Episode 035: The Public Health Agency’s Remedy for Ailing Point Solutions

Thanks for joining us. My name is Kevin Ledgister, your host. And today we’re talking about public health agencies, government agencies, so this is a lot of focus on their responsiveness right now. With me is our returning former CIO that now consultant CIO, Paul [orman, to talk to us about how technology can play a crucial part in these agencies operations. Not only with the situation at the moment, but also for future contingencies. So, welcome, Paul.

So, maybe you can just share with our listeners a little bit in terms of what are some things that are happening on that front and how are these things kind of being addressed from a budgetary standpoint, so that these public health agencies have the resources they need to really to respond.

Within public health, the agencies that are receiving the tests, these public health agencies, are reporting up to the Center for Disease Control. Then, down to the first responders so that everyone is aware of the latest and greatest information. That reporting process is really where funding has been freed up, if you will, by the Federal Government. What the most recent legislative and executive acts have done is they’ve eliminated specific processes that were in place to do things like the allocation of maps, for example. There was an allocation structure built into the regulations of federal public health that allocated maps to different industries.

Those allocations were just changed by an executive order. The funding streams that have been made available, FEMA has been brought in, and FEMA has the ability to provide funding for disaster relief. They’re typically the same grant processes that exist from public health agencies at the federal level, the public health agencies at the local level, but they have disaster relief rules and procedures applied to them. Those funding sources have just been made available. Total funding of about $50 billion has started to move through FEMA. Prior to this, there was an executive action and support from Congress for a piece of legislation that made about $500 million available to each of the States.

It’s broadly construed to be available to cover the costs of responding to the epidemic. So, for our listeners who are curious, I’m assuming at this point public health agencies are aware of what they’re getting. But for those that are not aware, it’ll roughly break down into about $10 million for that first round of funding per state, and roughly about $1 billion per state for the second round of funding. Although that second round of funding through FEMA is by application and it’s a grant application process that the States are going to go through. That’s the funding that’s coming into the States to help address the testing, purchasing additional supplies, and addressing the changes that are going to have to happen in their internal systems to manage the new tests that are coming in.

Just a little bit about those tests. In normal operating times, there are specific labs designated in each State that are designed as testing facilities that the epidemiologists use. So, regardless of where you go, if you go to your local doctor or you’re in the hospital and a test is ordered, those tests are sent to the labs that are in the States. Some States may have as many as 10 or 15 labs, other States, smaller States may only have two, but those labs are the ones that are essentially doing the reporting. So, report streams from those labs come into the public health agencies and the public health agency’s responsibility is to process those.

Identify the positive tests, report them to the CDC and to the first responders. What’s happened is, instead of two labs in a small State, there may be now a dozen different testing facilities that have come online, including federal testing facilities. All of these testing facilities do not already have systems for reporting. So, one of the things that we’re reaching out to the public health agencies to talk about is what we can do by way of assisting them in addressing this large influx of new tests coming into the agencies.

The reason for this is if you have a positive test for a communicable disease, they’re going to want to be able to instantaneously plot it and start doing the tracing that has to be done to determine who you’ve come in contact with. That information now needs to be gathered from a great many other sources of information. Within your doctor’s office, it’s completely controlled. They have the existing systems in place, they have the forms in place. They even probably have the direct connections in place to send this information to the labs. As you’re seeing the testing happening in Walgreen parking lots, Walmart’s, or wherever they’re setting the testing up, those facilities are not available there.

We need to be able to provide mobile testing, mobile data gathering, and mobile information at those tests sites, and a way to connect those tests sites directly to the labs that are doing the testing. That’s another part of the overall solution. Any piece of this breaks down, the testing does not flow smoothly and information delays will occur. And in a pandemic like that, those information delays can be devastating to the population. We need our decision makers at this point to have the best information possible available as soon as possible so they know what steps need to be taken. Many of the things that have happened in specific locations are because there are essentially 10 counties and three States, where over 50% of the positive tests have occurred in.

Those 10 counties and three States are taking different steps than States that do not have that concentration. So, we need to make sure that if a concentration develops in a State, we see it as soon as possible or in a County, we see it as soon as possible, so those additional ramifications and steps can be taken.

