How Public Health Strengthens Emergency Preparedness Through Data Readiness

SUMMER JOHNSON:
This is Public Health Review. I'm Summer Johnson. On this episode, a data readiness project benefiting several states.

MARGAUX HAVILAND:
This data that can be exchanged is essential for decision making; it's essential for state health agencies and territorial health agencies to understand the supplies that they need and where they need to get them to. So one of the biggest things from all of the sites that we have had participate in this recent cohort is the buy-in from their leadership about the prioritization of interoperability and data sharing during emergency.

JOHNSON:
Welcome to Public Health Review, a resource of the Association of State and Territorial Health Officials. On each episode, we explore what health departments are doing to tackle the most pressing public health issues facing our states and territories. And today, a closer look at an ASTHO collaboration with ASPR’s H-Core, or ASPR Center for the HHS Coordination Operations and Response Element.

The partnership is providing bi-directional sharing updates for states across the country. We will hear how states like Virginia, Massachusetts, and North Dakota are utilizing the project, but first, let's hear more about ASTHO's involvement. Margaux Haviland is ASTHO's Director for Preparedness and Response Coordination.

HAVILAND:
We had the great opportunity for the last two years to collaborate with H-Core, and that's ASPR's Center for the HHS Coordination Operations and Response Element, on what we refer to as the data readiness project work. This last year, actually, we had an opportunity to provide a subaward to eight demonstration sites. And the prior year, we were able to provide subawards to what we called pilot sites.

So this last year was for the demonstration of scalable solutions and that first year was really for some fact-finding and an opportunity to explore what opportunities and solutions were available.

JOHNSON:
Tell us about embarking on the National Landscape Survey and some of the things that you found.

HAVILAND:
Sure, so this past year, one of the most striking findings that we have from the Landscape Analysis that ASTHO completed was just how much variation exists across jurisdictions in terms of their inventory management systems, their ordering systems, and their responses indicated everything from fully manual processes using Excel spreadsheets and emails all the way to sophisticated vendor-based platforms, and some even custom-built solutions.

But despite the differences in the systems, the one consistent theme that we heard in our responses was funding and a lack of sustained investment being the most frequently noted barrier to adopting or upgrading any of their inventory management systems.

JOHNSON:
In the second cohort, you worked with Virginia. Can you explain briefly what their system looks like now?

HAVILAND:
Sure. So, really excited for our partners in Virginia as MCM portal that they enhanced on one of their current systems. They built out a custom solution to facilitate the ordering and inventory management of medical countermeasures on an internal system that meets all of the needs outlined in the project - but also meets all of the needs that they have learned from past responses to the extent of being able to identify their users, operational hours, what type of refrigerators they have, if they're open on Saturdays, and then additionally, the opportunity for folks to come in and report on the status of all their inventory and their administration.

So, they have filled the gap of the need for a system to capture ordering and inventory and administration by building a custom solution that fulfills the needs of all of those elements.

JOHNSON:
Massachusetts now had a different tactic, equally as impressive. Tell us about that.

HAVILAND:
So, Massachusetts actually was able to leverage some products that are available off the shelf in terms of systems that are available that are not cost prohibitive, that could potentially be an option available to all of our member jurisdictions that are reasonable and affordable and sustainable. And they were able to utilize those to meet their needs and connect systems for the data exchange and the processing of those current systems that are in place to enable them to meet the demands of the project plans.

JOHNSON:
And also, North Dakota has a unique story about their project. Set us up for that.

HAVILAND:
So, North Dakota in itself is also very unique because they serve a very unique population in a very unique kind of landscape in terms of how far and why they need to reach. But in the fact that their population may not be as large as some other jurisdictions, but they're very difficult to reach. And North Dakota has taken an approach where they have made sure that they can bolster their own internal infrastructure because of the fact that they know that when an emergency hits, they are going to be potentially one of the hardest places for folks and resources to reach. So how can they be as independent as possible and make sure that they can function internally without necessarily needing outside input and or resources?

So they have built a system that meets their needs for ordering and processing and the inventory of for their communities that they serve and done so, so that they can utilize that to leverage their existing warehouse space to be able to send out products based on the need that's validated.

So they have created a system that ticks all the buttons but also is able to operate in a system where they know that they are not going to be the first to receive support from outside sources because of potential weather constraints and just be able — the ability to get to their location.

