The following is a guest article by Scott Afzal, President of Audacious Inquiry.
This past year, Americans in nearly every community had to face the prospect that there may not be an ICU bed or ventilator available for them in the nearby hospital if they got sick with COVID. It was a stunning illustration of the terrifying scale and severity of the pandemic, and it exposed core limitations of the American health care delivery system and our public health infrastructure.
The COVID-19 response also brought national attention to inadequacies in health care system readiness for large patient surges. The unfortunate reality today is that we lack a modern system by which public health authorities and emergency response officials at local, state, regional, and federal levels can quickly understand critical information about hospital bed capacity, staffing levels, and availability of life saving equipment like ventilators. The result is what disaster response officials call a lack of “situational awareness,” or a real-time understanding of hospitals’ capacity and capability to accommodate an influx of patients. Without this information, making accurate decisions about where to route patients or allocate scarce resources is near impossible.
Last March, the onset of the pandemic immediately illuminated just how far behind the United States was with its basic public health infrastructure. As hospitals across the country became overwhelmed with patients, the federal government, while well intentioned, hastily entered into contracts for technology vendors to help address the situational awareness gap. In search of a quickly implementable solution, the government pulled together a system that required every single hospital in the country to manually enter data each day about bed availability, staffing, and other capacity information. The same hospitals struggling with an overwhelming influx of high acuity patients were simultaneously handed a mammoth manual daily reporting mandate that often required several staff to complete. Moreover, reports questioning the data’s fidelity soon followed as did questions about whether reporting at a daily frequency was regular enough to provide the situational awareness needed to make tough resourcing decisions.
There is now a growing recognition for the need for a more reliable and modern health system capacity reporting system. Agencies within the federal government have made promising commitments toward greater interoperability between public health and healthcare through common data standards and systematic analysis of information systems relevant to public health threats. While previous efforts to address the need for situational awareness in the last two decades never fully materialized as envisioned, the technical and political contexts are now better positioned for success. For starters, the health information technology field has made significant advancements over the last decade, particularly as related to the growth and proliferation of health IT standards and the widespread implementation of electronic health records. Furthermore, due in part to the COVID-19 pandemic, there is now shared political interest at the federal, state, and local levels to build modern and sustainable reporting systems to be better prepared for future incidents.
Audacious Inquiry believes fervently that modern health IT solutions – like the ones we operate for state and federal partners everyday – can be better leveraged to support public health emergencies and disaster response. In March of 2020, we recognized immediately that current hospital capacity reporting and situational awareness systems simply could not support operational decision-making in the ways most needed by healthcare and public health leaders. While we appreciated the need for a federal reporting system that could be rapidly implemented, we also knew that we should not, as a nation, focus only on a “band-aid” solution when we really need a more permanent suture.
To that end, we launched The Situational Awareness for Novel Epidemic Response Project, also known as The SANER Project. The SANER Project began as a grassroots initiative led by subject matter experts within Audacious Inquiry to collaborate with other health IT leaders toward the shared goal of improving state and federal response operations through real-time situational awareness of healthcare delivery system capacity. The caliber of the organizations that have joined in on this initiative is a testament to the importance and the need for SANER and we are humbled to be addressing this important topic with some of the best minds in healthcare IT.
At the center of the project are shared interoperability standards based on HL7 FHIR, now promoted through a critical collaborative to develop an HL7 Fast Healthcare Interoperability Resources (FHIR®) Implementation Guide. The Implementation Guide, a kind of blueprint for how to implement a technology standard consistently, has been developed to accommodate data reporting requirements for public health and emergency response agencies to address management of the COVID-19 Pandemic but the standards are extensible to myriad other disaster and public health emergency use cases.
While our progress is promising, it will take more than just private sector efforts to realize a national, industry-wide change. We need ongoing federal investment and policy support toward more effective and standardized communications between healthcare systems, public health departments, and emergency response agencies. We need our state, local, and territorial public health organizations, the Centers for Disease Control and Prevention, and the Department of Health and Human Services to align around a coordinated national strategy, heavily informed by the expertise of the private sector.
Developing a real time situational awareness system is not just about reacting to COVID, but preparing ourselves to better respond to any future health crisis that may arise, whether that be a natural disaster, act of terror, or infectious disease. It is time we get ahead of reacting to a crisis event and take decisive action now so we can have a SANER, more organized response when disaster strikes again.
