2020-09-21 COVID19 COVID-19 Mobile App Project - ED Staging

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@lmarcial

RTI

Bo Dagnall

Perspecta

Denis Gagne

Trisotech

x

Dhruv Sharma

American College of Emergency Physicians

Henning Von Schmeling

Korio

Ken Rubin

University of Utah

x

Linda Chan

Pivotal Insight, LLC.

Murray Oles

Chalexcorp

Matthew M. Burton, M.D.

Apervita, Inc.

Sean Muir

 JKM SW

Sree Vaddi

Red Hat

Robert Lario

University of Utah

Tracie Berardi

OMG

Nathan Vafaie

James McClay

Univ Nebraska Medical center

Keith Toussaint

Situation

Emergency Department (ED) Staging is a crucial aspect of determining and sharing operational and potential surge status for pandemic preparedness and could be better supported with a shareable electronic resource (an app) that could provide high level, visually rich information about the current stage of a given ED and steps that could be taken to recover.

Background

During the COVID-19 crisis, a lot of experience has been gained regarding the key factors needed to track and monitor how individual emergency departments are coping with varying degrees of strain on their systems. Much of the information that might support the process of staging an ED is already tracked but may live in disparate data sources and may not be standardized across systems.

Assessment

The current COVID-19 crisis has drawn significant attention to the strain EDs have been under in responding to the needs of patient care during a pandemic. Work done by the American College of Emergency Physicians (ACEP) has charted a path to provide better support for understanding the capacity of any given ED and help communicate that out broadly while also providing key insights into steps toward recovery. However, the data that would facilitate staging is not readily available in a format that would be useful to the staging process, no clear owners or managers of that data exist and no clear path to collecting, aggregating, storing and communicating this data yet exists. A tool (e.g., an application) that provides a standardized approach to identifying, collecting and reporting data on the relative stage of an emergency department under crisis conditions is needed.

Challenges:

• There is a need to foster communication and collaboration among EDs under crisis conditions about readiness to provide relevant patient care

• This need exists both within health systems and regionally

• While some data to support the staging process does exist, it often lives in different places within the health system environment

• There is no clear ‘owner’ of this type of information at any specific level within relevant stakeholder organizations

• Some of the information needed to support the staging process could potentially come from data that is already being collected and reported

• Some of the information needed to support the staging process could potentially come from public use data or public health data

• There are no standards associated with the collection and reporting of data on ED stage in a crisis

• Differing models (if any) exist on how to manage this data

• There are concerns about sharing data like this yet it is crucial to overall emergency response

• There is a lack of clarity on who should or could ‘own’ this data

Recommendation

The American College of Emergency Physicians (ACEP) has invested some effort into conceptualizing the staging process, measures which might inform it, operational methods for upstaging and/or downstaging an ED and approaches to assisting with recovery. In addition, some quality measures and other required reporting metrics are key elements of the staging process. Open APIs and other nascent tools may make it more plausible to combine disparate data streams to help prepopulate some of the metrics needed to determine a stage for a given ED. Individual ED’s, health systems, local state and federal government entities including public health departments, health information exchanges and pandemic preparedness organizations would find this information useful. If further developed to include a set of ‘recovery’ resources, EDs would find the staging process and mitigation steps invaluable.

• For federal disaster management, it would be highly valuable to use a cloud-based service (application) to collect and report in a standardized way the current stage of US EDs in a crisis

• API-level access to relevant data streams may make it plausible to automatically deliver some of the data needed for ED staging

• In order to establish some guidelines on staging, a shared understanding of the underlying data and its structure would be required

• Some of this data is already being collected and could be presented for validation

• This effort would foster the development of a standardized approach to determining how prepared a given ED is for disaster response which would facilitate the management of overflow, etc.

• A variety of stakeholders would benefit from being able to monitor this information over time

• Even the seasonal flu cycles could be better managed with this staging service

• The use of the application could foster improvements in communication and collaboration among EDs regionally and nationally

• Both individual EDs and related stakeholders would benefit from the additional guidance on steps to mitigate or recover during a crisis

• The steps that have been taken to date to develop an app to support ED Staging are in good alignment with a hackathon activity to invite further development

• The ACEP field guide is just the first of a wide range of resources and services ACEP is providing to 

• Notes in original table/matrix are good resources as well

• ACEP creates policies and guidelines and is working to convert them into machine readable and human readable versions via BPM+

• Evidence Care is helping connect this work (supporting ACEP to develop machine readable resources) as a developer/implementer organization

Resources:

• ED Staging matrix from ACEP

• Preliminary app wireframes

Data sources:

• Juvare: In 70% of EDs collecting data (not sure about links to state-level reporting) (Ed Bartell)

• EvidenceCare: Brian Fengler

• COVID-19 Maps/Resources

  • zip code/region

  • public health

  • reporting requirements

• Country examples

  • Singapore

  • New Zealand

  • South Korea

  • Norway

  • Taiwan

  • Sweden

GoToMeeting recording and Transcript

Pandemic instead of disaster preparedness

Notes

10/5/2020

Attendees: Robert Lario, Dhruv, Laura, Nathan

Notes:

• ED less filled with COVID (yikes)

•