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					Pediatric Emergency Care Informatics:
     (A Talk Formerly Known as, “Surge and Disaster
                Management Informatics”)
                                               Robert Neches
                            Director, Distributed Scalable Systems Division
                                                 USC ISI

                Jeffrey S. Upperman, MD, FAAP, FACS
                              Director, Trauma and Disaster Management
                                    Childrens Hospital Los Angeles


                                          National Academy of Science Report: Improving Disaster Management: The
                                          Role of IT in Mitigation, Preparedness, Response, and Recovery (2007)


Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                 Alternative Scientific
                                        Models
Where intellectual energy, excitement, & innovation is going:
Interdisciplinary, collaborative, “big science” initiatives

                                         • Pros:
                                               – Validation of significance (if it’s been
                                                 done before, it’s probably open source)

                                               – Growing financial support (cf. trends in
                                                 research calls of DARPA, NSF, NIH, ...)

One Laptop per Child Initiative                – Opportunity to regain popular support:
                                                 contribute to socially significant topics

                                               – “I get to learn about external problems”

                                         • Cons (or just differences?)
                                               – “I have to learn about external problems
                                                 to (re-)discover what interests me”
                         Social worlds
                         in Information Sciences
  Proprietary Material – USC SecondLife Institute and Children’s Hospitalshare control over directions”
                                                   – “I have to of Los Angeles
                                      Partnership with CHLA




                                                                      CHLA treats approximately 55,000 patients in
                                                                           the emergency department annually.
                                                                       Its pediatric trauma program evaluates and
                                                                       treats about 1500 injured patients per year.

    CHLA has a special role as a
 pediatric disaster resource center
     for ten umbrella hospitals.
It has a LA County-wide charge to:
           Enhance hospital planning
               and cooperation
      Enhance the hospital community’s
       ability to respond to and address
                  pediatric needs
 Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                 Information Science Challenges
                                       and Medical Needs:
                                      An Alignment of Forces
                                                                      Information
Pediatric Emergency Care                                                Science
                                                                                                   Information
 Informatics Questions                                                    R&D                      Technology
                                                                       Expertise
• What faciliates                                                                                   Advances
  cooperation under                                                                                  Enabling
  pressure?                                                                                         Affordable
• How do we get the right                                                                            Solutions
  information to the right                                                                               to
  people at the right time                                                                            Critical
   – in the right form?                                                                              Problems
• What communication                                                                                     in
  modes help most?                                                                                  Emergency
• How do we disseminate,                                                                               Care
  maintain, and update                                                  Clinical                        and
                                                                       & Delivery
  useful information, methods                                           Medical                       Service
  and technology?                                                      Expertise
Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                                                                                      Delivery
                      Why Focus on Children?
Children are a precious and especially vulnerable
population -- with special needs and considerations

   •    Unable to explain their needs,
        participate fully in treatment decisions,
        care for themselves after treatment


   •    Not “small adults”:
        physiological/psychological differences                                                    Impact of same
                                                                                                      degree of
        have dramatic implications for                                                               swelling in
        health and well-being                                                                      infant vs. adult
                                                                                                       airways


   •    Need significantly different treatment protocols – which has a broad range
        of impacts (especially when surges or disasters prevent children from
        getting to specialized care centers): training, equipment, supplies, ...
Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                        Why
     Emergency Care and Services / Pediatric Surge
               and Disaster Situations?
• Pragmatics
       – Increasing concern about broken health care delivery system
       – What works in intense situations will work in lesser situations
          – the reverse just isn’t true
• Critical technology issues
       – Increasing access in normal situations, and maintaining capability in
         extreme situations, both require outreach to point of care
              • Distributed, multimedia solutions
              • Heterogeneous, mobile devices
              • Cybersecurity
       – Scarce expertise, rapidly changing knowledge, resource limitations,
         uncertainty about future all require integrated reasoning
              • Reusable, multipurpose knowledge representations
              • Distributed information management
              • Decision support
Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                Pediatric Disaster
                           Preparedness Resource and
                                Training Center:
                         $5M HHS Grant to CHLA (ISI Sub)




Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                  Five Core Groups

                         Disaster Resource Core

                         Education and Training Core

                         Drill Evaluation Core

                         Informatics Core

                         Administrative Core


Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                          Informatics
                                              Core
  • Collect information on best practices for
    pediatric preparedness and response
  • Implement new technology and tools for
    both planning and execution of effective
    disaster responses
         – Information integration
         – Simulation
         – Decision support


Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                   Pediatric Surge / Disaster
                                      Information Needs
        Planning                                                            Training
          •    What could happen?                                            •   What scenarios should we train for?
          •    What would be the consequences?                               •   What would caregivers experience?
          •    What resources would that require?                            •   What resources will they have?
          •    Where do the resources need to be?                            •   What environment will they find?
          •    What are the roles and responsibilities?                      •   What tasks will they be performing?
          •    What are the key actions?                                     •   How will evaluation and feedback
                                                                                 occur?




