1.  Recipient Activities: 

1. Washington State does not currently have a statewide incident management system. However, state and local response agencies generally use the Incident Command System when responding to emergencies and disasters and employ the Emergency Support Function (ESF) structure to develop response plans and integrate specific disciplines into the State Comprehensive Emergency Management Plan (CEMP). 
   ESF-8 is the primary vehicle for integration of public health emergency planning and response into the State CEMP.  A similar situation exists at the local level. 

i.                     Our state emergency response system emphasizes local control. It takes a “bottom up” approach with local entities initiating and controlling response activity, and the state providing support when local assets become overwhelmed. Our emergency management statute (RCW 38.52) requires each local jurisdiction (cities and counties) in the state to have an emergency management program. This may either be a stand-alone program or a joint program with another local entity (usually a county). The Emergency Management Division of the Washington Military Department has the lead for emergency preparedness in the state of Washington.  The Department of Health (DOH) is the lead state agency responsible for ESF-8.  Many other state agencies participate as part of the State CEMP including the State Patrol, Department of Transportation, National Guard, Department of Agriculture, and Department of Ecology, depending upon the nature of the emergency.  As described above, local emergency management agencies take the lead at the local level.  Local health departments provide assistance through ESF-8 and may be called upon to take the lead if the incident involves a public health emergency. 

ii.                   Other participants include the American Red Cross, Indian tribes, hospitals, first responders (including fire, police, and emergency medical) the Department of Homeland Security, the Centers for Disease Control and Prevention, the Department of Health and Human Services, Federal Emergency Management Agency (FEM), and a variety of state and local volunteer organizations. 

iii.                  The Emergency Management Division of the Washington Military Department is responsible for overall emergency preparedness in the state of Washington.  DOH is responsible for public health emergency planning and response (ESF-8).

iv.                 Generally through the ESF process the state or local public health department is responsible for planning, coordinating, and possibly directing, jurisdiction-wide response activities within ESF-8. This includes health or medical emergency incidents, including bioterrorism. 

2. Washington State has established nine public health emergency preparedness and response regions. Each region consists of one or more local health jurisdictions, and one local health jurisdiction within each region serves as the lead jurisdiction for regional planning. Hospital planning is conducted using the state’s Emergency Medical Services (EMS) planning regions, which generally coincide with the public health planning regions. The Washington State Emergency Management Division, which is responsible for programs administered by the Department of Homeland Security, employs an intra-state regional structure that coincides with the public health regions facilitating joint planning, coordination, and operations.  (See attached “Map of local health jurisdiction and hospital bioterrorism planning regions”)
3. Not every intra-state region has an incident management plan at this time.  Regional response plans are under development. They are approximately 25 percent complete.
4. Summary of FY 2002 activity toward achieving Critical Benchmark #3
   Washington State conducted a comprehensive, integrated assessment of public health system capacity to respond to potential bioterrorism or other public health emergency at the state, regional, and local levels.  We are still analyzing and documenting the results of the assessment, but preliminary analysis identified the need to develop comprehensive local and regional plans to effectively respond to an incident of bioterrorism or other public health emergency.  These plans are now being developed and tested

Summary of FY 2002 activity toward achieving Critical Benchmark #5
Work is 75 percent complete toward updating and revising the ESF-8 annex to the state’s Comprehensive Emergency Management Plan (CEMP). This includes an appendix (completed) describing state actions to receive and distribute the Strategic National Stockpile (SNS).  A separate appendix comprising a mass fatalities response plan is under development.  Work on DOH’s statewide agency CEMP and work on local and regional plans was sidetracked by the required development of a Smallpox Response Plan and a Stage 1 Smallpox Vaccination Plan.  Implementation of Stage 1 involved many of the same people charged with plan development—further hindering planning efforts.  This work will be carried forward into the FY 2003 grant workplan.

We did use our emergency plans to implement Stage 1 vaccination: the SNS’s Incident Command System was used for clinic management, thereby enabling effective plan testing.

We believe that the intensive effort to develop smallpox plans will result in timesaving as we move toward completion of our response plans.  However, we also recognize that a requirement to expand the smallpox vaccination effort will have an impact on emergency planning.