But also, now, from a technological standpoint, it seems to me that with the new ones that are popping up, they don’t have that kind of infrastructure in place or even for the ones that are existing, they’d be not be able to scale their current operations. So, I know that you’re right now consulting with CIOs in different government agencies. You’ve been on the other side of the chair where you’ve had to make these kinds of decisions in terms of technology and how do we share data. How does something like OnBase really start to help or mitigate some of these processes both in the near term and as well as maybe going down the road in terms of, how do these agencies prepare for future contingencies?

That’s helpful because you don’t know what the next problem is going to be, but you’re pretty sure there’s going to be more problems. So, in OnBase, OnBase components can generate the template letters that are going to be needed. It’s going to allow you to capture data on mobile forms and there’s a number of different forms that are needed. Both test forms and consent forms that need to be filled out on those mobile locations. Many of these mobile locations are not going to have adequate internet access for these to be web forms. They’re going to need to have mobile forms that are available offline, and OnBase support staff.

We’re going to need to be able to capture email communications specifically from doctors, other professionals in the medical profession and be able to build the case information that are necessary to do the tracing of an individual, and where they’ve been, and who they’ve come in contact with. We need workflow processing that is rule-based workflows that allow us to route the information and notify people what specific steps have to be taken. When we build these rule-based processes out, we need to have the ability and flexibility to change them, that the locations from State to State are going to probably have different requirements as to who needs to be notified, what types of notifications have to be sent, and what stage they are in the emergency preparedness process.

So, if somebody has declared a state of emergency in their State and they have tapped into FEMA funds, they’re going to be behaving in a totally different manner than a State, maybe they have a state of emergency in that State, but they’re not yet at the FEMA level. These different changes have to be effective in the workflow and they changed the procedures and processes. So, one size fits all solution is not going to do for every State or even every location and every State. Case management is needed. Each of these positive test results is a case, and there’s a regulatory protocol that has to take place when a positive test case is made.

That results tracing where the individual’s been, contact with the people they have been in contact with, and quarantine procedures that are specific to the case. A lab test capture for the lab test. What typically happened in the very recent past is the lab tests that are coming in from the testing facilities, their laboratory information management system reports that come in, many of them have been hand data entered in the past, into the reporting systems that the CDC requires, and into the local first responders reporting. That needs to be streamlined now. So, the volume of tests are going to be in the hundreds and thousands and more coming into these facilities.

For example, in my own State of Kentucky, we’re going to have over 50,000 tests processed just today. That’s not something that is typically done through our labs here. It’s a volume that is very unusual and it’s something that is going to choke the State systems if they have not thought through a process to deal with that. We have a process to deal with that. We can take the reports coming directly from the labs, process them through an electronic report management system, turn the reports, which are essentially paper based reports, into data without having to have data entry done. Push that information directly into the responding systems for the CDC and the first responders.

If the labs are able to generate HL-7 messages and some of them will and some of them won’t. HL-7 is a protocol to exchange medical information. We can actually receive the HL-7 messages and do the same thing with them. So, with the same solution, we could process labs that are HL-7 based and those that are not, which is very important because you do not need two different solutions and two different streams of information going into the CDC. You just can do it all with one. Final part is the reporting and mapping. Because we integrate directly to GIS systems, we’re able to generate on the fly heat mapping showing where the outbreaks are occurring.

Showing where the positive test results are, and be able to allow decision makers to make rapid decisions regarding quarantine and social distancing for specific areas, as soon as that information is available. It’s essentially instant. The second the test results come into the system, the heat reports are automatically updated in real time. It allows very rapid management decision processing. So, separate reports don’t have to be run and you’re not manually dictating GIS connections to the map. Hugely beneficial when you’re responding to an emergency situation like this.

It’s a very high cost of ownership that you’re going to have to adopt literally just in staffing to support that many different systems. Not to mention the annual maintenance, and upgrades, and all the work that goes into having a mission critical system like that. From my perspective and as I’ve learned, I mean Lord knows I didn’t get here right away, I made all the bad decisions when I was a CIO. So, I sort of learned as I’ve grown. A better strategic decision is a platform solution which provides the solution components and allows the specific program solution to be configured on that standardized platform.

