Episode 035: The Public Health Agency’s Remedy for Ailing Point Solutions


As the world prepares for a “new normal,” public health agencies will be challenged to afford and implement processes that serve faster-paced, mobile day-to-day needs, as well as keep them prepared for future outbreaksAs we’ve learned to do with “all things government technology,” we turned to Former CIO, and now Government Consultant, Paul Gorman for insights.  

Tune in as we discuss how to marshal resources in preparation for the public health agency’s future technology needs, mobile testing and data gathering, how being equipped today mitigates tomorrow’s hurdles when responding to emergencies, and how to prepare for all prospective contingencies.  

For more information on “the public health agency’s digital solution,” visit https://www.imagesoftinc.com/government/public-health.html   

Check out this episode!

Read Transcript
Kevin Ledgister: Welcome to the Paperless Productivity podcast where we have experts give you the insights, knowhow, and resources to help you transform your workplace from paper to digital and making your work life better at the same time.

Thanks for joining us. My name is Kevin Ledgister, your host. And today we’re talking about public health agencies, government agencies, so this is a lot of focus on their responsiveness right now. With me is our returning former CIO that now consultant CIO, Paul [orman, to talk to us about how technology can play a crucial part in these agencies operations. Not only with the situation at the moment, but also for future contingencies. So, welcome, Paul.

Paul Gorman: Thank you. Thanks for having me.
Kevin: Yeah. So, Paul, thanks for coming back and joining us again. In the past, the information that you’ve shared with us and our listeners have been so helpful. I know that when we have a crisis like this that officials are tasked with doing a lot of different things, and it cost money to really to marshal the technology resources to address the current crisis as well as answer that question, what do we do in the future? How do we prepare, not only for today, but how do we also look to the future? That cost money, and government agencies typically can’t just manufacture money out of thin air.

So, maybe you can just share with our listeners a little bit in terms of what are some things that are happening on that front and how are these things kind of being addressed from a budgetary standpoint, so that these public health agencies have the resources they need to really to respond.

Paul: Sure. Thanks, Kevin. First off, I think it’s important to note that public health agencies, they’re a very broad endeavor. They do so many different things. If you think about how they regulate, they regulate anywhere from a restaurant inspection to a septic tank permit. Right now, what’s in the news is the epidemiology divisions of those public health agencies. The epidemiologists have a role to play where they’re receiving information directly from labs and medical facilities that are providing testing. The testing right now is for COVID-19, but they do testing for every other type of communicable disease, and positive tests are supposed to be handled in a very specific fashion.

Within public health, the agencies that are receiving the tests, these public health agencies, are reporting up to the Center for Disease Control. Then, down to the first responders so that everyone is aware of the latest and greatest information. That reporting process is really where funding has been freed up, if you will, by the Federal Government. What the most recent legislative and executive acts have done is they’ve eliminated specific processes that were in place to do things like the allocation of maps, for example. There was an allocation structure built into the regulations of federal public health that allocated maps to different industries.

Those allocations were just changed by an executive order. The funding streams that have been made available, FEMA has been brought in, and FEMA has the ability to provide funding for disaster relief. They’re typically the same grant processes that exist from public health agencies at the federal level, the public health agencies at the local level, but they have disaster relief rules and procedures applied to them. Those funding sources have just been made available. Total funding of about $50 billion has started to move through FEMA. Prior to this, there was an executive action and support from Congress for a piece of legislation that made about $500 million available to each of the States.

It’s broadly construed to be available to cover the costs of responding to the epidemic. So, for our listeners who are curious, I’m assuming at this point public health agencies are aware of what they’re getting. But for those that are not aware, it’ll roughly break down into about $10 million for that first round of funding per state, and roughly about $1 billion per state for the second round of funding. Although that second round of funding through FEMA is by application and it’s a grant application process that the States are going to go through. That’s the funding that’s coming into the States to help address the testing, purchasing additional supplies, and addressing the changes that are going to have to happen in their internal systems to manage the new tests that are coming in.

Just a little bit about those tests. In normal operating times, there are specific labs designated in each State that are designed as testing facilities that the epidemiologists use. So, regardless of where you go, if you go to your local doctor or you’re in the hospital and a test is ordered, those tests are sent to the labs that are in the States. Some States may have as many as 10 or 15 labs, other States, smaller States may only have two, but those labs are the ones that are essentially doing the reporting. So, report streams from those labs come into the public health agencies and the public health agency’s responsibility is to process those.