Summary of FY 2002 activity toward achieving Critical Benchmark #6
Washington state conducted a comprehensive, integrated assessment of public health system capacity to respond to potential bioterrorism or other public health emergency at the state, regional, and local levels. We are still analyzing and documenting the results of the assessment, but preliminary analysis identified the need to develop comprehensive local and regional plans to effectively respond to an incident of bioterrorism or other public health emergency.  These plans are now being developed and tested. Regional response plans are approximately 25 percent complete.

Summary of FY 2002 activity toward achieving Critical Benchmark #12
In 2002, Washington made progress toward development of 24/7 capability to transmit critical health information between key stakeholders, including state and local public health officials, hospitals and emergency management agencies. The primary focus was on assessing current capabilities for transmission of health information, especially among public health officials and hospitals. Washington also looked at how to improve the basic infrastructure of the notifiable condition reporting system, such as providing education and better tools for health care providers on what and how to report to public health officials. The knowledge gained in these efforts is helping the state to establish a realistic timeline and workplan for assuring 24/7 alerting and communication capability.

Summary of FY 2002 activity toward achieving HRSA Critical Benchmark #3 This is a new Priority Area with new Critical Benchmarks (PA 4, CB 4-1) for DOH in FY 2003. To date, the only connection we have had with hospital labs are portions of our 2002 hospital assessment that addressed laboratory capacity.

1. Recipient Activities:

The Washington State Department of Health established two advisory committees in the spring of 2002: The Public Health Preparedness and Response Advisory Committee and the Hospital Preparedness and Response Advisory Committee. Both committees are representative of Washington’s diverse public and private partners. The two committees merged into one body, the Public Health Preparedness and Response Joint Advisory Committee, in March 2003 (See attached “Joint Advisory Committee Roster”)
The Joint Advisory Committee was established to:

·          Facilitate the creation of a plan to prepare for and respond to public health threats and emergencies (as per section ESF-8 of the state emergency plan) – particularly our preparedness and response to infectious disease. The Joint Advisory Committee will be linked to the Governor’s Washington State Committee on Terrorism (COT) through dual committee membership among select members.

·          Proactively provide information to members’ respective partners and stakeholders about state plan development, expectations and needs.

·          Evaluate progress toward state plan implementation. This will include identifying gaps and trouble spots, possible collaborations with other states and Canada, lessons learned, significant innovations, successes, and opportunities. The committee will also provide possible solutions to problems and barriers hindering implementation of a state plan.

·          Advise the agency on coordination of Joint Advisory Committee efforts with other state efforts, including the work of the COT.

Before the two committees merged during the March 2003 Joint Advisory Committee meeting, the committees each met twice on their own: Hospital Preparedness and Response Advisory Committee (March 2002, October 2002); Public Health Preparedness and Response Advisory Committee (July 2002, November 2002).

Major Joint Advisory Committee accomplishments to date include:

·          Committee membership identified and formally organized.

·          Committee working charter developed and approved.

·          Washington State Public Health Emergency Preparedness and Response plan reviewed and discussed in detail, specifically – local health jurisdiction and hospital planning and assessments (process and results), epidemiology and surveillance efforts, smallpox preparedness, specific hospital planning efforts, and links to other state planning efforts such as the Tacoma Metropolitan Medical Response System (MMRS) program,  State Emergency Management, and smallpox vaccination planning and implementation at Madigan Army Medical Center.

·          Committee communications process (electronic) established and agreed to.

·          Committee meeting schedule and area location agreed to.

The Joint Advisory Committee now consists of more than 70 members, including alternates (See attached: “Joint Advisory Committee Roster”). Meetings are well attended (50-60 minimum) and discussions are lively and frank. The Joint Advisory Committee structure is living up to its expectations and truly serves as an open forum for partner information and resource sharing, as well as advice as to how plan efforts are progressing.

1.   Recipient Activities:

During the 2002-03 grant period, the Washington State Department of Health Public Health Laboratories (WAPHL) contacted and established operational relationships with a wide variety of analytical laboratories in and around the state. These contacts took the form of informal meetings, conferences, workgroups, tabletop exercises and definitive meetings aimed at establishing cooperative agreements for bioterrorism response and other public health emergencies. These assemblies served primarily to establish and strengthen communication links between and among the laboratory community in and around the state.

