The HIMSS Interoperability Showcase, part of the HIMSS Global Conference & Exhibition, demonstrates interoperability – the ability for different technology systems to communicate – in real-time with actual products in the marketplace. The following guest post shares the impact seamless data exchange can have on patients, providers and caregivers.
Biological and other disaster threats – whether accidental, driven by forces of nature, or intentional – pose fairly grave risks to the United States and the world.
Situational awareness has been a conspicuous topic ever since the 9/11 attacks and the anthrax scare that followed shortly thereafter. Since then we have experienced numerous disasters: health impacts of major weather events such as hurricanes and earthquakes, new virus outbreaks like Ebola in Africa, raging wildfires on the West Coast (I live in California), and the ever-present threat of pandemic flu which a hundred ago infected some 500 million people across the globe and killed an estimated 50 million people worldwide, according to the Center for Disease Control and Preparedness (CDC).
But since the initial flurry of public health preparedness funds in the ensuing several years after the 9/11 attacks, this topic has not had a high priority at CDC nor the funding necessary to implement it successfully.
Many of these issues came to a head with the formation of a Bipartisan Blue Ribbon Study Panel on Biodefense in 2014 which released its National Blueprint for Biodefense in October, 2015. This exhaustive study contains numerous recommendations related to the leadership, funding and tactical shortcomings of U.S. preparedness and response.
The publication of this report was followed by a September 2017 Government Accountability Office (GAO) report, Public Health Information Technology: HHS Has Made Little Progress toward Implementing Enhanced Situational Awareness Network Capabilities. Of particular interest to the informatics community, GAO pointed out lapses in completing Congressionally mandated requirements for this area including the definition of minimal data elements required and collaboration with state, local, and tribal public health officials on the development of standards and procedures to ensure proper data collection. Despite limited investments over the years, the lack of progress has been apparent.
More recently the Blue Ribbon Study Panel on Biodefense held a meeting in Washington in November 2018 that focused on assessing progress on implementing key elements of their 2015 report. I can't say I felt encouraged by the testimony which continued to lament the chronic under funding and lack of coordinated leadership at all levels of government. Anne Schuchat, MD, principal deputy director and former acting director of the CDC, gave a well-received report about real-time syndromic surveillance (SS) reporting in the United States from hospital emergency departments. In fact, her entire testimony was about work CDC is doing to strengthen its information systems, and in addition to SS reporting, she discussed mortality reporting, electronic lab reporting and flu surveillance.
I find the current situation distressing. But there may be some hope in sight. The Pandemic and All Hazards Preparedness Act (PAHPA) is in the midst of reauthorization by Congress (to date it has passed the House and awaits passage in the Senate). This legislation reauthorizes and provides continuing funding for a number of biodefense programs and agencies.
In October 2018, the White House released the National Biodefense Strategy, a concise document that defines a broad strategy for preventing, preparing for, and responding to natural, accidental, or deliberate biological threats. From a public health standpoint, this strategy is light on details but that is probably by design.
Hopefully, final passage of PAHPA will bring increased funding and focus to biodefense activities. It will likely bring increased reorganization and renewed focus within the Federal government.
Public health agencies at all levels – and professional associations – need to be ready to re-engage on biodefense-related issues as they emerge. It is important to recognize that infrastructure for biopreparedness and defense can often be put to good use for other initiatives, and in many way can be better justified through this "double duty" of supporting both biodefense and conventional activities.
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