The COVID-19 pandemic has exposed vulnerabilities across the United States healthcare system and provided a serious test of hospitals? resilience. The system has faced formidable challenges associated with all facets of disaster medicine, including prevention, such as containment strategies to prevent spread; preparation, such as ensuring sufficient supplies for testing and personal protective equipment; and response, such as anticipating surge events and ensuring sufficient staffing, space, and supplies. A robust disaster medicine response requires hospitals to engage in rapid, evidence-based decision-making where decisions need to be made on resource allocation, patient care, and other factors. Unfortunately, just-in-time data may not be readily accessible, and decision-making is further complicated by rapidly changing circumstances and uncertainty. Health information technology (HIT) has the potential to enhance the emergency pandemic response but has shortcomings in terms of usability and effective presentation of data, which are widely documented. The proposed project will examine local COVID-19 response through the lens of hospital resilience, decision-making, and human factors engineering at University Hospital of Brooklyn (UHB), a lower-resource, but highly impacted COVID-19 safety- net hospital located in Brooklyn, New York, which will serve as the primary site. Columbia University Irving Medical Center (CUIMC) will serve as a secondary site for Aim 1 to provide a point of comparison. The proposed research will address a critical barrier to effective pandemic response by (1) identifying information and data needs of local hospital decision-makers and (2) characterizing workflow around decision-making tasks. The results of this initial evaluation will be used to inform the design and prototyping of novel HIT solutions leveraging existing systems and technologies that have potential to support decision-making and hospital resilience to pandemics. Phase 1 of the research, consisting of Aims 1 and 2, will be a discovery process in which the study team interviews and observes members of the UHB and CUIMC emergency response teams central to pandemic response. The team will also interview key informants who provide necessary inputs into the decision-making process and who receive the outputs, such as directors of clinical departments. Phase 2 (Aim 3) will investigate how methods and tools support the UHB emergency management response team?s information and workflow needs. A set of prototypes will be developed that include dashboards, visualizations, and data integration tools. The study team will also investigate whether an established composable (drag and drop) interface platform, MedWISER, can be used to fashion solutions to address information needs and enhance decision-making. The ultimate objective is to facilitate the development of a more robust platform to meet information needs and enhance decision-making capabilities and resilience in response to the formidable strain imposed by a pandemic.
This research project will study how a lower-resourced safety-net hospital, University Hospital of Brooklyn, responds to a pandemic, specifically COVID-19, under conditions of great stress and strain and with much uncertainty. In the short term, the project will investigate how information needs are met and how decisions are made and communicated to other individuals internally and externally to the institution (Aims 1 and 2), and the results of this investigation will be used to develop a range of information technology solutions, such as dashboard displays, visualizations, and data extraction tools (Aim 3), so that the institution can better address gaps in information needs and workflow. In the long term, this work has the potential to impact public health by illuminating the needs of lower resource hospitals during pandemic situations and introducing novel approaches to improve decision-making and response and therefore enhance patient quality of care, safety, and well-being.