It can be a tremendous benefit to the agency because it dramatically reduces the IT support and as such, the total cost of ownership for each application. There are a lot of good choices for solutions, but I like, and I advocate for the flexibility, power and ease of a configured solution on the OnBase platform. Because it has the ability to manage forms, documents, content of all types, case management, workflow and business process automation, and even file cloud sharing for external views and third party access. It really kind of checks all the boxes that we need in public health solutions to allow us to, if something pops up, take our component parts. Just like a box of Legos, we can build what we need to address this specific solution when this specific solution arises.

I was thinking, too, just when you were talking, Paul, about how the fact that not only is the system highly configurable in terms of being able to quickly address things that are on the horizon and even when you’re in that moment, but also the fact that a government agency that has a platform like this, they can own some of that configuration. It’s not something that they’re always dependent on the vendor to do or a partner to work with. Although that can be helpful and that can accelerate a process, and that can get them through some of the trickier waters if they don’t have the in-house expertise. But it does give them a lot of flexibility to say, “Hey, we need to prepare for this. We need to put some work into it, and we’ve got the resources and we can partner with a vendor or a partner to help us through this process.” But it doesn’t have to be one or the other. It’s something that both can walk together through that process and come up with a timely solution to that.

That’s a massive amount of manpower to assemble in a very, very short period of time, and to do it accurately as well where technology can really augment that. So, if you could just maybe touch on that in terms of answering that question, has the train already left the station or is there still opportunities for public health agencies can, “Yeah, we can still do something even today.”

When you don’t actually have the infrastructure, the public health infrastructure in place can be a challenge. So, I would say there are definitely things that can be done right away on this. The other issue I think it’s important to point out, is that based upon the past 20 years, we have had one of these incidents about once every five years, courtesy of a variety of different sources. If you recall EBOLA, SARS, MERS, and swine flu epidemic, just occupying the last 20 to 30 years. It’s not like this is an infrequent occurrence. This has become maybe more of an issue and more of a problem because of the specific characteristics of COVID-19.

The fact that it is so communicable and it has a long survival rate on the surfaces of things. So, if somebody who has the infection touches a surface, it stays that way until that surface is cleaned for apparently quite a long time. They don’t know exactly how long yet. So, diseases with this kind of characteristic are certainly hopefully rare, however, I would say just that we know it’s going to happen again. So, even if you think in your area you’re over the curve, you know what pain you just went through, let’s make sure you don’t have to do it again. There are things that can be done with this, and there is going to be funding flowing for agencies to address it.

My advice to them, if you’re in the thick of it and you don’t have time to take a step back and put another solution in place, remember that there is a solution out there when you get to the other side of this. You can get a chance to take a breath and get yourself in a better position for the next one.

So, you think about that and where we are today, there’s a whole different level of expectation that people are expecting more of a quick response. And so, it’s going to become critical that we’re just prepared, that we can’t let this sit and say, “Okay, this happened. It’s now in the past. Let’s go on and focus on other things.” It has to become a priority for CIOs and different business leaders to address this. Not only from, how do we address the crisis, but how do we function in an environment where we can’t come to the office for instance and touch a piece of paper, right?

It may not be a communicable disease. It might be something like, it could be an earthquake, it could be some other catastrophe that really upsets or impacts the community, and you have to respond and scale up things very, very quickly, and you need to have tools and platform to do that.

That’s just an astonishing hit that you speak of natural disasters, there really isn’t a natural disaster that I think would affect all 50 States. Just thinking of the ones that I’ve worked on in the past is not really been one exactly like this that affects all 50 States. I don’t recall, even after 9/11, airlines having to lay off 70% of their workforce. I don’t recall bars and restaurants having to be shut down. There’s an economic price to pay for unpreparedness, and let’s learn our lessons and not be unprepared again.

There are ways that we can leverage technology to really help us through this so that we can make quicker decisions, reduce the economic impact, or reduce the life changing impact that sometimes these things can have. So, thank you for sharing that.