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Subject: Re: [emergency-have] Experience with Sandy Hospitals tracking

Thanks Mark. 

I saw this concept of "No Response" on the Skype room - I'll leave my comments here on the EDXL-HAVE track to avoid providing what may be seen as guidance in the Skype room.

Specifically on the Facility Status of "No Response" one of the things we have added in the HAVE 2.0 schema is the ability to track multiple states for a Facility. There is an overall status (values of Normal, Compromised, Evacuating, and Closed) but there is also the ability to add other states that need to be tracked. In the case of the "No Response" state I would argue that this isn't a Facility State but more of an internal state that pertains to whether that particular facility is being monitored by this group - perhaps a "CC_SANDY_OUTREACH" state or something.

Similarly the state information that you're looking at for power (on/off), power source (grid, generator), and other facility needs (steam, oxygen, etc.) should be handled in the HAVE 2.0 using the various ListExtension data types that can be tailored to meet a need, or based on a pre-determined structure. 

For the frustration that your group is hearing about "I already reported that" I have nothing but sympathy - nobody likes to do something twice. However, some groups simply don't have a mandate to share information outside of their organization (e.g. as it seems is the case in the health network there) or perhaps even more difficult, they may be precluded by policy or law from sharing what is really unclassified and very useful information. The only thing that I can say here is that by using open standards and open systems we can hook in the various groups that need the information with a goal of having single entry - but that is a way off for now.

I have some more comments embedded below. I'll add that I am only one member of the EDXL HAVE Sub Committee and you'll find I am very strong in my opinions. I certainly aim to reflect the greater consensus but at times I may drift into my own areas. If anything here feels wrong (totally or just slightly) please don't hesitate to call it out and I'll do my best to address things.

I am thoroughly impressed with the efforts that the CC Sandy team is making and I am inspired by the capabilities in Sahana that are being applied.



Darrell O'Donnell, P.Eng.
Member (volunteer)

On 2012-11-07, at 11:00 AM, Mark Prutsalis <mark@sahanafoundation.org> wrote:

Forwarding to the list....

On Nov 7, 2012, at 10:58 AM, Fran Boon wrote:

A further point on this:
* I was asked to add a Facility Status of 'No Response'
- in addition to the existing: 'Normal', 'Compromised', 'Evacuating' & 'Closed'

This allows the volunteers to more easily track which facilities have
been interviewed on their status.

I'm not sure whether this Status is really the best place to track a
workflow, however note that some hospitals refuse to divulge this
information as policy.
Others were frustrated that we were asking them when they were passing
the info upstream already.

We need some way of easily differentiating the 'unknown, need to call'
from the 'we tried'

Best Wishes,

On 7 November 2012 15:39, Mark Prutsalis <mark@sahanafoundation.org> wrote:
Hi Darrell/all--

Here's some further information I wanted to share with the EDXL-HAVE
committee some of our experiences in standing up a site to track hospitals
and medical facilities statuses in the post-Hurricane Sandy northeast.  This
request came to us from David Black at Crisis Commons, based on a request
out of the White House, as Darrell referred to yesterday.

Our site is live at http://sandy.sahanafoundation.org but not yet public
pending WH approval, so only registered users can get access to the site.
I'd be glad to approve any requests from committee members so you can
explore the site.

The site is based on the Sahana Eden Hospital Management System registry
that we deployed during the Haiti Earthquake response and is based on the
HAVE 1.0 specification.  We have not implemented any of HAVE 2.0 pending the
finalization of the specification and some use case demand.

But some of the following may be valuable validation for the work being done
on the EDXL-HAVE 2.0 specification or areas for discussion:

We needed to track not only Hospitals - but also other types of medical
facilities - especially Long-Term Care facilities.

One of the main reasons behind HAVE 2.0 was to go beyond just Hospitals. This included Long-Term Care, Urgent Care, temporary facilities (e.g. vaccination centres stood up in school gymnasiums), etc.

(In the context of our work for an EU-project - we've also had a request for
tracking pharmacies - which in other countries, provide more medical
services than in common in the US (such as providing triage medical services
and direct dispensing of prescription medications;)

Pharmacies would fit too.

These types of facilities are critical parts of the public health
infrastructure so practically, we are going to see applications (such as
Sahana Eden) which need to expand beyond "hospitals".
New York City shelters also provide medical services to individuals not
requiring hospitalization - and may be added to this site as such.

As would these.

We needed to track source of electrical power supply - whether from mains,
generators, or none (or other).

NOTED - HAVE 2.0 Draft supports a FacilityStatusListExtension that can be tailored to support this.

Other utilities that may be critical for facilities include gas and steam
We needed to track whether service disruption was caused by flood damage or
from power outages.
Again, a tailored FacilityStatusListExtension would make sense here.
We needed to track statuses: open, compromised, evacuating, destroyed, as
well as planned dates of re-occupation, re-opening for those facilities
temporarily closed.

NOTED: I don't have particular points on this but I will do some thinking here. The FacilityStatusListExtension data type allows for pretty flexible tailoring but perhaps it may make thing too tailorable to the point of data ambiguity.

The information and information requests come in waves.  It starts very

Name and location
Open or closed / Status
Type of Damage Sustained / Power availability
Services (all/some/none) - not yet granular - when we find that a hospital
offers all services they normally do, that doesn't mean we know what
services they normally offer.
Beds (total beds - generally - not by service and not available)
NOTED: I think that we need to understand from the larger community what this brings as far as a measurable metric. One can count beds but what does that provide? When it comes down to reallocating bed space amongst existing hospitals those discussions would typically happen inside the health/hospital system wouldn't it? I ask myself what utility this number has for outside agencies - what can we do with it? If I know that the emergency room is open do I need to know how many beds that hospital has? More difficult and potentially disturbing for me is that the knowledge of bed counts may inadvertently allow an emergency manager to second guess the health administrators/practitioners who have far more in depth knowledge of the system.1

So eventually, you get a complete picture of a facility, but there are many
interim steps to get there.
Without getting a real-time feed on hospital services and patient load from
hospital systems directly, it's going to be difficult to ever get an
accurate picture of availability.  The challenge of course is keeping it up
to date.  A hospital/facility which is compromised and offering limited
services last week may be fully restored and operational this week.  We are
finding it takes a lot of manual volunteer time and phone banking to try to
get updates entered so the data set continues to be valuable.  Obviously,
we'd love to live in a better world where these come to us automatically,
but we aren't there yet, so we have to work with what we have.
Political challenges in getting information from official sources - even
where public.

I've copied Fran Boon and Dominic Konig from our Sahana Eden team who have
done the development work and support for this system.  Dominic is the chief
architect of our Hospital Management System; he's also one of our
representatives to Oasis, but I don't think he's joined the HAVE SC yet.

Best regards,


Mark Prutsalis
President & CEO
Sahana Software Foundation
tel +1-860-499-0332
Follow us @sahanafoss and http://Facebook.com/SahanaSoftwareFoundation

* * * * *

The Mission of the Sahana Software Foundation is to help alleviate human
suffering by giving emergency managers, disaster response professionals and
communities access to the information that they need to better prepare for
and respond to disaster through the development and promotion of free and
open source software and open standards.


Mark Prutsalis
President & CEO
Sahana Software Foundation
tel +1-860-499-0332

* * * * *

The Mission of the Sahana Software Foundation is to help alleviate human suffering by giving emergency managers, disaster response professionals and communities access to the information that they need to better prepare for and respond to disaster through the development and promotion of free and open source software and open standards.

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