JOHNSON:
Did you find any commonalities among the states when it comes to data sharing?

HAVILAND:
We have. So, a lot of what we're really, really seeing is that there's a great deal of leadership buy-in. There is the recognition from state health agency and territorial health agency leadership that the data sharing during an emergency is essential. This data that can be exchanged is essential for decision-making, is essential for state health agencies and territorial health agencies to understand that this applies that they need and where they need to get them to. So, one of the biggest things from all of the sites that we have had participate in this recent cohort is the buy-in from their leadership about the prioritization of interoperability and data sharing during emergency.

JOHNSON:
What does it look like for the states when their time with ASTHO comes to an end?

HAVILAND:
So right now, our work with H-Core is currently coming to an end. And so our hope is that, and based on everything that we've learned this year, it really underscores the importance of improving data readiness, not through technology, but through sustained funding. And the need for cross-jurisdictional collaboration and the systems that are in place require sustained funding to maintain those and to improve those as the needs arise based on the types of response that come up.

JOHNSON:
We still have many more states and territories that have different types of data sharing. Talk to us a little bit more about the importance of sustainable funding in preparation for the next emergency.

HAVILAND:
So, maintaining and improving these systems over time is really going to require sustained investment. And that's not just the technology, but the licensing, the contracting, the vendor participation, staffing, training. And if we want to build a truly responsive, resilient public health system, we have to think beyond one-time funding. Long-term readiness depends on the long-term commitment, but that's not something that states and territories can do alone. The infrastructure, the people, and the continuous improvement that supports state and territorial public health data readiness really needs to be supported internally, but also from our federal partners, where a large amount of the preparedness funding comes from.

JOHNSON:
Margaux, what did this project in a whole prove to us?

HAVILAND:
So, this project in entirety showed what can happen when specific targeted funding can be available to jurisdictions. These jurisdictions all had different models, different structures, different systems in place, but they were all able to either jumpstart, accelerate, bolster, or kind of invigorate work that was already in process or had already been envisioned, but just needed a little bit of a boost.

And now those states were able to kind of make some meaningful progress in building systems that support a better, more informed data-driven response during public health emergencies.

JOHNSON:
Jonathan Kiser, the Director of Emergency Preparedness at the Virginia Department of Health, is here to explain how data sharing is helping his office.

JONATHAN KISER:
Yeah, this has been a really exciting project that's helped us move from really from concept to execution in a way that wouldn't have been possible otherwise. So before this, we had already developed a Naloxone distribution portal in-house. We knew it had potential for broader application.

However, like many public health agencies, we've been pretty limited by our funding and staffing and our competing priorities. So this project provided not just the financial support, but also the structure and the momentum really that we needed to take our initial idea and develop it into our new medical countermeasures portal.

I'd say what's exciting is that we were able to build the system before an emergency, which is a huge shift from more of that reactive approach we've often had to take in the past, especially during the COVID-19 pandemic response when it oftentimes felt like a new system or reporting tool was coming online every day. It also brought together our core medical countermeasures team from across the Virginia Department of Health. So that included our Office of Emergency Preparedness and Information Management and our Division of Pharmacy Services. Really, that collaboration is essential during responses. And of course it was essential as well during development of our new portal. Each group brings a different perspective and together, I think we've been able to design a system that's grounded both in operational reality and also informed by lessons that we've learned from our past public health responses.

JOHNSON:
What were the specific challenges that you were hoping to tackle?

KISER:
Yeah, so, you know, interoperability is one of the most critical components of modern public health infrastructure.

In an emergency, the ability to share data seamlessly across systems and jurisdictions is critical for establishing the common operating picture that we all want and need. I'd say one of the biggest challenges we faced during development was the uncertainty around the federal interoperability standards, which of course are still evolving. So we've designed our MCM portal to be as flexible and adaptable as possible.

It's built to connect with a variety of platforms and data exchange formats. So as those standards do become more clear, we'll be ready to integrate without having to rebuild from scratch. At the state and local level, we also focused on practical interoperability. So really understanding what our local health departments and our other MCM partners need to operate effectively. That's why we included features like real-time communication tools, some inventory tracking dashboards and automated reporting.

So really our hope is that these capabilities will help us coordinate more effectively and efficiently while reducing duplication of effort so that we can make those informed decisions during response.

