STEPS TO BUILD A ROBUST INFORMATION NETWORK

As discussed earlier, having information available to decision makers improves their ability to implement the most appropriate courses of action during a public health response. The key informant responses highlighted both the need for information and a better understanding of what data are available in a community. To assist communities, this plan for change describes necessary steps to developing a more robust information network making use of data from multiple sources, to provide early warning of disease and provide decision makers data upon which to inform their actions.

Step 1: Find a champion and build a citywide stakeholder group.

The first phase of this effort is to determine who is best suited to champion this effort. This advocate should have a significant role in community response, exhibit a firm understanding of the environment and players, comprehend how data would be valuable

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to response, and most importantly, have the time to dedicate to seeing the effort through to completion.

The role of the champion, first and foremost, is to support and promote this activity as a beneficial step in enhancing preparedness in the community. To this end, they will need to assist in defining the work group, assuring that the appropriate players are at the table. Responsibilities may include, but are not limited to, scheduling/hosting meetings, facilitating the stakeholder group through assessments, and developing recommendations.

The makeup of this stakeholder group should include both individuals in decision making roles in response to a public health disaster and individuals that own data and information that would assist in making decisions to mitigate human suffering and minimize impact on the city (e.g. environmental, economic). At a minimum, decision makers in the stakeholder group must include elected officials and directors of response departments. In addition, educational systems, owners of critical services (e.g. waste management), large businesses residing in the community, and non-governmental agencies (e.g. churches) should be considered to participate in the stakeholder group.

After the initial list of stakeholders is developed, there should be a second list developed to find groups or organizations that own data that would be beneficial in a response. It is possible that those identified through the second list have already been added to the group through the determination of decision makers.

Step 2: Determine information requirements in a public health emergency.

To fully understand what information decision makers would like to have during a public health emergency, a face-to-face session to determine the information

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requirements needs to be accomplished. To get stakeholders in the mindset of response, it is suggested that this requirements generation is done using disaster scenarios. This tactic provides a sense of reality, allowing stakeholders to ask the questions they would ask during actual response. As a result, information requirements will be made clearer. The two scenarios built, based on the review of previous outbreaks, proved to be realistic of what could actually occur in a community. Information on data availability and

information required was easily generated during these scenarios delivered during the key informant interviews. The scenarios have been included in Appendix G for use during this phase. National planning scenarios could be utilized to identify information requirements based on other types of public health disasters.

In addition to the goal of building information requirements, documentation of data that does and does not exist should be accomplished. This is most easily done as the stakeholders move through the scenarios. It will be beneficial to have at least two scribes capturing data types, sources, and gaps as they are described. Appendix H is a template for data collection. It may be modified to meet local need.

Step 3: Build an information map of data types and sources

Using the data documented during the generation of information requirements, develop a map of both current and future data that is required. The map should designate data ownership and how the information flows at a minimum. Figure 6.1 provides an example of what a city information map might look like. This activity will provide a clear picture of gaps that exist, based on current data infrastructure and the information requirements generated.

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Figure 6.1. Example Information Map of Data

Step 4: Accomplish an analysis to determine priority level of gap, requirements necessary to correct gap, and potential barriers.

Once the gaps have been identified, the stakeholder group should reconvene to determine the priority of the gap, activities necessary to correct it, and potential issues that would prohibit closure of each gap. First, stakeholders should assign each gap a priority to determine how critical it is to decision making and operational response. The group can establish their own priority ratings based on the complexity of analysis they would like to apply. Secondly, stakeholders should identify all the actions necessary to close the gap. This becomes the task list that members will take action on to close the gap. This may include assessment of information technology (IT), grant writing, changes in policy, education and training, or creation of standard operation procedures. Finally, in

Organizations Data Types Data Exists Future Need Emergency Operations Center Dept. of Public Health Confirmed Cases (Laboratory) Suspect Cases (Hospitals, Clinics) Sale of Medications (Drug Stores)

Data Map Example: City A

Information Requirements All-Hazards Emergency

Syndromic Surveillance Verbal Environmental Sensor Alarm Dept. of Environmental Health Dept. of Natural Resources

Wild animal disease cases School Absenteeism (School Districts, Universities) City Intelligence Fusion Center Epidemiologic Characteristics (EPI Investigators) State Department of Health Intelligence (Law Enforcement, FBI) Verbal Domestic animals and livestock disease cases State Emergency Operations Center Verbal LEGEND Fire Department Verbal 911 Call Reports

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reviewing the activities that need to occur, the group should honestly assess what barriers may exist to closing the gap and brainstorm how they can be overcome. For instance, if funding is a barrier to purchase of IT software that allows for the rapid transfer of data, stakeholders may want to determine if there is grant funding available through

preparedness dollars to procure the software.

Step 5: Build a ranked task list to close gaps.

Rank the gaps and their associated task lists determined in step 4. It is important to consider that not all high priority gaps may fall into the top echelon of the ranked task list. Stakeholders must consider the feasibility of tasks associated with each gap along with cost estimates to accomplish them. Another important component to consider when ranking gaps is the potential barriers to successfully closing the gap. If the barrier is too great at the time of ranking, it may appropriately fall lower on the list. Once the order has been set, the stakeholder group must determine what gaps they are able to close in the upcoming year. In some communities this may be two, while other locations may be able to close out their entire list.

Step 6: Create work groups to tackle tasks

To accomplish the task list for each of the selected gaps chosen for the upcoming year, a work group should be established. These groups should have representation from multiple agencies that have a vested interest in the gap being closed. Once membership has been determined, a work plan for individual groups can be established with timelines for completion.

At anytime a significant barrier arises within the work groups, to stop the progress of the activity without resolution, it should be brought to the stakeholder champion. At

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that time, it can be determined if it should be brought to the entire stakeholder committee for assessment of ways to move forward.

Step 7: Hold annual checkup: report out, evaluate

One year from initiation of the work groups, an annual meeting should be held to assess progress to date. Each workgroup should be given an opportunity to report out to all the stakeholders. Reports should include: tasks accomplished, description of barriers encountered along with solution set to overcome that barrier, and timeline to completion.

Step 8: Refine task list and reprioritize goals for the next year.

The task lists and ranking of gaps should be reviewed and reprioritized at the annual meeting since the environment will have undoubtedly changed over the past year. Limiting barriers, such as an obstinate political party in office, may no longer be an issue and the gap could be easily resolved in the upcoming year. Another example may be funding changes at local, state, and federal levels that remove or add barriers to forward progress.

Action 2 – Convey a funding need to policy makers to improve nationwide