Identify the positive tests, report them to the CDC and to the first responders. What’s happened is, instead of two labs in a small State, there may be now a dozen different testing facilities that have come online, including federal testing facilities. All of these testing facilities do not already have systems for reporting. So, one of the things that we’re reaching out to the public health agencies to talk about is what we can do by way of assisting them in addressing this large influx of new tests coming into the agencies.

Kevin: Paul, that’s one of the things that I think maybe that we’ve been hearing on the news, that we haven’t always been aware of, is that the current testing that’s, regimen that’s in place right now are for the things that are essentially are kind of controlled process, right?
Paul: Absolutely.
Kevin: Whereas what we’re dealing with right now is something that is requiring these agencies, not only to scale up new locations, but also significantly scale up their volume with something that they really weren’t designed for or weren’t prepared for. Is that a correct statement?
Paul: Yes it is. If you think about the testing process, I think we might want to break that down a little bit for everybody. In normal times, when you go in and see your doctor, the doctor will take the samples for the test and they’ll complete a form that has to go in to the testing lab that contains the sample and the information about you. It’s specific demographic information that they’re required to gather. They also want to know where you live, where you’re located, where you work. This information is contained in every test that goes into the testing labs.

The reason for this is if you have a positive test for a communicable disease, they’re going to want to be able to instantaneously plot it and start doing the tracing that has to be done to determine who you’ve come in contact with. That information now needs to be gathered from a great many other sources of information. Within your doctor’s office, it’s completely controlled. They have the existing systems in place, they have the forms in place. They even probably have the direct connections in place to send this information to the labs. As you’re seeing the testing happening in Walgreen parking lots, Walmart’s, or wherever they’re setting the testing up, those facilities are not available there.

We need to be able to provide mobile testing, mobile data gathering, and mobile information at those tests sites, and a way to connect those tests sites directly to the labs that are doing the testing. That’s another part of the overall solution. Any piece of this breaks down, the testing does not flow smoothly and information delays will occur. And in a pandemic like that, those information delays can be devastating to the population. We need our decision makers at this point to have the best information possible available as soon as possible so they know what steps need to be taken. Many of the things that have happened in specific locations are because there are essentially 10 counties and three States, where over 50% of the positive tests have occurred in.

Those 10 counties and three States are taking different steps than States that do not have that concentration. So, we need to make sure that if a concentration develops in a State, we see it as soon as possible or in a County, we see it as soon as possible, so those additional ramifications and steps can be taken.

Kevin: You’re exactly right, Paul. So, from that perspective, having that data, that real time data, or as close as possible to real time data, is critically important, especially as these new things pop up. So, from a technology, and now we’re going to … Thanks for giving such a great, helpful understanding in terms of how these public health agencies and the doctors and the medical professionals have to all connect together, share data, share that information so that it becomes something actionable from a political level.

But also, now, from a technological standpoint, it seems to me that with the new ones that are popping up, they don’t have that kind of infrastructure in place or even for the ones that are existing, they’d be not be able to scale their current operations. So, I know that you’re right now consulting with CIOs in different government agencies. You’ve been on the other side of the chair where you’ve had to make these kinds of decisions in terms of technology and how do we share data. How does something like OnBase really start to help or mitigate some of these processes both in the near term and as well as maybe going down the road in terms of, how do these agencies prepare for future contingencies?

Paul: That’s a fantastic question. First off, in a public health agency and in an outbreak like this, OnBase provides something that is very beneficial in that it’s a configurable solution with component parts. So, we are able to stand up, IT departments and organizations like ImageSoft, are able to stand up a customized response tool literally in a matter of weeks, weeks being the outside end. OnBase provides essentially interlocking components that are going to work together out of the box, and that makes a big difference. We do not require a point solution built specifically to do this.

That’s helpful because you don’t know what the next problem is going to be, but you’re pretty sure there’s going to be more problems. So, in OnBase, OnBase components can generate the template letters that are going to be needed. It’s going to allow you to capture data on mobile forms and there’s a number of different forms that are needed. Both test forms and consent forms that need to be filled out on those mobile locations. Many of these mobile locations are not going to have adequate internet access for these to be web forms. They’re going to need to have mobile forms that are available offline, and OnBase support staff.

We’re going to need to be able to capture email communications specifically from doctors, other professionals in the medical profession and be able to build the case information that are necessary to do the tracing of an individual, and where they’ve been, and who they’ve come in contact with. We need workflow processing that is rule-based workflows that allow us to route the information and notify people what specific steps have to be taken. When we build these rule-based processes out, we need to have the ability and flexibility to change them, that the locations from State to State are going to probably have different requirements as to who needs to be notified, what types of notifications have to be sent, and what stage they are in the emergency preparedness process.

