# Presentation: 231598

## Countermeasure Allocation, Distribution and ResponsePopulation Health andClinical Care Connections Workgroup

**Aggie Leitheiser, RN, MPH**
- Director of Emergency Preparedness
- Minnesota Department of Health
- June 15, 2007
- _[Aggie.Leitheiser@health.state.mn.us](mailto:Aggie.Leitheiser@health.state.mn.us)_
- 651-201-5711

## Objectives for presentation

- Describe Minnesota’s plans and priorities for countermeasure use
- Highlight health information exchange needs and barriers for implementing countermeasures
- Make recommendations

## Quick overview of Minnesota

## Minnesota Context

**Minnesota Context**

- 87 Counties
- Population about 5 million
- 60% live in Metro area
- Borders Canada and 4 states

## Minnesota’s plans and priorities for countermeasure use

- Social distancing
- codeReady
- Isolation and quarantine
- Personal protective equipment and healthcare supplies
- Antivirals and antibiotics
- Vaccines
- Exchange of accurate information with partners and the public

## Social distancing

- Exchange accurate information with partners and the public
- Avoid areas of exposure (infectious, chemical, radiological, natural)
- Evaluate effectiveness of measures
- Track affected people
- Provide event-specific information for healthcare providers, emergency managers and other partners

## Personal and Family Preparedness Campaign

## Isolation and quarantine

- Identify and track ill person (case management)
- Identify and track contacts (ongoing monitoring, need for supportive services, monitor change in status, maintain communication)
- Exchange information:
- federal/state/local public health
- health care providers of affected persons
- public safety and emergency managers
- other responders

- Legal framework

## Personal protective equipment and healthcare supplies

- Developing and managing stockpiles (federal, state, private)
- Setting priorities for use
- Tracking use and billing for public and private resources
- Ventilators
*Chronic care and psychotropic medications currently not included*

- N-95 mask

- Emergency ventilator

## Antivirals and antibiotics

- Inventory management
- Tracking from federal and state stockpile to provider to patient
- Data needs:  summary situation awareness level (% of community) and detail (individual medical record)
- Monitor for adverse outcomes
- Goal of 48 hour timeframe for response (so need systems ready-to-go)

## Vaccines

- More complicated administration
- Potential for more adverse outcomes
- Immunization registries modified to track countermeasures
- Booster doses and recall

## Countermeasure information flow

- Federal
- material

- State
- material

- Private
- material

- Receipt
- Staging
- Storage
- Warehouse

- Regional
- Distribution
- Node

- Billing, Payment, Restocking

## Information for partners and the public

- Public health’s product is information
- Partners’ needs may be different from the public’s needs (emergency management, health care provider)
- Rapid, accurate, timely, complete, concise, science-based, 6th grade level, ongoing, not too much, use up-to-date technology, have alternate plans when technology not available, comforting messages, information about possible negative outcomes.....
- Delivery integrated into the partner work processes so information readily available:  “push”

## Some of Minnesota’s Countermeasure Information Tools 

- Health Alert Network
- MN*Trac*
- MNResponds
- MN.**TRAIN**
- MNStar
- MNTrauma
- Secure Web portal
- Internet and web pages
- Disease surveillance system
- Laboratory Response Network
- Good relations with providers
- Syndromic surveillance
- Video conferencing

- Strategic National Stockpile Asset Management System (SAMS)
- Minnesota Immunization Information Connection (immunization registry)
- Autocall notification
- Web-based training
- DisasterLAN
- Isolation and quarantine database
- Hotline
- Local media
- Geographic Information System
- Many others

## Local outbreak of vaccine preventable disease

- 05/07/2007 Fourth Case of Hepatitis A Confirmed
- Cases linked to restaurant workers in Murray County (9,000 residents) about 150 miles from State Health Department
- Over 2,300 people received immune globulin in 2 days
- Restaurant closed, cleaned and reopened

## Hepatitis A Information issues

**Healthcare Delivery Information**
- Laboratory data
- Assessment information for contraindications for IG
- Information about the vaccination for persons being vaccinated and their healthcare provider
**Planning and coordination**
- Phone calls with planners and responders
- Coordination of work between public health and local medical clinic
**Public Information **
- Hotline
- Information about the vaccination and clinic location and times
- Media interviews and contacts

**Public Health Information**
- Epidemiology information (exposure, contacts, source of disease, testing)
- Ongoing outbreak investigation
- Consultation with CDC
- Information about the vaccination for persons being vaccinated,  provider, and public health
- Health Alert Network message to local public health and healthcare providers in the state
- Information about supplies, volunteers, use of IG
- Autocall to restaurant owners in surrounding counties
- Staff scheduling
- Ordering and managing IG

## Countermeasure information exchange gap

- Disaster

- Normal

- Small Event

**Information Capacity**

- Desired

- Possible

**Gap**

## Barriers to Integrated and Interoperable Data 

-  Rapidly changing information technology
-  Lack of public health standards
-  High cost to develop and maintain system
-  Limited state / local public health input

## Needs and Recommendations

**Coordination**, **integration**, and **interoperability**
- Clear and consistent guidance, standards, and shared expected outcomes
- Long term plan and vision shared by federal and state partners
- Systems to be useful for daily work and able to expand for an emergency, disaster, or catastrophe
- Technical support
- Ongoing **funding**

## Needs and Recommendations (cont)

- Implement uniform minimum data elements for essential functions
- Implement standards for interoperability for exchange with our public and private partners