Local First .. A SANER Approach

As I think about various models for communicating data to public health agencies, I keep thinking about a federated model, where hospitals push to their local public health network, and the local public health authorities then push data upwards to state and federal agencies.  There's a good reason for this, based on my own experience.  I live fairly close to Boston, and lived even closer in 2013, the year of the Boston Marathon Bombing.

Boston emergency management officials immediately knew when the bombs first struck what the state of the EDs were in the area, and were able to mostly route patients appropriately, and coordinate efforts.  While that same article notes that the number of available operating rooms and ICUs was not known, it also mentions practice and drill which very likely made it possible for hospitals to quickly clear and prepare operating rooms to treat incoming patients.

I think also about what's happening in thee City of Chicago right now, with Rush Medical coordinating efforts to capture data for the City's public health department, and then local public health passing that same data on to federal agencies on the hospital's behalf, and it just makes sense.  It certainly makes a lot more sense than what I've heard elsewhere, where hospital staff are having to collect data, log into different portals and send data to local or state public health, and then also to two different federal agencies, all the while a slightly different data feed containing similar data is silently being sent to the state department of health from a past program intended to meet the very same need.

I can't and won't argue the point that FEMA and CDC both need the data that is being requested.  But I will say that there should be a local public health network that supports this sort of communication without placing additional burdens on hospital staff.  Let the locals push to the state, and the state to the federal government as needed, and when needed (e.g., in cases of a declared emergency).  Don't make 6000+ hospitals do the same thing twice or thrice (even if with different data sets), when 50-odd state agencies could do it more efficiently and in bulk with better quality control.  Oh, and maybe fund that (or use existing funds that have already been allocated for that very kind of thing).

And when the emergency is over, the state or local public health agencies should still keep getting what they need to address local disaster response, much like what Boston had during the Marathon bombing.  It's too late after the disaster happens to "turn it on", and in fact, the switch might not even be accessible if you wait that long.

Compare the Boston stories to Dirk Stanley's story about being at the epicenter of 9/11, and you'll see that we've come a long way in handling local disasters, but still we can do better.  Even with Boston's amazing response, there are notes in some of my reading about it regarding the lack of information about operating rooms and ICUs.

For me, The SANER Project might have been inspired by COVID-19, and one nurse informaticist's complaint to me about the crazyness she was experiencing in trying to get data where it needed to go, but I've spent the last decade an then some looking at the challenges public health has been facing since AHIC first offered ANSI/HITSP what some of us still call "The Bird Flu Use Case", and which was preceded by the "Hurricane Katrina" use case, and before than the "Anthrax Use Case".  All of these were about public health and emergency response.  The standards we wanted weren't ready then, but they are now.  And so am I.  Let's get it right this time.