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HERDS Critical Asset Survey of Hospital
Communications Capacity/Preparedness

• 98-100 have internet access in multiple
  locations (EOC, pharmacy, laboratory)
• 72 have at least one satellite phone, most are
  fixed base phones ISSUE CAPACITY OVER SOLD
• 45 have satellite phones also capable of data
  transmission
• 80 have portable radios for intra and/or inter
  facility communications, but local communications
  and not standardized.
• 50 report radio connections with their
  respective office of emergency management.
• 60 report a relationship with an Amateur Radio
  Emergency Services (RACES).

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Statement of the problem

• Sophisticated electronic Public Health
  preparedness and response systems are evolving at
  the state and local level designed to establish
  exchange of critical data between response
  partners.
• The response systems are used in emergencies and
  their effectiveness is dependent on efficient and
  timely accessibility by all health response
  partners ( state and local health, health
  facilities,etc.)
• Access to data or information exchange resources
  needed for clinical care for both victims
  affected by the event and health consumers within
  the affected health care region are also
  dependent on continuity and availability of
  communications infrastructure during the event.
• All critical health functions are therefore
  dependent on the very communications
  infrastructure( voice, data, video) that would be
  subject to outage/disruption due to the emergency
  event itself.
• During an event the outage/disruption could be
  due to
• Physical damage related to the event
• Surge due to usage during the event
• Reallocation of communications resources to other
  sectors via national or regional ICS decisions.

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Needed

• The equivalent of an Office of National
  Coordinator NHIN initiative for Nationwide Health
  Information communications Network
  infrastructure. A national plan, standardization
  and funding process.
• Support for both urban and rural areas
• Diverse and redundant, multimodal , interoperable
  communications modalities ( broadband, wireless,
  HF radio, Satellite ).
• Connect state,regional local public health,
  health care facilities, OEM, tribal nations,
  clinicians and consumer needs as appropriate
• On demand priority access.
• Dual use Routine and emergency
• Core interoperable low level application support
  for reliable, continuous, secure voice, data,
  video communications
• High level application support for e-mail ,web
  services, manual web browsing, telemedicine.
• Interoperability with EMS and Public Safety

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References and Background

• Gotham I, Sottolano D, Hennessy M, et al. An
  Integrated Information System for All Hazards
  Health Preparedness and Response. NY State Health
  Emergency Response Data System (HERDS). J Public
  Health Management Practice, 2007, 13(5), 486496
• Gotham I, Eidson M, White D, et al. West Nile
  Virus A Case Study in How NY State Health
  Information Infrastructure Facilitates
  Preparation and Response to Disease Outbreaks.
  Journal of Public Health Management Practice.
  2001, 7(5) 75-86.
• Gotham I, Smith P, Birkhead G, Davisson M.
  Policy Issues in Developing Information Systems
  for Public Health Surveillance of Communicable
  Diseases. In OCarroll P, Yasnoff W, Ward E,
  Ripp L, and Martin E, editors. Public Health
  Informatics and Information Systems. New York
  Springer-Verlag 2003 537-73.