So, if somebody has declared a state of emergency in their State and they have tapped into FEMA funds, they’re going to be behaving in a totally different manner than a State, maybe they have a state of emergency in that State, but they’re not yet at the FEMA level. These different changes have to be effective in the workflow and they changed the procedures and processes. So, one size fits all solution is not going to do for every State or even every location and every State. Case management is needed. Each of these positive test results is a case, and there’s a regulatory protocol that has to take place when a positive test case is made.

That results tracing where the individual’s been, contact with the people they have been in contact with, and quarantine procedures that are specific to the case. A lab test capture for the lab test. What typically happened in the very recent past is the lab tests that are coming in from the testing facilities, their laboratory information management system reports that come in, many of them have been hand data entered in the past, into the reporting systems that the CDC requires, and into the local first responders reporting. That needs to be streamlined now. So, the volume of tests are going to be in the hundreds and thousands and more coming into these facilities.

For example, in my own State of Kentucky, we’re going to have over 50,000 tests processed just today. That’s not something that is typically done through our labs here. It’s a volume that is very unusual and it’s something that is going to choke the State systems if they have not thought through a process to deal with that. We have a process to deal with that. We can take the reports coming directly from the labs, process them through an electronic report management system, turn the reports, which are essentially paper based reports, into data without having to have data entry done. Push that information directly into the responding systems for the CDC and the first responders.

If the labs are able to generate HL-7 messages and some of them will and some of them won’t. HL-7 is a protocol to exchange medical information. We can actually receive the HL-7 messages and do the same thing with them. So, with the same solution, we could process labs that are HL-7 based and those that are not, which is very important because you do not need two different solutions and two different streams of information going into the CDC. You just can do it all with one. Final part is the reporting and mapping. Because we integrate directly to GIS systems, we’re able to generate on the fly heat mapping showing where the outbreaks are occurring.

Showing where the positive test results are, and be able to allow decision makers to make rapid decisions regarding quarantine and social distancing for specific areas, as soon as that information is available. It’s essentially instant. The second the test results come into the system, the heat reports are automatically updated in real time. It allows very rapid management decision processing. So, separate reports don’t have to be run and you’re not manually dictating GIS connections to the map. Hugely beneficial when you’re responding to an emergency situation like this.

Kevin: Yeah, and if anything that has taught us in this scenario is that when it comes to viral outbreaks timing is critically important. Otherwise, you don’t want to be behind, you want to be in front of those types of decisions, right? It’s better to prevent a contagion spreading rather than having to treat it after the fact.
Paul: Absolutely. We can see the results of that by comparing the results in a country like South Korea that really got on top of this, and they’re going down the other side of the curve versus what has happened in Italy. I just feel for the people in Italy, you are dealing with this, this is still going up the side, they are not yet at full contagion. They just don’t have the internal facilities to deal with what they’re dealing with.
Kevin: Yeah, and if anything that has taught us in this scenario is that when it comes to viral outbreaks timing is critically important. Otherwise, you don’t want to be behind, you want to be in front of those types of decisions, right? It’s better to prevent a contagion spreading rather than having to treat it after the fact.
Paul: Absolutely. We can see the results of that by comparing the results in a country like South Korea that really got on top of this, and they’re going down the other side of the curve versus what has happened in Italy. I just feel for the people in Italy, you are dealing with this, this is still going up the side, they are not yet at full contagion. They just don’t have the internal facilities to deal with what they’re dealing with.
Kevin: Yeah, and we have actually family that’s in Italy, related family through marriage and they’re elderly people, and that’s one of the big concerns right now, is the isolation that takes place, and they’re somewhat invalid. They need help from their children and they can’t get out. So, you’re right, containment of these things and stopping the spread really does have a downstream effect. So, Paul, I know just from you in conversations that we’ve had offline that you have a favorite scene when it comes to the military, that they’re always fighting the last war.
Paul: Yeah
Kevin: Just because of, the last war always tells the lessons that they need and then they implement those and that’s how they prepare the op for the next one. So, how does this kind of technology that you just outlined, and it may not be another viral outbreak, it might be something else that may occur, but how does this type of technology, this something like OnBase, which is highly configurable, and you can build case applications, and workflows, and be able to even automate and digitize official forms without modifying those? How does all of that stuff play into really helping a public health agency or anybody really prepare for the next contingency that might happen down the pipeline?
Paul: Well, as I’ve mentioned when we first started talking today, a public health agency has such a broad set of responsibilities. It’s precisely that wide variety of programmatic responsibilities that makes a product like OnBase such a good fit for the agencies. If an agency tried to implement specific point solutions for each of their areas of responsibility, a public health agency did this, they would be tasked with supporting literally dozens of diverse systems, which may be similar but were not quite the same with each other. From an IT support perspective, that’s speaking as a former CIO, that is quite a burden. If you have two dozen different mission critical systems that you’re supporting.

