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The healthcare system and its many key components (public and private hospitals, medical supplies & equipment, pharmaceuticals, medical practitioners, healthcare professionals, and support staff) represent one of the most multi-disciplinary information producing and information demanding environments in the world.
Many hospitals are fairly adept at scaling up ("flexing up") for a relatively small and anticipated protracted event (e.g., flu season) and rescheduling a very large and diverse work force. However, with the major reductions in bed numbers in recent years, compounded by the closing of many hospitals, and coupled with the advent of just-in-time purchasing practices intended to lower operating costs, the healthcare system now finds itself unable to quickly identify sources and procure many different resources (people, supplies, food, drugs, etc.) in sufficient quantities needed for response to massive acute or even smaller, prolonged mass casualty events. It is very unlikely that current business practices, directed toward conserving resources, would be significantly changed in order to increase preparedness for what most hospitals consider a statistically unlikely event such as local terrorist actions or a Category 5 hurricane. One need only look at the examples set by hundreds of hospitals in close proximity to large airports, most of which are totally unprepared for the mass casualties that might be the product of a major airline accident. Thus it is apparent that a different, more effective planning, management and martialling process is required to minimize the impact of large scale "assaults" on thinly-stretched healthcare resources.
In the absence of essential real-time information about the potential demand for health services in relationship to resource availability and capacity, hospitals and healthcare systems represent a major weakness in the overall preparedness and defense of the community, and therefore the nation. As of February 14, 2006, nearly six months after Hurricane Katrina devastated the New Orleans area; the Louisiana Hospital Assn. still lists six acute care hospitals in Orleans Parish as "closed/evacuated" (LHA, 2006). Before Katrina, "Big Charity" Hospital alone handled 144,000 emergency visits annually and many now believe it will be torn down as a result of the damage sustained in Hurricanes Katrina and Rita (KFF, 2005). The practical implication is that the healthcare sector and its hospital systems will be required to create new types of information and information systems that essentially reduce the "cycle time" of ramping up for large scale emergencies.
The Agency for Healthcare Research and Quality efforts to develop evidence-based information aimed at improving the quality of the U.S. health care system is a critical component of the larger initiative of the U.S. Department of Health and Human Services to develop public health programs to combat bioterrorism which easily can be conceived as supporting all-hazards response. Projects and activities comprising AHRQ's comprehensive bioterrorism preparedness portfolio are designed to assess and enhance the interface between the clinical care delivery system and public health infrastructure.
HavBED (Hospital Available Beds for Emergencies and Disasters) is an information technology proof-of-concept project to demonstrate a standardized "real-time" hospital bed and resource availability information system that can be used by decision makers, planners and emergency personnel at the local, state, regional and federal levels.
The HAvBED prototype has demonstrated the feasibility and utility of a system that captures and integrates currently accessible bed availability data from disparate systems in use with hospital and healthcare organizations and across the country and coupling those data with data from organizations that do not currently participate in these systems to produce a large-scale picture of patient bed availability and hospital status across the country. These amalgamated data would be of assistance at a local, regional or national level in dispositioning patients from one (or more) large-scale multi-casualty events from either natural causes or from the use of weapons of mass destruction.
Important recommendations from the HAvBED project are the basis for what is needed in a fully implemented interoperable, multi-scale hospital/healthcare information and decision support system. The system should be scalable so that it meets the needs of individual hospital and healthcare organizations as well as regional, state and National decision makers. Being able to link to existing hospital status and bed capacity reporting systems is considered a critical success factor in assuring system acceptability. Hospitals and organizations that don?t have electronic reporting systems should be provided a means for manual data entry via web interface.
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