JOHNSON:
Virginia is a pretty large state, right?

KISER:
Yeah, absolutely. Very large state, a mix of urban and rural areas. We've got it all.

JOHNSON:
You talked a little bit about your dashboard, but if you could also talk about your MCM portal and how that will allow you to distribute those materials quickly, to that very large, diverse Virginia population.

KISER:
Yeah, so again, it's all about having the right data at the right time and really making that data actionable. So when partners register in the new portal, they provide detailed operational information, which includes things like whether they have a loading dock and if they do, what size truck it can accommodate, what kind of cold storage they can support, like standard refrigeration or ultra cold freezers, their hours of operation, and other key pieces of information. I think another important feature that I'm most excited about is the ability to upload and track our MOAs and MOUs for points of dispensing of pod sites. These documents are critical for ensuring that the roles, responsibilities, and expectations are clearly defined ahead of time. So our hope is that by centralizing them in this portal, we can quickly verify which sites are authorized and ready to operate during an emergency.

The portal also includes built-in tools for inventory management and order processing. So we're not just sending out medical countermeasures. We're tracking what's been delivered, what's still needed, and how those needs are changing in real time. So hopefully that level of visibility is going to be a game changer for our emergency logistics program.

JOHNSON:
How do you roll that out with your partners?

KISER:
Yes, we're going to take a phased approach and a thoughtful approach to the rollout. Our first step is going to be to finalize our standard operating procedures and our user access requirements with our local health departments, really to ensure that our local health departments remain front and center in our MCM distribution and dispensing process. The next step will be to reconnect with past partners, so organizations that have already worked with us through Naloxone Distribution Platform or from our closed pod partners that have worked with us for many years.

So, you know, since the MCM portal builds on that Naloxone Distribution Foundation, I think many of them will find the interface familiar, which does help reduce that learning curve. But it also provides an opportunity to engage with new partners to expand our MCM network in a more standardized way statewide. Training and support are also going to be key here.

So we're developing user guides, we'll be hosting live training sessions, and of course we'll offer one-on-one technical assistance wherever that's needed. So really, ultimately, we want this to be a tool that partners trust and rely on, not just during an emergency, but also as part of their ongoing preparedness efforts.

JOHNSON:
Over to North Dakota, Tim Weedrick is the section director for the Health Response and Licensure section with the North Dakota Department of Health and Human Services. Wiedrich says his department was facing challenges that H-Core has helped solve.

TIM WIEDRICH:
We had this concept of having a state medical cash to fulfill those needs when the normal supply chains aren't available to us. And that supply chain, we have had the creation of a medical cash system that has 900 distinct items in it in quantities are sufficient for our size population in certain strategic areas. And that we've coupled with having an internal courier system as well. Now, all this sounds really, really good and it is really, really good. We're very proud of what we built over the last, frankly, 15 plus years. But where the weaknesses exist is what is really being filled now by our participation in this ASTHO H-Core data readiness project. And that was taking these frankly, multiple disparate systems that we have and centralizing them into an actual coordinated data system.

Now, what I mean by that is that, you know, previous to this, if you're going to place an order, let's say that you're a hospital and these items can be ordered by hospitals, long-term care, EMS providers, public health, any of the stakeholders that are part of the response system, you'd have to go online, in an online shopping environment, much like our own little amazon.com and pick out the items that you want, order the quantities that you want.

But then our staff would have to manually transfer that information into our warehouse electronic inventory system. And then it would get picked and then packaged and then distributed. either using common carriers, if FedEx or UPS makes sense. But if time does not permit that or the cost is not as efficient as using our own couriers, we have a small carrier system as well that will deliver product at 2 a.m. on a Saturday morning if that's necessary.

So that's the way it was, but what this now is doing is consolidating and allowed us to consolidate those multiple systems I just described from online to the order fulfillment, to the distribution process, into a centralized hub of coordinated data systems. And what that then means is that by having those items brought together in that centralized hub, we now have a coordinated system limiting the manual transfer of information and just frankly being able to accelerate and modernize the system moving forward. At the end of the day, what this really does for us is it improves our situational awareness because we're not relying on manual transfer processes. And it also helps us with kind of the efficiency and effectiveness of staff that rather than doing this manual process now can devote to the actual response activities.

JOHNSON:
It sounds like a lot of work.