It’s a very high cost of ownership that you’re going to have to adopt literally just in staffing to support that many different systems. Not to mention the annual maintenance, and upgrades, and all the work that goes into having a mission critical system like that. From my perspective and as I’ve learned, I mean Lord knows I didn’t get here right away, I made all the bad decisions when I was a CIO. So, I sort of learned as I’ve grown. A better strategic decision is a platform solution which provides the solution components and allows the specific program solution to be configured on that standardized platform.

It can be a tremendous benefit to the agency because it dramatically reduces the IT support and as such, the total cost of ownership for each application. There are a lot of good choices for solutions, but I like, and I advocate for the flexibility, power and ease of a configured solution on the OnBase platform. Because it has the ability to manage forms, documents, content of all types, case management, workflow and business process automation, and even file cloud sharing for external views and third party access. It really kind of checks all the boxes that we need in public health solutions to allow us to, if something pops up, take our component parts. Just like a box of Legos, we can build what we need to address this specific solution when this specific solution arises.

Kevin: I think one of the things that I’ve appreciated in our response in the federal level is that you’ve seen both public and private agencies come together and work together to address this, right? We had a conversation before we got online talking about how some of the cruise lines are turning their ships into floating hospitals or mobile hospitals that can move to different areas of the country where there might be an outbreak, and be able to house people and treat them where we may not have enough beds, for instance, in a particular city, which I think is just great when you have that partnership.

I was thinking, too, just when you were talking, Paul, about how the fact that not only is the system highly configurable in terms of being able to quickly address things that are on the horizon and even when you’re in that moment, but also the fact that a government agency that has a platform like this, they can own some of that configuration. It’s not something that they’re always dependent on the vendor to do or a partner to work with. Although that can be helpful and that can accelerate a process, and that can get them through some of the trickier waters if they don’t have the in-house expertise. But it does give them a lot of flexibility to say, “Hey, we need to prepare for this. We need to put some work into it, and we’ve got the resources and we can partner with a vendor or a partner to help us through this process.” But it doesn’t have to be one or the other. It’s something that both can walk together through that process and come up with a timely solution to that.

Paul: Absolutely.
Kevin: Yeah. Yeah. So, any other thoughts on this subject, Paul? And just in terms of has the train left the station in terms of dealing where we are right now or is there still some opportunities for some public health agencies to say, “Hey, there’s some things that we could still do today.” One of the reasons I ask that question is because when you talked about 50,000 tests today alone in Kentucky, I just thought, “Who’s going to key in all that information and all that data so it becomes something that we can act on?”

That’s a massive amount of manpower to assemble in a very, very short period of time, and to do it accurately as well where technology can really augment that. So, if you could just maybe touch on that in terms of answering that question, has the train already left the station or is there still opportunities for public health agencies can, “Yeah, we can still do something even today.”

Paul: They could still do something even today. We don’t know where we are. I hate to have to say this, but we don’t know where we are in this particular disaster cycle. I would love to say that we’re … We know we’re on the upside curve, but we don’t know where it’s going to top out or how long it’s going to last. They have not reached their peak in Italy or any of the European countries yet. The information that we have on places that had to deal with this a little longer, China and some of the Asian nations, might not be as accurate as we would have it in this country. Part of the problem is just getting the counts right.

When you don’t actually have the infrastructure, the public health infrastructure in place can be a challenge. So, I would say there are definitely things that can be done right away on this. The other issue I think it’s important to point out, is that based upon the past 20 years, we have had one of these incidents about once every five years, courtesy of a variety of different sources. If you recall EBOLA, SARS, MERS, and swine flu epidemic, just occupying the last 20 to 30 years. It’s not like this is an infrequent occurrence. This has become maybe more of an issue and more of a problem because of the specific characteristics of COVID-19.

