Facility and Status dashboards

Every Emergency Manager familiar with the capability of EMIS or CIMS systems talks about the need to have 'Dashboards' - display views showing critical information that are often shaded or coloured to highlight particular values based on priority, time due, alert level etc.

Unfortunately as much as everyone thinks they are a good thing (and the answer to all their briefing problems), no-one can really agree on what should actually be in a dashboard. Over the last year or so I've learnt that whilst most database EMIS systems can be built to record and display whatever their administrator or project manager can think of, the real challenge is in identifying data of worth that needs to be displayed.

Some of the NZ Health Emergency Managers may remember a WebEOC board that was used during the WebEOC trial in Ex Cruickshank May 2007. That board was based on the second page of the national health sitrep and allowed a District Health Board to report on bed availability, staff shortages, infrastructure damage, system status and utility failure.

Whilst this was turned into a great looking WebEOC board (a consolidated series of screenshots for 'Shortland St' Hospital is shown below) it underlined the fundamental difficulty in designing effective dashboards - that is how do you usefully record dashboard information such as fire, water damage, power outages or staff shortages for multi-sited, mulit-building, multi-department sites like a modern healthcare facility?

For example the paper based form had the ability to record as 'Functioning' 'Partially Functioning' and 'Not Functioning' for utility and service status that was subdivided into Electricity, Gas, Potable Water, Steam, Sewerage etc. Whilst these three values are easily added to a WebEOC form as a drop down field, and can be shaded in the display view green, orange and red the trouble is it does not really tell you what you need to know.

If Power is 'Partially Functioning' what does that actually mean on a multi-building hospital site, how does the partial power outage impact on the ability to receive casualties? What if it is in the Emergency Department - then there may still be options around field triage or generators but if it is in other departments, such as imaging or ICU the effects may be much greater.

Bed availability is another area that on first glance looks easy but is notoriously difficult to record within a dashboard. Intensive Care Unit capacity is not just the physical bed but also require trained staff, equipment such as ventilators and support systems. Furthermore clinical staff are excellent at actually freeing up capacity when it is required but all of this is dependent on capacity of other departments and wards and is not something that can easily be entered.

Some of the most successful dashboards in this area have been developed in jurisdictions that are linked to business as usual systems, especially Patient Management Systems. For example EM Systems provide a PMS that is used in about a third of US hospitals and is constantly updated on patient location, bed availability and staffing.

In the event of a hospital activating their Emergency Plan this data is immediately available to WebEOC via a special Application Program Interface. The advantages of this are obvious, clinical and clerical staff can get on with responding to the influx of casualties whilst the Emergency Operations Centre will have access to real time data right from the start of the incident.

The design of the NZ Health EMIS is such that it is intended to also support local incidents and not simply to be used in regional or national events. Over the last couple of weeks we've developed a number of APIs for this instance of WebEOC and going forward there is no reason why any NZ Health agency cannot develop APIs between their own business as usual systems and WebEOC.

With the Influenza response ongoing for the forseeable future I'm currently working on some options to host the next EMIS Reference Group meeting and another 'Board Building Boot Camp' to train some additional adminsitrators.

Shared EOC and Sig Event boards for Ambulance

Two new display boards have been created that allow Ambulance users to view EOC Event data from around the country.

This change was requested because Emergency Ambulance Communications Centre (EACC) was monitoring St John Northern Regions response to the Battle of The Streets last weekend but as everything was going to plan there were very few 'National Sig Events' created and National Sig Events are the EOC log entries which external agencies can see. Now whilst it was clearly a good thing that nothing was 'Nationally Significant' it is often beneficial for agencies to see what is happening routinely . I guess this is human nature, but it also serves to re-assure other agencies that everything is under control and that in fact there are not a whole load of log entries that have been recommended as a "national Sig Event' that the controller has not got around to reviewing and releasing.

We have got around this very quickly by creating 2 new boards; 02a. Ambulance Shared EOC Events and 03a. Ambulance Shared Sig Events. This means that all 10 of the Ambulance regions or structures can view these common logs. Obviously if an emergency occurs at a pre-planned event these logs will quickly grow in size, but at that point agencies should start using the controller reviewing function and posting to the 'National Sig Event' board.

It is important to remember that the Username will indicate the organisation (Ambulance Region) that has posted the entry. but depending on feedback I may add an additional field to the display on these boars to clearly show posting Agency.

I know some agencies in the US have used a slightly different approach whereby they give user access to a 'National Sig Event' board that will filter and show both controller reviewed entries and those awaiting controller review but I think this approach will work equally as well.

At the next meeting of the EMIS reference group we'll discuss whether similar shared Event logs would be useful on a geographical basis for example between groups of District Health Boards (DHBs) in a defined area, or DHBs and their Public Health Units.

Sometimes you need the old systems as well

Whilst I'm quite proud of the Health sectors national EMIS capability we've always recognised that its inherent strength, the ability to rapidly share information across agencies, is of course reliant on internet access. This is a balance of risk; the enhanced information management offered by WebEOC is offset by the risk that internet access may be compromised by the very event we are managing. While a number of agencies are now looking at satellite broadband in order to help ensure resilient connectivity it may still take 12 or 24 hours to get this capability operational in an affected area.

We've therefore developed a standardised self-carbonising message pad that allows users to record position log and task entries in exactly the same way as they would do in WebEOC. These pads produce 4 copies, allowing one each to be assigned to the Position Log, EOC Event Log, EOC Sig Event and Tasking. All pads are uniquely numbered as well as having each data field labelled allowing national sig event or tasks to be accurately communicated between agencies.

Emergency managers in health agencies that have access to EMIS have been sent their agencies allocation of forms.

I've also developed some pre-formatted display boards to record EOC & National Sig Events as well as EOC Status. These are A3 word documents and can be used as a paper based form or enlarged to A0 and laminated as shown below. If anyone would like a copy of these please email me. Used in conjunction with the pads these also provide an excellent visual demonstration of how a EOC event, Sig event or task is visible to all users in an EOC.