WIEDRICH:
It is, but it has really produced benefits in terms of, whether we look at a small event, you know, certainly nothing that reaches national scale, but North Dakota, have about 14 to 16 of these types of responses that may be having like a medical facility being evacuated or, or shortage of supplies that are necessary and just not available to the large events like we had during COVID and other situations where those products also become in short supply. And so we really believe that this medical cash process is, as I said, one of our three foundational core competencies. It's necessary for us to have that process.

JOHNSON:
Talk to us about the partnership with ASTHO. When I say it sounds like a lot of work for you to tackle this project, what did ASTHO specifically bring in to help you all?

WIEDRICH:
Yeah. So with frankly, the H-Core data readiness project funds, we coordinated really the coordination of movement away from these disparate systems and now built a process that lets us link those systems. And I haven't talked about this yet, but the important part of that linkage now in creating that centralized hub isn't just the efficiency of not having to do manual transfers, but those linkages have given us the capability now to build dashboards. And those dashboards are much more effective than just having individual linkages. So, prior to the H-Core funding and ASTHO's collaboration and our exposure, frankly, as part of this process through ASTHO to other states that have systems that are under development, while there's greatly, there certainly are differences. But there's commonality.

And so we were able to draw that information. But the main thing is, you know, so funding through the H-Core process didn't buy the management information systems. That was funded through FEP and HBP over a long period of time. And we continue to maintain those systems that way. But what this did is it gave us a focus to be able to concentrate on linking those into an organized system rather than disparate systems. And ultimately that means that we can turn raw data into useful information and distribute that information through Dashboard.

JOHNSON:
It sounds like the grant just kind of gave you a boost.

WIEDRICH:
It did. We had disparate systems that were functional, but not in the most efficient and effective way. I'll come back to this point, you know, once again, is that this whole notion about interoperability, you know, it really goes beyond just connecting the systems though. It really is about taking that raw data that exists in all these different formats and compiling it into something that's actually useful. And that's really where the dashboard frontier is, is opening up the horizons to be able to take this information in a real-time or near real-time environment. So an EMS provider, frankly, can look and see which hospitals are on what we call admission advisories. And we've accomplished that now with part of this process, not related to the inventory that I was talking about earlier, but by those same processes that were installed as a result of what we accomplished with the H-Core process to be able to have EMS providers in other hospitals do admission advisories if their CAT scans down, they're not in a position to take stroke patients or those types of situations. And as I said, we're just scratching the surface of who we intend to share this information with.

JOHNSON:
You said you were able to take a peek at what other states were doing in their programs. What's the biggest lesson that you would share with other health departments who are trying to do the same thing?

WIEDRICH:
Yeah, and again, I think that probably the biggest lesson is, you the whole notion about this interoperability needs to be a transparent process, that we really do need to look back to not just what our needs are, or what another response agency's needs are, or what level of government is requesting the information, but really to be able to pull that into a bigger picture so that can have systems that are actually adequately responding to those needs. And that transparency has to come from, frankly, I saw we and our counterparts reaching out to stakeholders in these systems and basically driving those processes in a way that isn't just the state of North Dakota reaching out and saying, you've got to provide this information to us, but really having that collaborative process. I would say the same thing at the federal level and at local levels as well. This really does have to come together in a way that really augments that collaboration and reduces this to useful information rather than raw data.

JOHNSON:
Massachusetts also made sure to participate in capacity building for the H-Core Data Readiness Project. Shane Keville-Wagner is the Resource and Inventory Coordinator with the Massachusetts Department of Public Health, Office of Preparedness and Emergency Management.

Shane, how has participating in the capacity building for the H-Core Data Readiness Project accelerated the work of the Massachusetts Health Department?

SHANE KEVILLE-WAGNER:
The most obvious way that participating in the project enabled our bi-directional data sharing work is of course funding. There are so many important projects being undertaken at the department, and staff time is so precious, so getting leadership's buy-in for these new projects is so much easier when the financial burden is reduced. Outside of funding, the department's work was accelerated by the fact that the minimum data elements to be shared were pre-identified as part of a prior year funding opportunity that we were able to participate in. And this allowed us to focus on resources, on verifying that we were accurately capturing this data in our inventory management system and home in on the mechanics of transferring the data to our enterprise data platform. The project goals for the grant aligned with our ongoing data modernization initiative work and we were able to tap into that and our IT team to write the API calls between our data systems. The DMI was crucial in implementing the system integrations, but also ensuring that the data we are capturing is meaningful and as future proof as possible.

