In late November, Tom Ridge, director of the Office of Homeland Security, said the creation of a national system that would allow public-health agencies at all levels - federal, state and local - to quickly share information would be a key part of devising a strategy to counter bioterrorism.
Ridge said such a network would be an extension of work already done by the Department of Health and Human Services, which he said has partially completed a health alert network.
New Mexico has been working on its own health alert network (HAN) for 18 months, and the state's HAN coordinator, Kevin Bersell, spoke with Government Technology about what's been done, what needs to be done and the obstacles the state faced.
GT: What levels of agencies are hooked up to your HAN?
Bersell: There's a grid we work with; we look at folks in terms of professional affiliation. Are you health care? Are you a government emergency manager? Are you a first responder?
We also track people geographically as a cross-reference. What county are you in? What part of the state are you in?
We have organizations in the emergency-preparedness community - county emergency managers, for example. We have first responders - folks like fire and police and EMS staff. We have health-care professionals - that would be non-government, folks in a hospital or primary-care centers, and infectious-disease clinicians. Then we have government contacts - we are part of the Department of Health, and we have access to all the staff of the department for communications.
We also have contacts with the New Mexico Environment Department because the department would have a key role in the cleanup of a chemical attack.
GT: If you had to make some recommendations to other states and other departments of public health looking to set something like this up, what would you say to them?
Bersell: It's really all about relationships. It's one thing to put together an e-mail list of everybody, but you have to have that relationship defined and in place so that people know what to do and what's expected of them when they do get the message. They need to know how they fit into that picture, and to have those relationships defined is the important part. It's important to not just be an IT person in all of this; you have to work as part of a bigger team and understand the business practices of emergency preparedness.
That helps you craft your message and your audience.
GT: So you have to put together the infrastructure and you have to put together the teamwork behind it.
Bersell: Yes, and it's kind of hard. You have to put together the teamwork ahead of it - the network needs to reflect the plan. Right now, that's really hard because everybody is scrambling to get this stuff in place. There's kind of a parallel development going on in terms of putting technology in place and developing plans.
That's a really difficult aspect of this; we really don't have the leisure of waiting for the plan to be fully fleshed out, but it's hard to put the technology in place without knowing what the plan is. It's very much a parallel development process.
GT: What led you to create the New Mexico HAN?
Bersell: We received a substantial grant from the Centers for Disease Control for bio-terrorism preparedness, and about one quarter of that money was for Health Alert Network development. I believe that most states received similar grants.
GT: Are they doing the same sort of work you're doing? Is there a front-runner?
Bersell: Yes, and we'd like to think we're the front-runner, but I don't know that that's true.
Each state is responding to what it perceives as its unique needs, capacities and resources, and not everybody is doing the same thing in lock step. In New Mexico, we had a head start because we had already linked together almost all of our local health agencies into a WAN.
That's a hard piece for a lot of other states because, one, they hadn't worked on that, and, two, their department of health isn't organized the way New Mexico's is. Here, we're fortunate that we have a centralized Department of Health in that all of the local health offices, all the way down to the smallest health office in the state, are a Department of Health facility. That's not true in most states.
In most states, the local health office may be a facility of the local community or the county, and there's a lot of work that needs to be done to connect state agencies to county agencies to city agencies. There are not only a lot of technical issues there, but there's a lot of politics.
In New Mexico, we were fortunate that those barriers didn't exist. We were able to just order up the high-bandwidth connection and get it into the local health office. That was relatively easy for us, and we were able to jump ahead beyond that piece and think about, "How do we communicate to everyone. What's the paradigm we would use for a mass e-mail program. What do we need for video conferencing?"
GT: What sort of communication vehicles does the HAN support?
Bersell: Right now, we have broadcast fax. We have mass e-mail. We have some level of video conferencing; not down to every community but to key partners in the state and to the district level. New Mexico is divided into four public-health districts, and there's a central office for each district. We have video conferencing to each one of those.
We're also working on using radios for communications as a redundant level of communication. We have an EMS/first responder radio system that already exists, and we're purchasing equipment to tie our emergency-preparedness unit and the public-health offices into that system.
GT: Is the communication between the HAN and the agencies one way?
Bersell: The e-mail is two-way, of course, but the broadcast fax is a one-way type of thing. It's interesting, a few years ago, fax was a critical piece of communications. Any more, I'm thinking about it as a redundant level of communication. At least in our organization, the primary means of communication is e-mail, but that fax is there, and it does put the information where it needs to be.
We're talking about things like satellite phones, and we've talked about handheld devices, but I don't know how much redundancy that would really give us. That's going to be on the same backbone as the e-mail system, and, if the Internet as a whole goes down, the handhelds won't give us the redundancy we need. They would allow us to locate people where they are if they're away from their desks.
GT: I've seen some comments from Tom Ridge and the Office of Homeland Security concerning setting up a nationwide health alert network. How would something like that play out?
Bersell: That really is in place right now. The CDC is funding all of this right now, and it has a centralized health alert network. They send information to people like me in each state, and I turn around and forward it to the local folks. There's a cascading effect there.
It doesn't have quite the reach that it should, but the major pieces are in place. I would see it basically as it is now, but with better reach and more redundancy.
GT: Does such a national network need to address fostering interactivity between local health officials and the CDC?
Bersell: It has to go in tiers - local, state, federal - and people at our state level could probably handle 90 percent of the needs of the local folks, and there would be some percentage that would need to be bumped up to the federal level.
That's how I would see that, in terms of having some kind of full interactivity, is to regionalize it and tier it in terms of where you are in the government schemata. Part of it is how you not just do messaging, but how you transfer data between communities, states and the federal level.
GT: What have been the biggest barriers that you've faced in putting this all together?
Bersell: It's been hard to put low-probability events onto people's agendas when they're consumed by day-to-day business problems. But, since Sept. 11, that's really turned around. People are interested in what we're doing, and they want to know how they can get involved.
Another thing is that government doesn't move quickly. A lot of people who are interested in government don't want it to move too fast. Government that moves too fast can be dangerous, so they want it to move relatively slowly, and that isn't necessarily good for emergency preparedness.
GT: What do you see as the greatest benefit of the HAN?
Bersell: If something does happen; if we do have a biological terrorism event and the HAN is able to get the right information into the right people's hands at the right time, we'll be able to save lives. For a health department, there's no greater benefit than that.