Although the primary emphasis of the collaborative meetings was to enhance WAPHL working relationships with hospital (clinical) laboratories in Washington State, many of the contacts made during the 2002-03 grant period were with food testing laboratories (e.g., FDA Bothell), veterinary laboratories (e.g., Washington State University’s Animal Disease Diagnostics Laboratory, Pullman), environmental testing laboratories (e.g., Region 10 EPA Laboratory, Manchester), regional/local public health laboratories (Seattle and Spokane), and the public health departments/laboratories of countries that share our borders and public health interests (e.g., the British Columbia Provincial Public Health Laboratory, Vancouver, BC, Canada). As a group, these laboratories have the collective expertise to test for terrorism-related pathogens and chemicals in humans, food, animals and environmental samples. The meetings coordinated and/or attended by WAPHL management and staff provided opportunities to establish and strengthen ongoing working relationships and to plan for coordinated public health collaboration during “peri-event” and “post-event” phases of public health emergencies. With the inclusion of Focus Area D (Development of Chemical Laboratory infrastructure) in the continuing CDC/HRSA grants, the WAPHL now plans to expand collaborations to provide a balanced and comprehensive response to biological and chemical terrorism as well as other public health emergencies.

As mentioned above, the primary emphasis of collaborative meetings held during the 2002-03 grant period was toward hospital-based clinical laboratories within the state.  In order to establish adequate surge capacity for bioterrorism response and other public health emergencies beyond the existing public health laboratory system capacity, several meetings focused on establishing formal memorandums of understanding (MOUs) with large full-service hospitals such as the University of Washington Medical Center’s Department of Laboratory Medicine in Seattle. Other meetings addressed the need for improved laboratory surge capacity through local health jurisdiction laboratories in western (Public Health Seattle and King County Laboratory) and eastern (Spokane Regional Health District Laboratory) Washington.  Enhancements to the state’s local health jurisdiction laboratories were coordinated through amendments to existing consolidated contracts between the Washington State Department of Health (DOH) and LHJs.

The WAPHL was also able to establish/enhance critical lines of communication with Level A and Level B LRN laboratories through a series of regional training sessions and site visits (outlined in the 2002-03 Bioterrorism Grant CDC Benchmark 10 timeline) during the past year.  These meetings were held in collaboration with clinical laboratories in Washington State, the state PHL Training Coordinator, other state public health laboratories, the National Laboratory Training Network (NLTN) and other state/local health department agencies.  Site visits and training sessions provided the opportunity to emphasize the need for standardized protocols, regular and efficient communication, coordinated and seamless cooperation with bioterrorism-response partners (from first responders and the public at the local level to HHS, the CDC, and the APHL at the national level), and common safety/security issues.

Through continuing support provided by HHS and the CDC, the WAPHL has been able to improve the emergency public health response infrastructure in Washington State and the surrounding region by providing critical support and guidance through training in rule-out testing, safe laboratory practices, safe specimen packaging, appropriate referral, quality control and assurance practices, and rapid reporting of test results.  Opportunities for face-to-face training sessions also served to strengthen professional relationships and provide the basis for strong long-term collaborative efforts.

WAPHL have participated and continue to participate in the effort sponsored by the APHL to investigate the recommended standards for the public health laboratory information management system (LIMS).  This effort involves participating in planning sessions and developing requirements definitions documents, in addition to looking at possible mechanisms for building a LIMS that would meet a public health laboratory’s needs.  This work would ensure the use of standards in the systems development, along with the implementation of standard communications mechanisms that could be used between public labs in-state and intrastate, and with federal and military labs and public and private labs that are using the same standards.  

In addition to the national work with other state labs, the WAPHL have been working with commercial and hospital labs to promote use of national standards as appropriate for the coding, reporting, distribution of laboratory and hospital information of public health importance. In this work, special emphasis is given to the National Electronic Disease Surveillance System (NEDSS) / Public Health Information Network  (PHIN) standards in the development of automated laboratory reporting systems. Specifically, Washington is working with private labs to promote:

·        Use of the national standard test coding naming convention, Logical Organism Identification Naming Convention (LOINC), for identifying test orders for reporting to public health.

·        Use of the national organism identification standard, Systematized Nomenclature of Medicine (SNOMED), for reporting of laboratory conditions of public health importance.

·        Use of Health Level 7 (HL-7) version 2.x (x = 1, 2, 3.1, 4) for the reporting of personal, and clinical information from the WAPHL as well as commercial and hospital laboratories.

Washington state has developed and is currently utilizing secure File Transfer Protocol (FTP) through a Virtual Private Network to receive electronic data on a batch basis from a limited number of private clinical laboratories.  Access to this system is limited and data is protected through use of the PHIN security standards.