JOHNSON:
How will this improve your capacity to respond to future emergencies?

KEVILLE-WAGNER:
Right, well, the interoperability between our inventory management systems through our enterprise data platform, Snowflake, positions the state to better respond to public health and healthcare emergencies. Basically, the data from our newly opened state public health warehouse, our six regional partners, and our vendor managed RSS site is consolidated so that we have complete visibility into all of our inventory, no matter where it is. Those updates happen automatically and send us notifications if something is wrong. For example, if a regional partner adds something to an inventory that isn't in our list of pre-existing items, all of that data are brought together in Snowflake so that we have a complete reporting on our inventory from where it is, where it goes, who gets it, and when it expires.

And Snowflake has lots of connectors to visualization platforms and other analytic software so that we can use these data whenever we need them. Needless to say, by bringing real-time healthcare resource data to the table when quick decisions need to be made, it supports our agency's ability to make informed and science-driven determinations.

JOHNSON:
What sort of challenges or questions does the platform answer that help you make MCM decisions better or faster?

KEVILLE-WAGNER:
We utilize Power BI, which is a business analytics platform to pull real-time up-to-date data from Snowflake, which is our enterprise data platform. Our amazing in-house Epi data team, or really anyone in the office, is able to then build out interactive dashboards within Power BI that we then use to quickly answer questions like, how many of this item do we have, or when do they expire, and so forth.

For blue sky days, our visualization platform is great for projecting burn rates or determining when stock needs to be rotated and using these metrics to justify operational budgets. Now, in the event that stockpiled goods need to be distributed across the Commonwealth in response to an event, the Power BI dashboards can monitor who is requesting resources, where resources are being requested, and allows us to dive into the actual transactional history.

Resource data analytics during and after disaster are crucial in informing public health policy and ensuring that our vulnerable populations are cared for and equally supported.

JOHNSON:
What drove the decision to custom make the platform?

KEVILLE-WAGNER:
So when our team was initially researching the inventory management platforms, we were looking for a system that could handle every aspect of the inventory management and distribution needs. Ideally, we wanted a platform that would allow us to retrieve and track inventory within the warehouse, differentiate between loaned items and consumable items, and permit end user requesting, similar to kind of like an e-commerce platform and allow for the end user to then report on the item's disposition. And we quickly found out that a system that achieves all of those functions doesn't readily exist. So we explored the viability of a custom-built solution. And it didn't take long to realize that a custom platform was not advantageous due to the anticipated high costs.

So we looked to other state agencies who have a warehouse and do this work and found that, that our colleagues in the Massachusetts Emergency Management Agency had a solution already in place. So to allow for the cross-training and familiarity of use, we opted to use the same solution. And in terms of the interoperability, the data management solutions, we're lucky that our department's data modernization initiative implemented Snowflake a few years ago because we were able to use it at a shared cost and it offers a lot of flexibility in how we build our data and the connections.

Since it was already in use in the department, there was a support team and experts on hand that could help us build out the more complicated data flows between the systems. Snowflake gave us the extra flexibility we needed to take the off-the-shelf warehouse management software and make it work well for our specific needs.

JOHNSON:
Thank you, Shane. Here's Haviland again.

HAVILAND:
So this project in entirety showed what can happen when specific targeted funding can be available to jurisdictions. These jurisdictions all had different models, different structures, different systems in place, but they were all able to either jumpstart, accelerate, bolster, or kind of invigorate work that was already in process or had already been envisioned, but just needed a little bit of a boost.

And now those states were able to kind of make some meaningful progress in building systems that support a better, more informed data-driven response during public health emergencies.

JOHNSON:
Thank you for listening to Public Health Review. If you like the show, please share this episode with your colleagues and on social media. And if you have comments, questions, or ideas, we'd love to hear from you. Just email us at pr at astho.org. Never miss a new show by hitting the follow button on your favorite podcast player. Also, stay up to date on everything happening at ASTHO and in public health by tuning into the Public Health Review Morning Edition.

We cover news like this every weekday morning in under five minutes. Look for the link to the newscast in the show notes for this episode. For Public Health Review, I'm Summer Johnson. Be well.