                                                            Shared
                                                          Information




         Recovery
           •   What happened?
           •   What is the right follow-up?
                                                                         Response
           •   What are the lessons learned?                               • What is the situation? Do plans match?
           •   What resources require replenishment?                       • How should the plan be adapted?
           •   What are the targets and schedule for                       • Are tasks, roles & responsibilities being
               returning to normalcy??                                       picked up?
                                                                           • Are the plans being carried out?
                                                                           • Are the plans working?
Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                    Long-Range Vision:
   Comprehensive Information Technology Support for Pediatric Surge/Disaster Functions

                                                                                                   Preparation
                                   ...                                      ...                     • Set quantity and
                          Services                              Disaster Modalities
                                                                                                      placement of supplies,
                      Facilities                       Personnel and Supply Status                    equipment, personnel
              Pharmaceuticals                              Infrastructure
                                                                                                    • Assign roles and tasks
   Surgical Procedures and Equip.                Environmental Conditions
                                                                                                    • Integrate best
                                                                                                      practices, detailed
   Medical Best                        Regional Situation                                             models of potential
Practice Knowledge                      Awareness and                                                 disaster situations
   Repositories                          Risk Analysis                                             Training
                                           Services
                              Resource                                                              • Use best practice data
                              Allocation                                                            • Use prep. simulations
                              and Task                                                              • Support constant use
                              Planning                                                                of response tools
                                Tools                                                              Response
                                                                                                    • Monitor planned vs.
                                                                                                      actual situations
          Response Execution Monitoring
                                                                                                    • Situational changes
              and Coordination Aids                                                                   trigger updates
                                                                                                    • Updates sensitive to
Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                                                                                      best practices
                                     Comprehensive Information Technology Support for
                                            Pediatric Surge/Disaster Functions:
                                       Medical Best Practice Knowledge Repositories

What is a Medical Best Practice Knowledge Repository?
  – Web-based system
  – Captures and advises on data and protocols
  – Ideally supporting humans and software
    advisory systems (used for training                                                              ...                              ...
    & actual events)                                                                        Services                     Disaster Modalities
                                                                                        Facilities               Personnel and Supply Status

  – Updatable, extendable by practitioners with                                 Pharmaceuticals                     Infrastructure

    limited programming knowledge, with                               Surgical Procedures and Equip.       Environmental Conditions


    built-in data validation processes
                                                                     Medical Best                        Regional Situation
Benefits & Applications:                                          Practice Knowledge                      Awareness and
                                                                     Repositories                          Risk Analysis
 – Generic:                                                                                                  Services
                                                                                                Resource
    • Rapid dissemination (get specialists’                                                     Allocation
      knowledge to first receivers when can’t get                                               and Task
      patients to the specialists)                                                              Planning
    • Reduced time and cost for synchronizing                                                     Tools
      training with practice
    • Enables medical communities to maintain                               Response Execution Monitoring
      their own information                                                     and Coordination Aids

 – Across lifecycle:
    • Planning: inform requirements computations
    • Training: establish knowledge/skill targets
    • Response: advise on procedures
    • Recovery: capture lessons learned
 Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                   Comprehensive Information Technology Support for
                                            Pediatric Surge/Disaster Functions:
                                 Regional Situation Awareness and Risk Analysis Services


What are Regional Situation Awareness and Risk Analysis Services?
Continuous review of current and potential sources of demand for medical services
 – What is currently going on in the geographical area of interest?
      • Relatively static information: population, demographic, critical locations, transportation routes,
        other data of interest
      • Dynamic information: events (fires, earthquakes,                                ...                                           ...
                                                                                            Services                     Disaster Modalities
        police reports...), data (traffic conditions, weather...)
                                                                                        Facilities               Personnel and Supply Status
      • Mix of geospatial data, audit trails and sensors                        Pharmaceuticals                     Infrastructure


 – What could happen in the area of interest?
                                                                      Surgical Procedures and Equip.       Environmental Conditions


      • Predictive models: severe weather forecasts.                   Medical Best                      Regional Situation
      • Simulation models: earthquake, flood.                       Practice Knowledge                    Awareness and
      • Risk vulnerability analysis tools                              Repositories                        Risk Analysis
                                                                                                             Services
                                                                                                Resource
Benefits & Applications:                                                                        Allocation
                                                                                                and Task
  – Generic: Understand and prioritize what
                                                                                                Planning
    could hurt the most at any given point in time                                                Tools
      • Real-time decisions
      • What-ifs
                                                                            Response Execution Monitoring
      • Policy planning
                                                                                and Coordination Aids
  – Across lifecycle:
     • Planning: identify the most critical set of dangers.
     • Training: set-up realistic exercises
     • Response: support real-time prioritization decisions
     • Recovery: use data about what happened to improve services for next time
 Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                   Comprehensive Information Technology Support for
                                         Pediatric Surge/Disaster Functions:
                                     Resource Allocation and Task Planning Tools