Based on this work, Washington state in collaboration with a large county public health agency is developing a process for the “real time” reporting of laboratory tests to communicable disease epidemiology public health staff for use in outbreak surveillance and control. 

Beyond the current limited electronic data transfer activities, Washington state is working to expand its mechanisms for secure transmission of information between state, local and private partners through the use of the Valicert system. This system is installed at and operated by the Washington State Department of Information Services and serves as a standard secure transport system for various programs in the DOH.

Washington state is sponsor of the national Electronic Laboratory Reporting forum that meets on a monthly basis.  Members attending include about 15 states, staff from the CDC, public and private laboratories, the Council for State and Territorial Epidemiologists, and the APHL. This activity provides a forum for all groups interested in electronic laboratory reporting to identify, discuss and resolve major issues that are impeding the implementation of this technology.

Finally, Washington state participates in a Vocabulary work group hosted by the CDC. This work group is identifying the vocabulary standards for use in all areas of electronic disease surveillance.  The goal of this group is to oversee and provide input into the development of a mechanism for the distribution and maintenance of these code sets.    

There are no preparedness initiatives during the current budget period that receive joint funding from the CDC and HRSA cooperative agreements

 State and local public health agencies in Washington state continue to make concerted efforts to integrate notifiable condition surveillance systems. State and regional surveillance coordinators are developing protocols describing notifiable condition surveillance in order to document existing practices and identify areas for improvement.  In October 2002, DOH published statewide guidelines for notifiable condition reporting and surveillance, and launched a Web site providing common resources and definitions to all public health agencies. These tools will be supplemented with common, standardized case report forms for all notifiable conditions. The forms will allow public health agencies to collect comparable information in a comprehensive manner and improve the utility of notifiable condition surveillance data. It will also allow uncomplicated review and evaluation of surveillance system attributes, such as timeliness and completeness of reporting. DOH will provide training to further educate public health staff on requirements and resources for notifiable condition reports.

In addition, state and local public health agencies are collaborating on the development of the Public Health Information Management System (PHIMS), a Web-based application for notifiable condition surveillance and reporting. State and local agencies will be able to use PHIMS to share a common database of notifiable condition reports and allow them to make and receive reports of immediately notifiable conditions in real-time.

Washington established electronic syndromic surveillance systems in three of its regions. These systems capture data electronically from hospitals, outpatient clinics and EMS providers. Selected participating hospital and outpatient sites are transitioning to a data extraction program that will: Improve data quality by eliminating duplicate records; Allow for a patient link which could be used for more rapid follow-up for a possible disease cluster or outbreak; and Include disclosure of patients’ names, addresses, and phone numbers for those patients who have a notifiable condition.  Documentation of lessons learned about data collection, quality, security, diagnosis grouping, analysis, and system evaluations will provide valuable information as electronic communications are expanded to include additional hospitals, clinics, laboratories and EMS providers. 

Laboratories will continue to build technology infrastructure consistent with electronic data standards to support electronic data interchange with public health partners.  The DOH will continue to guide these efforts by providing standards built on the Public Health Information Network (PHIN) and other national standards.  As laboratories develop the capacity to meet the Information Technology (IT) standards through modification of existing information systems or creation of new systems, DOH will provide implementation guidelines for laboratories to begin sending electronic messages and will build systems for sharing information by modifying software code from other states or sources.  This electronic messaging system will be pilot tested prior to implementation in laboratories across the state.  The end-product will have functionality to accept notifiable condition reports from clinical and hospital laboratories and deliver reports to appropriate LHJs using PHIN standards including required coding formats.  

Washington is home to 29 federally recognized tribes.  Tribal lands are located in all areas of the state including eight of our state’s nine local public health and hospital bioterrorism planning regions (See attached “Map of local health jurisdiction and hospital bioterrorism planning regions”). 

Washington has proactively solicited tribal participation in state and local public health emergency planning.  At the state level, the Director of the Governor’s Office of Indian Affairs and a member of the Northwest Area Indian Health Board are members of Washington Public Health Preparedness and Response Joint Advisory Committee.  Additionally, the tribes are represented on the State Board of Health. 

