When Disaster Strikes
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1 When Disaster Strikes Supporting Disaster Response The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved. Copyright 2018 The Sequoia Project. All Rights Reserved.
2 Our Panel Nora Belcher, Executive Director, Texas ehealth Alliance Kristen Finne, Program Manager, empower and Senior Program Analyst Assistant Secretary for Preparedness and Response Leslie Witten-Rood, Program Manager, California Emergency Management Services Authority Mariann Yeager, CEO, The Sequoia Project The Sequoia Project 2018 Annual Member Meeting Copyright The Sequoia Project. All Rights Reserved. 2
3 An Introduction to PULSE The Sequoia Project 2018 Annual Member Meeting Copyright The Sequoia Project. All Rights Reserved. 3
4 Why Do We Need PULSE? 4 The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
5 History 2013: California Emergency Medical Services Authority (EMSA) hosted 1 st HIE in EMS Summit March 2015: HHS Idea Lab funds PULSE use case and technical architecture development March 2016: Ai engaged by EMSA to develop PULSE July 2017: PULSE Go-live with Ai as operator January 2018: PULSE becomes Sequoia program; Advisory Council formed April 2014: ONC engages Ai to evaluate use of HIE infrastructure for disaster preparedness and response July 2015: ONC awards EMSA a grant to advance HIE statewide during a disaster and regionally in daily EMS January 2017: HHS IDEA Lab blog publishes PULSE post November 2017: PULSE connects to ehealth Exchange and is activated for CA fires The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
6 PULSE Advisory Council Nora Belcher, Texas e-health Alliance (TEHA) Rim Cothren - California Association of Health Information Exchange (CAHIE) Tara Cramer Georgia Regional Academic Community Health Information Exchange (GRAChIE) Kristen Finne, HHS Assistant Secretary of Preparedness and Response (ASPR) Dan Smiley, California Emergency Medical Services Authority (CalEMSA) Lee Stevens, HHS Intergovernmental and External Affairs (IEA) Sean Turner, Dignity Health Leslie Witten-Rood, California Emergency Medical Services Authority (CalEMSA) Jeremy Wong, Audacious Inquiry (Ai) The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
7 What Does PULSE Do? Provides volunteer access to health records to treat patients seeking care in Alternate Care Facilities The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
8 How Does PULSE Work? Disaster Healthcare Volunteers report to assigned facility Volunteers log into PULSE portal using state credentials PULSE authenticates user against state s database Volunteers search and view records from connected providers and networks The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
9 Technical Architecture The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
10 PULSE Connects to Nationwide Networks Already connected to ehealth Exchange network, with California connections, and ability to connect nationwide Connectivity will be expanded through Carequality ehealth Exchange Carequality The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
11 Sample Workflow Triaging Patients Seeking Treatment at a Field Hospital Volunteer greets patient at triage Finds patient match CCD Summary of Care Documents Retrieved and utilized by a disaster health volunteer Broadcast patient to all PULSE participants Searches for patients using state ID, insurance card, or last known encounter Searches for Document(s) The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
12 DHV Single Sign-On The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
13 Select ACF The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
14 Patient Query The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
15 Patient Staging The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
16 Document List The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
17 Clinical Document Review The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved.
18 California PULSE Leslie Witten-Rood Program Manager California Emergency Management Services Authority The Sequoia Project 2018 Annual Member Meeting Copyright The Sequoia Project. All Rights Reserved.
19 STATE OF CALIFORNIA EMERGENCY MEDICAL SERVICES AUTHORITY Patient Unified Lookup System for Emergencies (PULSE) Presented by Leslie Witten-Rood
20 PULSE General Background Idea/concept came from experiences during Katrina (i.e., Katrina Health) April ONC published a report that assessed opportunities in CA and Gulf Coast to use HIE to support Disaster preparedness and EMS. The report identified two scenarios: 1) EMS data exchange with hospitals and 2) development of a disaster response medical history portal (PULSE) May ASPR and ONC received a $50,000 grant from HHS Ventures and IDEA Lab to establish the core technical approach/requirements, scope of work and use cases (scenarios) for PULSE July California EMSA received funding from ONC to design, build and implement PULSE
21 IDEA Lab in Action - California Connect HIEs so that providers and emergency responders have a way to access health information across systems Respond to disasters Improve Clinical Decision Making Improve patient health and Measure outcomes Interoperability
22 PULSE Patient/Provider Landscape Statewide Project in California 58 Counties and 53 Congressional Districts Target Populations: All victims experiencing a medical or trauma emergency served by EMS Displaced Victims of Disasters Providers & Practices: Paramedics and EMTs Physicians in Emergency Departments Physicians working in a Mobile Field Hospital or Alternate Care site Nurses Pharmacist
23 Earthquakes in California 1906 San Francisco Bay Bridge Collapse Northridge 1994 Napa 2014 Earthquakes Measuring 5.5 to 7.0+ from 1769 to 2000
24 March 2011 Tsunami Del Norte, Humboldt, San Mateo,& Santa Cruz
25 February 2017 Flood Evacuations Oroville, California
