March 2008
In Defense of a Nation

HMT From the Editor

By Michael McBride

Healthcare professionals prepare for all types of disaster. ED physicians and first responders plan for mass-casualty events. IT directors plan for network recovery after system failure and data loss. Operations directors consider how to keep hospitals going when Internet access, supplies and power become limited or non-existent. C-level executives examine the overall repercussions and ensure continuity of the business during disaster and its aftermath.

On Oct. 18, 2007, President Bush issued the "Homeland Security Presidential Directive 21 (HSPD-21)," which builds on principles laid down in "Biodefense for the 21st Century," a roadmap for protecting America against bioterrorism, released by the White House in 2004.

HSPD-21 transmutes the latter, primarily intended to counter biological attacks, and combines it with principles drawn from two other national strategies to form a "National Strategy for Public Health and Medical Preparedness," which provides directives that organizations should use to prepare for all types of disasters, including floods, fires, hurricanes and earthquakes, as well as terrorism. The key principles include: "Preparedness for all potential catastrophic health events; vertical and horizontal coordination across levels of government, jurisdictions and disciplines; a regional approach to health preparedness; engagement of the private sector, academia, and other nongovernmental entities in preparedness and response efforts; and, the important roles of individuals, families and communities." It's a comprehensive directive and well worth your time to read.

Among the 20 or so key strategies scheduled to come to fruition in 2008, is the "implementation of, a plan to use current grant funding programs, private payer incentives, market forces, Center for Medicare and Medicaid Services requirements, and other means to create financial incentives to enhance private sector healthcare facility preparedness in such a manner as to not increase healthcare costs." Haven't we been doing this all along?

Another key strategy includes the creation of the Office for Emergency Medical Care (Office) within the Department of Health and Human Services (HHS). Its job will be to "promote" - through funding - research to enhance and improve our EDs, triage, distribution and disaster preparedness. The Office will analyze the entire continuum of care in order to make its recommendations to the HHS Secretary. It will also "coordinate with existing executive departments and agencies that perform functions relating to emergency medical systems in order to ensure unified strategy, policy and implementation." It's the latter statement that has me concerned. How will the government "ensure" all this, I wonder.

Regardless, many of the HSPD-21 strategies involve the promotion or implementation of some form of information technology, which will no doubt drive standardization, and which should be a boon to our industry, enabling the growth of regional health information organizations, and, enabling the National Health Information Network to finally come into existence.

What do you think? I'd like to hear from HMT's readers on this issue. Is the government preparing to "federalize" our hospital emergency systems and departments, and if so, what effects do you think this will have on healthcare in America?

You'll find links to both directives at the bottom of the online version of this editorial on HMT's Web site. E-mail me your thoughts and we'll post them online and in eNews, HMT's electronic newsletter.


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