Top officials from DOH have addressed tribal gatherings and conferences to enlist their participation in our public health emergency planning efforts.  For example, DOH officials addressed a FEMA-sponsored forum held in Washington state last June.  At this meeting, the tribes were introduced to our state’s regional planning structure and encouraged to work with their local and regional public health emergency response coordinators.  Additional staff presentations before the American Indian Health Commission for Washington State and at a gathering of tribal law enforcement officials focused on smallpox planning and on law enforcement coordination following a bioterrorism event.  

Our planning guidance to local health jurisdictions emphasizes tribal coordination, and many of our regions have invited tribes to participate in the development of local and regional plans. To facilitate this process, the tribes have each identified a tribal bioterrorism contact person. Our Region 3 planners (see map) have been particularly successful in integrating the tribes into their planning process.  Other regions are using Region 3 as an example of successful interaction with our tribal partners.  

During the upcoming grant period, we plan to intensify our outreach activities to the tribes.  We will continue to encourage the tribes to actively participate in the development and testing of our local and regional plans. Additionally, we plan to contract with an individual to serve as a tribal liaison during the grant year.  This person will provide technical assistance to each tribe to assist them in fully integrating into the public health emergency response system and, as necessary, to facilitate coordination with local and regional jurisdictions in developing plans and procedures for responding to a bioterrorism event.  Further, we plan to work with the over 22 tribally-owned health care facilities in our state to identify opportunities to provide financial resources which will permit them to become full partners in the planning and response process. 

 An important goal of our emergency preparedness and response communications efforts is to create sustainable systems to meet the ongoing information needs of special populations. To effectively address these issues, we will continue to build on the foundation of resources, partnerships and communication channels established during the past year and, with the Washington State Hospital Association (WSHA), will expand on these activities to develop a comprehensive statewide system.

We will employ four main strategies to accomplish these goals:

1)   Further develop effective partnerships with community organizations, programs within hospitals, and state and local agencies that serve special populations as part of a statewide Community and Agency Partner Matrix. Work with these organizations to ensure the needs of special populations are incorporated into overall planning efforts, and to develop effective information dissemination channels.

Matrix partners will include: DOH Division of Community and Family Health (various programs serving families, the elderly and other special populations), Governor’s Office on Indian Affairs, Washington State Department of Social and Health Services (including offices of Aging and Adult Services, Children and Family Services, Mental Health Services, Deaf Services, Residential Care Services), Washington State Council of the Blind, Asian American Affairs Commission, Washington State Human Rights Commission, Washington State Office of Public Instruction, Washington State Department of the Military (Emergency Management Division, Public Education Unit), Washington State Coalition for the Homeless, American Red Cross (local offices), and other state, regional and local entities serving special populations.

2)   Identify and provide cultural competency training and learning opportunities to system partners. Incorporate cultural competency issues into risk communication training offered through DOH in coordination with WSHA. Ensure opportunities—such as Government-to-Government Training through the Governor’s Office of Indian Affairs—are available system-wide. Work to establish other training channels such as distance learning on relevant issues.

3)   Further enhance materials development and translation systems that test messages for effectiveness and cultural appropriateness with target audiences. Make these materials available throughout the system.

In support of this strategy, we will partner with DOH Division of Community and Family Health, Office of Health Promotion, in their efforts to establish a structured translation and review resource for public health materials. This program will work with community organizations to ensure that target audiences receive effective and culturally appropriate messages. DOH will translate key emergency materials into six languages most used in Washington state as identified by the Washington State Department of Social and Health Services (Spanish, Russian, Vietnamese, Cambodian, Chinese, Korean) and support local efforts to establish other needed translation mechanisms.

4)  Continue work to ensure accessibility of materials, Web sites, emergency hotlines and other resources for communities with special needs. Support implementation of critical services—as appropriate—including Access Washington Resource Directory (statewide health and human services database that serves as the backbone of local 211 efforts), TTY lines, AT&T Language Line services.

To ensure psychosocial issues are addressed in public health emergency planning efforts, we will seek expertise and resource development assistance through the creation of a Community and Agency Partner Matrix. Developed through the DOH in partnership with the WSHA and key member organizations, the matrix will include representatives of hospital programs and other state, regional and local entities with expertise in mental health issues. Those represented will include:

• The Association of County Human Services, DOH Division of Community and Family Health (various programs serving families, the elderly and other special populations), Washington State Department of Social and Health Services (including offices of Aging and Adult Services, Children and Family Services, Mental Health Services), Washington State Department of the Military (Emergency Management Division, Public Education Unit), Washington State Coalition for the Homeless, American Red Cross (Together We Prepare initiative), the Washington State Employee Assistance Program, and the American Psychiatric Association.

