Promoting Clinician Readiness

1
Promoting Clinician Readiness

• Leslie Beitsch, M.D., J.D.
• Commissioner and State Health Officer
• Oklahoma State Department of Health

2
Efforts by Health Departments

• Over the past 3 years, many State health
  departments were recipients of CDC sponsored
  bioterrorism (BT) grants
• Grantees made concerted outreach efforts to
  clinical practitioners
• Strengthening the Health Alert Network (HAN)
  included coordination with local and State
  medical societies
• Establishing ties with Metropolitan Medical
  Response System (MMRS)

3
Clinician Needs after 9/11

• Definitive information on BT
• Diagnostic criteria
• Surveillance and reporting primer
• State and local medical societies wanted greater
  participation in the BT planning and advisory
  processes

4
Engaging Clinicians

• Have a BT event it creates the teachable moment
• Clinicians without further prodding will seek to
  enhance their competency in diagnosing BT related
  illnesses
• Modest educational efforts will pay immediate
  dividends by raising the clinical index of
  suspicion
• Reminding medical societies and individual
  physicians of legal duty to report diseases
  (e.g., anthrax, etc.)
• Reducing barriers to simplified reporting (e.g.,
  electronic disease reporting)

5
Steps for State and Local Health Departments

• Build a systemic response to BT events
• Provide education and training to the entire
  public health workforce, not only staff with
  day-to-day BT responsibilities
• Enhance epidemiology, biostatistics,
  microbiology, and communication skills through
  core courses, seminars, and distance learning
  technologies
• Offer graduate education for selected staff who
  demonstrate potential for future leadership roles

6
Role for Clinicians

• Physicians are now engaged
• New BT grant requires planning and advisory
  committees
• Coordination with local and State medical
  societies requires further strengthening
• Recruitment/involvement with MMRS

7
Testing the System

• April 12 and 13, the Oklahoma State Department of
  Health (OSDH) staged largest BT exercise ever
• Blueprint and lessons will be available for
  others to use across the country
• Planning activities and exercises are the best
  methods to test systems responsiveness
• Employ hackers to test security
• IT system redundancy test

8
Preparing for Bioterrorism

• State and local task forces in virtually every
  health jurisdiction
• Involvement with Gubernatorial and Legislative
  task forces
• ASTHO and NACCHO have provided tools,
  recommendations, and enhanced Web sites
• CDC BT grants
• Enhanced surveillance

9
Public Health and Clinical Medicine

• Renewed appreciation of the importance the public
  health system plays in protecting our communities
• Better understanding of the need for disease
  surveillance and reporting systems
• Willing participant now in BT and other related
  advisory groups

10
Model Emergency Health Powers Act

• Act is attempt to codify the various powers and
  authorities needed to respond to the most
  catastrophic public health events (BT)
• Private sector may be called upon to assist
  governmental public health
• Hospitals and other facilities may be
  statecized
• Conceivably clinicians could be asked to practice
  in adjacent jurisdictions

11
Coordination with Tribal Governments

• Coordination required under the terms of the new
  CDC grant
• Oklahoma example 39 federally recognized tribes
  
• Short-term approach include Bureau of Indian
  Health (BIH) in advisory group
• Expand to all interested participants in the
  long-term planning process

12
Available Tools

• All States recently completed a Department of
  Justice (DOJ) survey, with results now available
• National Public Health Performance Standards look
  at broad public health systems capabilities
• Reconcile laws in jurisdiction with Model
  Emergency Health Powers Act

13
Lessons Learned

• Build close working relationships with clinical
  colleagues before threatened BT events
• Use HAN resources to tie clinicians into public
  health network
• Examine disease reporting and surveillance
  systems from perspective of the user and lower
  barriers to easy accessibility
• Improve web sites so that clinicians seeking
  information can obtain it rapidly
• Anticipate ongoing educational needs, and use CME
  as a carrot