26 California PULSE Pilot Design Emergency or Disaster Occurs Request is made to EMSA to Activate PULSE EMSA Activates PULSE through the PULSE Operator DHV Volunteer can log into PULSE from DHV System (single sign-on through DHV website) Access to patient information for 4 Health Information Organizations 6 types of Licensed Volunteers can log into PULSE when its activated by EMSA : 1. Physician 2. Nurse Practitioner 3. Pharmacist 4. Registered Nurse 5. Physician s Assistant 6. EMT / Paramedic
27 Late June 2017 PULSE Table Top Drill Test the PULSE System are (Vendor Audacious Inquiry ) Ensure connections with four health information organizations (HIOs) 1. OCPRHIO 2. Santa Cruz HIE 3. Sutter Health 4. UC Davis Health Testing connectivity of the DHV System (Vendor Intermedix & Directory Services as part of the California Trusted Exchange Network (CTEN), operated by CAHIE Received end user feedback from the Sacramento Medical Reserve Corps and Sacramento County
28 Fall 2017 PULSE Implementation Roles & Responsibilities Develop Workflow Update Key Planning & Deployment Documents Communication Train end users Asset Request Process Deployment
29 2017 Wildfires Statewide October through December EMSA partnered with EMSA partnered with the Sequoia Project to increase Geographic Coverage for PULSE PLUSE was successfully connected to ehealth Exchange
30 October 2017 Wildfires Napa & Sonoma Over 250 Major Wildfires 1.3 million Acres Burned 9,470 Structures Destroyed - Approx. 5,000 Residential Destroyed 47 Lives Lost Includes 5 of the 20 most destructive fires in CA history
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32 TITLE
33 Both Kaiser and Sutter Hospital had to be evacuated in Sonoma County TITLE
34 Principles of Disaster Medical/Health Operations Local Operational Control and Response Standardized Emergency Management System (SEMS) Compliant Structured to Facilitate Mutual Aid State Responsible for Resource Assistance Coordinate and Integrate Private and Public ESF 8 Partners
35 Standardized Emergency Management System (SEMS) During an emergency, multiple jurisdictions and agencies will likely be involved The purpose of SEMS is to: - Manage multiple agencies and jurisdictions in CA - Facilitate the flow of information within and between system levels - Coordinate amongst all responding agencies - Ensure structured and common response to emergencies - Incorporate the Incident Command System (ICS)
36 California 58 Counties 6 Mutual Aid Regions Home Rule State Power of local city or county to establish own system of self-government Gaps: - Every County is different - Disparate Systems (communications, patient tracking, resource requesting etc.) - Limited Cooperative Agreements between counties and across regions
37 EMS Mutual Aid/Assistance 15 Ambulance Strike Teams deployed over 100 ambulances used over the course of a week Teams from 13 California counties Medical/Health Personnel EMT, Medic, RN, MD, RT, mental health clinicians, Enviro Health, CALMATs, DHV, MRCs
38 Medical Impact
39 January 2018 Southern CA Mudslides After weeks of wildfires, heavy rain caused flash flooding and mudslides in Santa Barbara and Ventura County
40 June 2018 USAR/CAL-MAT Field Training Exercise (Moffett Field, CA)
41 80 CAL-MAT/DHV Users Trained at PULSE Exercise The Scenario used for the PULSE Exercise was a large scale earthquake in the Bay Area. The exercise objective was to train CAL-MAT/DHV Providers on PULSE and to use the PULSE Asset while testing PULSE workflow in a disaster environment.
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43 July 2018 PULSE was activated and deployed in Shasta and Lake County EMSA partnered with Sequoia and CAHIE to onboard additional patient records for affected areas: Sacvalley Medshare Dignity Health
44 July and August 2018 Wildfires Northern California Medical Reserve Corps (MRC) supported local medical and health operations at the shelter. Contra Costa County MRC provided care in Lake County
45 My Top 5 Challenges 1. Statewide Coverage for PULSE 2. Sustainable Funding 3. Procurement Process 4. Stable Internet Connections 5. Improve Review Function Highlight within, or parse, C-CDA documents those data elements or fields most appropriate or more urgent for use in an emergency (most likely allergies, medications, problems, perhaps immunizations) Consolidate all requested documents into a single report with provenance to improve review time
46 Next Steps Medi-Cal (Medicaid) 90/10 Funding provided for PULSE Phase II identify contributors for matching funds Expand Care Plan Exchange for Disaster response adding additional HIE/HIOs Onboard to ehealth Exchange & Carequality Expand Capabilities of PULSE Expand DHV users to include hospital and EMS staff PULSE will stay in active state and the access control will be with the DHV Single Sign on. Continued collaboration with federal, state and local partners ONC NHTSA NEMSIS ASPR CalOHII CAHIE Local EMS Agencies Sequoia Project
47 Next Steps Statewide Coverage
48 Onboard Additional HIOs Current Connections 1. OCPRHIO 2. Santa Cruz HIE 3. Sutter Health 4. UC Davis Health 5. Sacvalley Medshare 6. Dignity Health
49 Patient Tracking
50 The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved. 50
51 Building Support for PULSE in Texas Nora Belcher Executive Director Texas ehealth Alliance The Sequoia Project 2018 Annual Member Meeting Copyright The Sequoia Project. All Rights Reserved. 51
52 How PULSE Relates to Federal Strategies to Support Disaster Response Efforts Kristen Finne Program Manager, HHS empower Program Senior Program Analyst, Assistant Secretary for Preparedness and Response The Sequoia Project 2018 Annual Member Meeting Copyright The Sequoia Project. All Rights Reserved. 52
53 Thank you for your participation. S E Q U O I A P R O J E C T. O R G The Sequoia Project 2018 Annual Member Meeting Copyright 2018 The Sequoia Project. All Rights Reserved. Copyright 2018 The Sequoia Project. All Rights Reserved.
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