With WSHA and key member organizations, DOH will form a special advisory committee on mental health and crisis communication issues with matrix partners. Together, we will work to develop emergency communication planning recommendations and strategies for the following initiatives:

• Helping emergency staff to cope with the psychosocial consequences of their involvement in crisis response.
• Helping the general public and special populations cope with the psychosocial consequences of a crisis. This includes effectively addressing psychosocial issues in related materials, and ensuring mental health resources are available through DOH and other emergency hotlines. (In support of hotline activities, we will participate in the planning of related statewide initiatives such as the Access Washington Resource Directory—the health and human services database associated with the state’s 211 initiative.)

·        Ensuring the psychosocial consequences of crisis are addressed in crisis and risk communication strategies.

·        Identifying training opportunities for emergency system staff.

·        Materials and best practice review and recommendations for system use. (Including general public materials from the American Red Cross, and staff materials from the CDC’s Crisis and Risk Communication Guide.) Distribute materials and recommendations throughout the emergency partner system.

In FY 02-03, human resource capacity was increased to leverage existing local, state and federal training and distance learning capacity through investments in local and state staff with expertise in technology applications, instructional design, and training/learner support. FY 03-04 funds will continue to support this existing capacity and focus on increased collaboration and integration across the other focus areas and selected related program areas. Focus Area G liaisons will be identified by making investments in existing program staff (e.g. Immunization Program) and in additional staffing (e.g. Communicable Disease Epidemiology) to improve the ability to target more specific performance areas for education and training. (See attachment: “Statewide Training Needs“)

Education and training was included as a separate section in the quantitative Emergency Preparedness and Response (EPR) capacity assessments completed by hospitals and local health jurisdictions in Fall 2003. Results of the sections on education and training have undergone preliminary analysis to identify priorities. (See attachments: “Statewide Training Needs”, “LHJ PHEPR Capacity Assessment”, “Hospital EPR Capacity Assessment”, “Washington Public Health Training Network”)  A qualitative assessment process will be conducted in the upcoming grant cycle to further define education and training performance gaps and target learning needs for both hospital and local health staff. Technology and equipment needs were also identified and priority areas for both hospitals and LHJs will be addressed in the upcoming grant cycle as data is further analyzed. (see CB-25/RA-3)

Seattle participated in the TOP-OFF2 exercise conducted in May 2003 and efforts are underway to collaborate with the University of Washington’s Northwest Center for Public Health Practice (NWCPHP) to identify lessons learned so that they can be shared with others in the hospital and local public health workforce across the state.

In February 2003, Washington conducted 2 pilot clinics as a test of its’ Smallpox Mass Vaccination Plan and as a way to train local health jurisdiction (LHJ) staff in roles and responsibilities. LHJ staff continue to operate smallpox clinics for members of Smallpox Response Teams as part of the Stage I plan. Lessons learned are being compiled and any appropriate revisions will be made to the plan. (see Focus Area G/RA-6)

In conjunction with its local partners the state will conduct a regional full-scale bioterrorism exercise testing all major components of the public health response system during the upcoming grant cycle. (see Focus Area A/CB) Additionally, DOH and each regional LHJ will conduct a tabletop, functional or full-scale exercise of their plans to demonstrate proficiency and preparedness in responding to bioterrorism, other infectious disease outbreaks, or other public health threats and emergencies. Focus Areas G and A will collaborate to assure that these exercises and the lessons learned will also be used as education and training tools for others who may not have the opportunity to participate.

DOH will implement a Learning Management System capable of collecting and reporting data on all training and educational activities, as well as sharing best practices, with other health agencies. Priority stakeholders for the next grant cycle for participation will include state and local health agencies. Hospitals can choose to either participate in the DOH system or use their own system for collecting and reporting data to DOH. (see Focus Area G /RA-2)

Summary of activities already undertaken

·        DOH and University of Washington NWCPHP collaborated and shared expenses on a risk communication satellite broadcast and live presentation by Dr. Vincent Covello. The materials from that broadcast remain online on the NWCPHP Web site.

·        Eastern Washington’s Region 9 collaborated with the NWCPHP on a presentation about smallpox vaccination that was also broadcast to other sites in eastern Washington, using videoconferencing.