The fact that it is so communicable and it has a long survival rate on the surfaces of things. So, if somebody who has the infection touches a surface, it stays that way until that surface is cleaned for apparently quite a long time. They don’t know exactly how long yet. So, diseases with this kind of characteristic are certainly hopefully rare, however, I would say just that we know it’s going to happen again. So, even if you think in your area you’re over the curve, you know what pain you just went through, let’s make sure you don’t have to do it again. There are things that can be done with this, and there is going to be funding flowing for agencies to address it.

My advice to them, if you’re in the thick of it and you don’t have time to take a step back and put another solution in place, remember that there is a solution out there when you get to the other side of this. You can get a chance to take a breath and get yourself in a better position for the next one.

Kevin: Yeah, you’re absolutely right. Because I think we’re at a point now with the amount of communication, the 24-hour news cycle, the availability of data that when the next thing hits, the next flu or whatever it is that hits, that we have to deal with, there’s probably going to be a lot less patience for the public if the government agencies are not prepared or find themselves still unprepared. They’d be like, “Well what happened last time?” In the past we didn’t have as much data. We didn’t have as much technology. In the past, we go back 10 years ago or 15 years ago where … 15 years ago, we didn’t even have smartphones really, 15 years ago, in any wide capacity.

So, you think about that and where we are today, there’s a whole different level of expectation that people are expecting more of a quick response. And so, it’s going to become critical that we’re just prepared, that we can’t let this sit and say, “Okay, this happened. It’s now in the past. Let’s go on and focus on other things.” It has to become a priority for CIOs and different business leaders to address this. Not only from, how do we address the crisis, but how do we function in an environment where we can’t come to the office for instance and touch a piece of paper, right?

Paull: Yeah, absolutely.
Kevin: Yeah, if it’s required that you need to touch a piece of paper for your function to exist, then that puts you at a huge disadvantage. It also puts you in a position where you may end up communicating something because you are in that position, whereas no process is going to be 100% paperless in terms of, there’s always going to be somebody that says, “I don’t have a computer. Something happens, so I have to submit paper.” But if you can take care of 80% to 90% of your cases that are electronic and keep that data flowing, that information flowing, and keep that process going, whatever agency that you’re at, that just means you’re going to be so much more prepared when the next contingency occurs.

It may not be a communicable disease. It might be something like, it could be an earthquake, it could be some other catastrophe that really upsets or impacts the community, and you have to respond and scale up things very, very quickly, and you need to have tools and platform to do that.

Paul: Yeah, absolutely. I think for agencies of State government who wonder if this is a worthwhile investment, I would just say, “Look at what the economic devastation from this is going to be, and recognize that you may be able to mitigate some of that devastation just by having better and quicker information.” Because we’ve seen what the … Lots of life is going to be in a loss. The sickness and misery that’s probably being generated from this is tragic, but there’s going to be an economic price to pay here. I believe we’re going to probably have an unemployment rate spike to somewhere around 25% when the next numbers come out.

That’s just an astonishing hit that you speak of natural disasters, there really isn’t a natural disaster that I think would affect all 50 States. Just thinking of the ones that I’ve worked on in the past is not really been one exactly like this that affects all 50 States. I don’t recall, even after 9/11, airlines having to lay off 70% of their workforce. I don’t recall bars and restaurants having to be shut down. There’s an economic price to pay for unpreparedness, and let’s learn our lessons and not be unprepared again.

Kevin: I wholeheartedly agree. So, Paul, I want to thank you for joining us again and just sharing us your expertise in this area and your insight into what’s happening behind the scenes. It’s just so helpful, even for me, just to understand how much [inaudible 00:32:24] our public health agencies. I’ve gained a whole new appreciation for what they have to do during this. I think anybody listening to this would also agree that it’s really, really a tall challenge. So, kudos to those people that are really trying hard to just step in and step up. I really appreciate that, and it’s great to know that there are opportunities.

There are ways that we can leverage technology to really help us through this so that we can make quicker decisions, reduce the economic impact, or reduce the life changing impact that sometimes these things can have. So, thank you for sharing that.

Paul: I’m absolutely delighted to talk with you today. It’s been interesting to have this conversation and think through what can be done to improve things in the future. I will tell you, I think we have the best public health agencies in the world, and we have some very wonderful, dedicated people that are working very, very hard right now. That’s been my experience when discussing this with them.
Kevin: Yeah. Thank you, Paul.
Paul: Thank you much.
Kevin: Thanks again for joining us on this podcast, and if you haven’t already done so, be sure to subscribe to Paperless Productivity, where we tackle some of the biggest paper-based pain points facing organizations today. We’ll see you next time.

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