# Presentation: 178691

## National Health Information Infrastructure and Bioterrorism Preparedness

- William F. Raub, Ph.D.
- Department of Health and Human Services
- NHII National Conference
- 30 June 2003

## THESIS

- 	A National Health Information Infrastructure (NHII) will guarantee high level of preparedness for bioterrorism (BT).
- 	Piecemeal applications of information technology (IT), while necessary for the short run, inherently can’t measure up.

## Relevant Features of NHII

- Ubiquitous Electronic Health Records (EHRs)
- Anytime/Anywhere Access to EHRs
- Medical Decision Aids Readily at Hand
- On-Line, Real-Time Link with Local Public Health Department (PHD)

## Core Capabilities for BT Response

- Early Detection of Possible BT Incident
- Prompt Investigation of Suspicious Outbreak of Infectious Disease
- Health Care Surge Capacity for Management of Mass Casualties

## Clinician Readiness:Key to Early Detection

- Knowledgeable about BT Threats
- High Index of Suspicion When Presented with Unusual Symptoms or Disease Pattern
- Motivated to Report to Local PHD

## The Suspicious Case (1)

- Review Patient’s Medical History
- Seek Laboratory Test Results
- Consult with Colleagues Locally
- Consult with Colleagues at Other Facilities
- Compare with Contemporary Patients

## The Suspicious Case (2)

- Without NHII:
- This full suite of tasks often is prohibitively labor-intensive.
- With NHII:
- Such analysis will be so much easier that it will become standard practice.

## Keeping Current re BT (1)

- CME Courses
- Specialized Web Sites
- Professional Journals
- Traditional Library Resources

## Keeping Current re BT (2)

- Without NHII:
- Decision aids generally are separated spatially and temporally from the doctor/patient encounter.
- With NHII:
- Decision aids will be embedded in the IT infrastructure for patient care.

## Interaction with Local PHD (1)

- Reporting Suspicious Cases
- Collaborating with the Ensuing  Epidemiological Investigation

## Interaction with Local PHD (2)

- Without NHII:
- Reporting cases is a non-routine act often encumbered by poorly maintained lines of communication.
- With NHII:
- Case reporting aids will be embedded in the IT infrastructure for patient care.

## Syndromic Surveillance (1)

- 	Continuous community-wide scanning of sentinel indicators of possible BT incident:
- 	unusual clusters of common symptoms
- 	atypical pattern of pharmacy sales
- 	spike in ambulance calls and ER visits

## Syndromic Surveillance (2)

- Potentially invaluable complement to individual clinicians’ detections and reports
- Could enhance epidemiological investigation of incident by enabling rapid identification of population at risk

## Syndromic Surveillance (3)

- Without NHII:
- Most current efforts are limited severely by paucity of EHRs or lack of ready access to current EHRs
- With NHII:
- EHRs will be accessible routinely over a geographic scope scalable to the region(s) affected by the incident.

## Outbreak Investigation (1)

- Epidemiological (Epi) investigations necessarily are incident-specific
- Process generally begins with design of a customized data form

## Outbreak Investigation (2)

- Without NHII:
- Current suite of IT tools to facilitate design and use of Epi forms is very limited and doesn’t provide routine linkage to EHRs
- With NHII:
- Epi IT aids will feature built-in interoperability with EHRs.

## Hospital Surge Capacity (1)

- Mass casualties are likely to overwhelm routine hospital operations.
- Much of mass casualty care will occur in non-routine settings.

## Hospital Surge Capacity (2)

- Without NHII:
- The regular IT infrastructure for patient care generally will not suffice to support care given in non-routine settings.
- With NHII:
- The regular IT infrastructure will be adaptable and scalable to support care in non-routine settings.

## Critical Infrastructure Protection for the Healthcare Industry (1)

- National Security Directive 63
- Healthcare industry responding to “National Strategy to Secure Cyberspace”
- Draft “Call to Action” approved 3/2003

## Critical Infrastructure Protection for the Healthcare Industry (2)

- Collaboration among private sector, DHS, and HHS
- Healthcare Advisory Council, made up of key industry leaders, launched 6/30
- Creation of the Healthcare Information Sharing and Analysis Center (HCISAC)

## Healthcare Advisory Council

- Services to help protect the industry (i.e., alerts, best practices)
- Partnerships with federal government and cross-industries
- Advocacy for healthcare industry
- Communication and outreach to increase industry awareness
- Embracing principles of information sharing

## How to Get Involved

- Learn more
- Become a participant
- Reference the website:
- 	_[http://www.hcisac.org](http://www.hcisac.org/)_
- Thanks to Tim Zoph, CIO, Northwestern Memorial Hospital, for inspired and tireless leadership.

## Technology Can EnergizeNew Paradigms (1)

- 	Some technologies don’t just help;
- 	they change the rules of the game –
- 	or even the game itself.

## Technology Can EnergizeNew Paradigms (2)

- 	Why didn’t the Ancient Greeks invent chemistry?
- 	Perhaps because they didn’t have glass!

## Technology Can EnergizeNew Paradigms (3)

- 	NHII could be the crucible from which emerges a safer homeland as well as better health care.