·        The curriculum, "Preparing for and Responding to Bioterrorism: Information for Primary Care Clinicians," was developed by the NWCPHP. Representatives from the Washington Area Health Education Centers (AHECs) attended a "train-the-trainer" session by the lead developer. The curriculum is being used by AHECs in Washington state for primary care clinicians.

·        DOH supported the new Northwest Public Health Leadership Institute (NWPHLI) through a $27,000 contract. Washington state has10 scholars in the first cohort. The NWPHLI is the product of a partnership among the NWCPHP, Portland State University, and the states of Alaska, Idaho, Montana, Oregon, and Washington. It offers a yearlong experience to increase participants' collaborative leadership skills through on-site and distance learning opportunities guided by practice-based faculty. Scholars from diverse backgrounds (e.g., government public health, community health centers, community hospitals, community-based organizations, social services agencies, justice and law enforcement agencies) work together to develop collaborative leadership skills to apply personally, in their organizations, and in their communities with a goal of creating integrated and innovative approaches to fostering healthy communities. http://healthlinks.washington.edu/nwcphp/nwphli/

·        Forty-two Washingtonians attended the weeklong NWIPHP last September in Seattle. The program theme was "Bioterrorism and Emergency Public Health Preparedness."

·        The NWCPHP Distance Learning Specialist posted announcements of satellite broadcasts and other emergency preparedness resources to a mailing list of northwest hospital librarians. In return, we have been able to obtain information regarding the granting of continuing education credits that has been shared with public health.

Summary of Planned Activities: (see Focus Area G/RA-7)

·        Continue working with the NWCPHP to refine the curriculum, “Preparing for and Responding to Bioterrorism: Information for Primary Care Clinicians.”

·        Collaborate with the NWCPHP and HHS Region 10 to identify groups in the Northwest region who are looking into using Web conferencing software to deliver presentations. Collaborate with these stakeholder groups to test possible solutions, compare notes on functionality and perhaps even make a solution. With continued travel restrictions and long distances to travel, as well as the lack of sound cards and speakers available in both local health jurisdictions and hospital settings, this solution seems useful for many types of learning opportunities.  Using audio by phone may get around this limitation will work with at least these groups.

·        Collaborate with the NWCPHP to explore working with some key participants in the TOP-OFF2 exercise to identify lessons learned and make presentations to the public health and hospital communities.

·        Explore with the University of Washington School of Public Health and Community Medicine the possibility of using or extending a graduate level course that is being created for the Washington National Guard that will include basic information about epidemiology for those who are not epidemiologists and information about bioterrorism agents. Pieces of this curriculum might be appropriate for public health and/or other stakeholders such as hospitals and EMS.

·        Continue providing funding support at the current level to the NWPHLI and market to the Washington public health workforce.

·        Partner with the NWCPHP and Thurston County LHJ, to pilot NACCHO’s “Public Health Ready” program and evaluate how well it can be used as a tool to strengthen the capacity of local public health agencies to respond to bioterrorism and other public health emergencies.

·        Collaborate with the NWCPHP and the Pacific Northwest Region of the National Network Libraries of Medicine to evaluate the best use of the National Library of Medicine resources to:

1.      Improve EPR awareness and skills for the public health workforce and key stakeholders

2.      Examine possible partnerships among public health, hospitals, and medical librarians for cross cutting learning opportunities.

·    Collaborate with additional academic health centers to identify potential resources for expanding education and training initiatives and projects to reach a larger share of the public health and stakeholder workforce (see Focus Area G, RA-4).

Washington state has focused its IT connectivity and interoperability efforts on three key groups of stakeholders:

1) The public health system (including the state and all local health agencies)

2) Hospitals

3) Emergency management agencies.

Each of these groups, in turn, has the ability to address connectivity with other key groups – state and local health agencies with other states and with federal health officials, hospitals with emergency medical services, and emergency management agencies with public safety agencies. By keeping our direct efforts narrowly focused, we are able to implement change more quickly and maximize our chances of success, while taking advantage of and leveraging activities and relationships that already exist.

