As a Bostonian and an emergency physician, Jonathan Teich's first instinct when the explosions shook the Boston Marathon on April 15 ordinarily would have been to rush to Brigham and Women’s Hospital to help treat the victims, many of whom had life-threatening injuries.
But this Patriot’s Day, it was different. Teich’s son and brother-in-law were both running the marathon. His brother-in-law crossed the finish line at the time of the second explosion – unhurt. Teich’s son, just a couple of miles back, was among the runners diverted off course. So an anxious Teich waited for that first text message saying he was OK. It would be two hours, though, before father and son were reunited.
Once he had seen for himself his son was all right, Teich called Brigham & Women’s emergency department, where he is on duty most Friday nights, to see what he could do to help. By then the hospital was adequately staffed.
Emergency physician is one of several roles Teich assumes in his professional life. He also serves as chief medical informatics officer for Elsevier and as assistant professor of medicine at Harvard.
All three roles keep him immersed in the world of informatics and health IT.
"There are several aspects to information management in a disaster," he said. "As you can imagine, this is a situation full of many more patients with much higher acuity than we're used to, often with types of problems, such as blast injuries, that we train for but do not see very often."
However, at the Brigham & Women's, Teich said, there are emergency physicians who spend a lot of their time going to disaster sites around the world, taking care of crisis situations, from Haiti to Indonesia.
“Over time," he said, "they have developed some small but functional documentation, record-keeping and specific management systems that are very helpful in this kind of once-in-a-lifetime (hopefully) situation here in the U.S."
Beth Israel Deaconess Medical Center
John Halamka, MD, the CIO of Beth Israel Deaconess Medical Center in Boston, a practicing emergency physician and Harvard professor, was on a flight returning from Los Angeles, when he started receiving real-time Twitter feeds, video and email about the explosions.
BIDMC’s director of support services assured him all systems were go.
"From an IT perspective," Halamka said, "maintaining a high-bandwidth, reliable and secure infrastructure was key. The demand for communication – voice, email, social media and streaming video was very high. The scalability built into the design of all our systems – networks, servers, storage and client devices – served us well."
Halamka shared with Healthcare IT News (sister publication of PhysBizTech), and posted on his blog, the details the director of support services reported to him.
"The IS Manager on Call was in phone contact with me within 20 minutes of the explosions. Staff covering the Computer Operations/IS Alerting function did a great job. Our desktop staff was paged by the BIDMC Command Center seeking media services support for LCD displays/projectors. The Emergency Response folks located the Command Center on the West Campus because of the ED activity (they usually locate it on the East Campus during storms, etc.). We stood ready to deploy additional equipment but the Command Center was stocked with everything necessary. We check and maintain Command Center equipment on a monthly basis.
"I was in touch with all my managers and staff by 4 p.m.," said Halamka. "There were no open IT issues."
He added, “Aside from the shock and eventual anger we all felt at having this happen in our home town, it was a typical operational day."
Boston Children's Hospital
Daniel Nigrin, senior vice president for information services and CIO at Boston Children’s Hospital, was out of town during the explosions, leaving Scott Ogawa, CTO and deputy CIO, in charge.
"Like many organizations, Boston Children’s Hospital trains for a myriad of emergencies," Ogawa said. "We have a very detailed hospital incident command system, HICS, in which key departments are always at the ready. Information technology is just one of the many HICS command positions which are on-call at all times."
"Anytime an incident is declared, the overall 'incident commander' will contact the entire HICS team and within minutes, we are connected to discuss the specifics and assignments are given," Ogawa said.
"Shortly after the incident occurred, the entire team of HICS leaders was on a conference call mobilizing staff and putting plans into action," he said.
"The role of IT in this incident was primarily to facilitate communication," said Nigrin.
"In this case," said Ogawa, "we were largely in a support role to the many clinical resources who mobilized with pretty amazing speed."
Partners HealthCare in Boston was founded by Brigham and Women’s Hospital and Massachusetts General Hospital. Today the health system also includes the Center for Connected Health in Boston, 11 community hospitals in the Boston suburbs.
“What is important to remember is our IT staff are all members of the Boston community, and our thoughts and prayers are with the families and friends of those tragically injured and those that lost their lives,” Jim Noga, vice president and CIO Partners HealthCare told Healthcare IT News.
Next, we are part of a medical community that is the world’s finest. Thirteen hospitals received 180 victims, and they received the finest care from physicians, nurses and other healthcare workers,” he said.
As Noga sees it, in a crisis, IT’s role is subordinate to the direct care providers.
“It is our job to ensure we make available to them the IT resources they need,” he said. “IT participates in emergency planning exercise and understands the importance of steady-state, assuring the high availability of systems, keeping communications channels open and otherwise staying out of the way. That is our focus during a crisis.”
“It's a really heroic hospital-wide effort," said Brigham & Women’s Teich. "Not only are there additional emergency staff and a lot of additional trauma surgery staff, but the inpatient services have to clear out beds, by identifying patients that are potentially ready for discharge, and have to be ready for five times our usual number of admissions in a really short period of time."
We use our standard online CPOE system, however, and we have several trauma-specific order sets – for example, for emergency blood release, blood pressure support agents and pre-surgical trauma orders. We only recently finished a revision of our emergency blood transfusion orders, which came in very handy here."
Going forward, mobile technology could help
At the Center for Connected Health, part of Partners HealthCare in Boston, founder and director of the center, Joseph Kvedar, MD, envisions several ways mobile technology could help as victims of the bombings recover.
"While we were not immediately deployed to assist in the disaster response efforts following the tragic bombings at the Boston Marathon, the center and our full resources will remain available to assist our medical colleagues in their heroic efforts to treat and heal the hundreds of victims, families and emergency responders affected by this devastating and unthinkable act of violence," Kvedar said.
Connected health solutions, he said, may be helpful in providing remote patient monitoring, video conferencing could help to connect providers or deliver mental health counseling, or mobile technologies may provide motivational messaging and reminders to help individuals maintain their care plans in the coming weeks and months.
Several of the center’s team members were near the finish line, Kvedar noted, and were, "thankfully," unharmed. "Our thoughts and prayers remain with the victims, the fearless emergency responders and our very capable colleagues at hospitals throughout Boston, as we begin the long healing process."
"In a disaster as devastating as what transpired this week at the Boston Marathon, health information technologies and mobile devices can play a critical role in the timely transmission of vital data and long-term patient care and monitoring," said Chuck Parker, executive director, Continua Health Alliance, an organization that bills itself as an partnership of technology, medical device and healthcare industry leaders dedicated to making personal telehealth a reality.
Interoperable systems can begin to collect data at the zero point, making it a valuable tool for quick disaster response, Parker said.
As he sees it, for the hundreds of victims of the blasts, emergency responders and others affected by this tragedy, technology can keep people connected with their care teams, provide timely interventions, monitor their vital signs and wound healing, and even provide mental health counseling.
"As we have seen in other disaster response efforts,” Parker said, "end-to-end, plug-and-play interoperability of personal connected health devices and systems has helped to save lives, valuable time and money."