What are Resource Allocation and Task Planning Tools?
Software advisors on best assignments of personnel and other resources to critical activities:
   – Prospectively for training, budgeting,
     project planning purposes
   – Effective, real-time adjustments as situations evolve,                                         ...                              ...
     priorities and protocols change                                                       Services                     Disaster Modalities
                                                                                       Facilities               Personnel and Supply Status
                                                                               Pharmaceuticals                     Infrastructure
                                                                     Surgical Procedures and Equip.       Environmental Conditions


Benefits & Applications:
                                                                    Medical Best                        Regional Situation
   – Generic: assistance in evaluating tradeoffs                 Practice Knowledge                      Awareness and
     of competing demands on limited resources                      Repositories                          Risk Analysis
   – Across lifecycle:                                                                                      Services
                                                                                               Resource
        – Planning: effective budgeting, pre-                                                  Allocation
          positioning                                                                          and Task
                                                                                               Planning
        – Training: semi-automatically generate                                                  Tools
          training scenarios
        – Response: adapt to fluid situations
                                                                           Response Execution Monitoring
        – Recovery: effective budgeting,                                       and Coordination Aids
          scheduling, priority setting



Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                  Comprehensive Information Technology Support for
                                Pediatric Surge/Disaster Functions: Response Execution
                                           Monitoring and Coordination Aids


What are Response Execution Monitoring and Coordination Aids?
Make sure the right things happen by:
  – Advising on plans
  – Verifying that assignments are made and tasks are under control
  – Trigger contingency plans by:                                                   ...                                       ...
      • Identifying/anticipating arising out of bounds                       Services                            Disaster Modalities

         conditions (overload, under-utilization)                        Facilities                      Personnel and Supply Status
                                                                  Pharmaceuticals                           Infrastructure
      • Noting when expected/required actions          Surgical Procedures and Equip.              Environmental Conditions
         did/didn’t occur
                                                                     Medical Best               Regional Situation
Benefits & Applications:                                          Practice Knowledge             Awareness and
                                                                     Repositories                 Risk Analysis
 – Generic: more effective execution in closer                                                      Services
   accordance with best practices, earliest possible                                   Resource
   warning of breakdowns                                                               Allocation
                                                                                       and Task
 – Across lifecycle:                                                                   Planning
      • Planning: collect & feeds back actual                                            Tools
        performance data for lessons learned,
        improved planning & training
                                                                          Response Execution Monitoring
      • Training: provides action advisors for user                           and Coordination Aids
        in both training and live situations
      • Response: conveys plans to individuals focused on what they need to do now
      • Triggers warnings when plans are breaking down
      • Recovery: more accurate information helps identify hot spots, lingering problems
Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                        Information Technology
                                            Research Issues
• Knowledge representation
        – Representations of processes
        – Multi-purpose representations
        – Human and automated consumption.
• Community-based knowledge capture, update and validation
• Integration of heterogeneous data, model and simulations
• Collaborative sensemaking of complex data
• Interest-based alerting and information dissemination
• Human-in-the-loop distributed collaborative planning,
  scheduling and activity coordination
• Managing, analyzing, interpreting and disseminating large
  volumes of data from instrumented environments
• Robust, secure, reconfigurable computing to support robust,
  secure, adaptable organizations
    Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                        Possible Relationships
                                        Between Life Sciences
                                         Informatics Thrusts
      From a life sciences                                                                                                          From an information
  Curent
         perspective                                                                                                              technology perspective
Science                   Emergency Care
      =>                                                                                                                                            Emergency Care
                            Informatics
    Best                                                                                                                                              Informatics
Practices




                                                       Individual Patient Information
                                                                                        Service Organization Information
                                                                                                                                                     Data/model/simulation
                                                                                                                                                           integration
                                                                                                                                                         Collaborative
                                                                                                                                                         sensemaking
                                                                                                                                 Knowledge             Human-in-the-loop
                                                                                                                               representation,       planning, scheduling &
                                                                                                                             capture, validation,         coordination
                                                                                                                                   update
   BioMedical                                                                                                                                       Managing, analyzing,
   Informatics                                                                                                                                          interpreting,
                                                                                                                           BioMedical               disseminating large
                                                                                                                           Informatics                volumes of data
                                                                                                                                                           Robust
   Patient                     Imaging                                                                                                                   computing
    data                     Informatics                                                                                                               infrastructures
                                                                                                                                                         Imaging
   Proprietary Material – USC Information Sciences Institute and Children’s Hospital of Los Angeles
                                                                                                                                                       Informatics

				
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posted:10/23/2011
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