Washington is pursuing interoperability through connectivity and messaging, rather than through complete interoperability of systems. Our emphasis has been and will continue to be making sure that key stakeholders are able to securely send and receive electronic information, and to generate electronic messages in a way that allows ready interpretation by recipients (i.e., through the use of standard vocabularies and formats).  To support this direction, DOH actively participates in the development and implementation of national information technology standards for public health, including the National Electronic Disease Surveillance System (NEDSS) and Public Health Information Network (PHIN) standards. DOH has incorporated applicable NEDSS standards in the Washington Electronic Disease Surveillance System (WEDSS) program, which includes electronic data interchange, a Web-based case management, an integrated data repository, and security of information systems. DOH is also educating local health agencies and other partners about the NEDSS and PHIN standards, to promote their adoption in all aspects of public health information technology development.

For many years DOH has participated in the Community Health Information Technology Alliance, a coalition of healthcare organizations, health professions, insurers and other groups dedicated to improving the quality of healthcare through appropriate use of information technology. In this forum, DOH has worked to disseminate knowledge about national information technology standards of interest to public health, to learn about the direction of the local health care system relevant to information technology, and to influence community-based projects so that the public health system can get and share the information it needs. One example was the HealthKey project, where DOH used its knowledge about national standards and its need to collect electronic laboratory data to help develop a security solution that was acceptable to the health care community and public health. Washington is building on this experience and is proceeding with implementation of electronic laboratory reporting. In this effort we are working with major local and national laboratories and are participating in national discussions to assure our approach is consistent with that being implemented in other states.

While much of the direct work of DOH has focused on connectivity and electronic messaging between public health and the health care system, we have been actively involved in the state’s efforts to assure interoperability among communications systems, especially between emergency management, first responders and public safety agencies. The state’s Committee on Terrorism, convened by the Governor and composed of members from multiple state, federal and local public safety and emergency response agencies, is tasked with assuring that communications systems from different organizations are able to work together. This group is overseeing the dispersal of federal funds associated with emergency response communications systems, and has defined criteria for those systems to assure their interoperability. Efforts in interoperability and connectivity, for all fund sources, will continue in the coming year.

Washington’s state and local health agencies are actively working to facilitate cooperation and coordination with our counterparts in British Columbia.  Three of our state’s nine public health emergency planning regions share a border with Canada (See attached “Map of local health jurisdiction and hospital bioterrorism planning regions”).  Each of these regions has been advised through planning guidance to include coordination with their Canadian counterparts in the development of their regional plans.  Region 1 (in the northwest corner of the state and immediately adjacent to greater Vancouver, BC) has been particularly proactive in involving their Canadian colleagues in their meetings and planning efforts. 

DOH has contracted with Harborview Medical Center in Seattle to establish a redundant prehospital-to-hospital communications system. The contract requires that the contractor collect baseline information about our technical ability to share bioterrorism and disaster preparedness communications information with surrounding governments, including British Columbia, as the first step in coordinating response activities with these entities. Further, local, regional and hospital planners are working together to jointly develop mutually compatible region-wide plans for effectively dealing with a mass casualty event. 

At the state level, we continue to maintain an on-going dialogue with our Canadian neighbors.  Representatives from the British Columbia Ministry of Health have attended the Washington State Committee on Terrorism’s meetings to provide information to the Committee on the current status and plans of the bioterrorism and disaster response system in British Columbia and to continue the dialogue on cross-border cooperation and planning for such an event. Our state public health laboratory is continuing to collaborate with their Canadian counterpart to share information and coordinate activities and training, particularly in the areas of food borne pathogens and infectious disease. The potential for a joint laboratory response network, which would involve neighboring states as well as Canada, is also being explored. Additionally, our communicable disease and epidemiological staffs regularly share information regarding disease outbreaks and monitoring.  For example, British Columbia is on our COMDIS list-serve, and we recently worked with them on an investigation of an outbreak that involved residents of several states and provinces who were visiting Washington.

In the upcoming grant period, we will continue our efforts at the state, regional and local levels to integrate planning and implementation activities with Canada.  As our state regions finalize their bioterrorism plans, we will ensure those bordering British Columbia have fully included the Canadians in their planning and exercise processes. Additionally, we propose to conduct a major, full-scale bioterrorism exercise in 2004. We will invite our provincial and local counterparts from British Columbia to participate in this exercise. Finally, we plan to host a workshop/roundtable discussion including British Columbia and our local health jurisdiction partners to discuss ways to effectively coordinate and integrate our activities in the event of a bioterrorism incident or other public health emergency. Representatives from other affected state agencies and the federal government will be invited to participate.