Mahboob ali khan MHA,CPHQ (Phd Proposed Thesis)Consultant Quality and patient Safety

Co-authors: Dr.Juveria Majeed,Dr.Arun Raj.

Research motivation

◦ Response information system interoperability

◦ Standard - data model

Research question

◦ What is the data model design methodology

◦ What are the key data elements to be contained in an

emergency data model

Fire incident scenario

◦ $14.6 billion loss in 2012

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Community Data Standards Focus Objectives

Emergency Medical Service

EMS Data Dictionary (v. 2.2.1)Within-Domain Interoperability

Enable the efficient sharing of EMS information on personnel, patients, situations, assessments, medical history, and medical devices.

Health Care HL7 Messaging ProtocolWithin-Domain Interoperability

Enable the efficient sharing of medical data among all healthcare systems.

Public HealthPHIN Vocabulary Standards and Specifications

Within-Domain Interoperability

Enable and foster the use and exchange of consistent information among public health partners.

TransportationVehicular Emergency Incident Data Exchange Format Standard

Within-Domain Interoperability

Enable the automatic distribution of vehicular emergency incident data between the TelematicsService Providers and emergency personnel

TransportationIEEE Std. 1512 Standards

Traffic Management StandardWithin-Domain Interoperability

Enable the sharing of traffic and incident information among agencies

Public Safety Traffic Incident Management Message Sets

Enable the sharing of transportation safety information among agencies and the public.

Justice Global Justice XML Data ModelWithin-Domain Interoperability

Enable the sharing of criminal justice information among law enforcement

Homeland Security and

Justice

National Information Exchange Model(NIEM)

Mixture of Within- and

Cross-Domain Interoperability

Enable the nationwide sharing of information on justice, emergency management, geospatial and infrastructure protection, immigration etc.

9-1-1 ServiceE9-1-1 Standards

Standards for Automatic Location Identification (ALI) & GIS Mapping Within-Domain

Interoperability

Enable the automatic sharing of ALI data between Service Providers and 9-1-1 Data Base

Standards for Local Exchange Carriers, ALI Service Providers & 9-1-1 Jurisdictions

Enable the efficient sharing of number pooling, database communication, and general message exchanges among Service Providers and 9-1-1

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Activity theory

◦ Psychological meta-theory

◦ Key tenets

Subject, object, tool, rule, community, division of labor

◦ Development

First, second, and third generation activity theory

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Small Time Window

(Mini-Second)

Offsite (EOC)

Managerial

Onsite (ICP)Operational

Large Time Window

(Many-Second)

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Shared Objects

inquiry, request &

command

Community

fire, police, & EMS

Division of Labor task

assignment

Division of Labor

collaboration

Object

global situational awareness,

strategic response

management

Instrument

dispatch channels

Rule

manual

Instrument

field note

Rule

regulation

Community

local & state

Subject

supervisor

Object

Awareness of local

situation, tactical operation

Subject

first

responder

Environment

social setting

Environment

natural setting

Timeline

(de) activation

Timeline

alarm, respond

Communication activity

during onsite response

(Mini-second)

Dynamics of

Interactions

Communication activity

during offsite response

(Many-second)

Technical issues

&

Social issues

Technical issues

&

Social issues

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Preplanning State

Incident liability, equipment damage, loss estimate, etc

Critique, after-action-report, case archiveRecommended improvement

Building property use, structure (e.g., floor map), etc

Revised response plan

Recovery StateResponse State

Performance record

Mini-Second

Many-Second

Performance record

Corrective action

Solid line: typical communication during the response statesDotted line: response cycle with reinforcing feedbacks for corrective actions

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Inspired by Cybernetics Research

Illustrative Issue

Potential Contradiction New Data Type

Fire, Police, Emergency

Medical Service, Hazardous

Material Team

Response agencies often compete for theincident commander position. Most of thetime, the fulfillment of this position isdetermined by the incident type. Forexample, if there is a criminal aspect to anincident, law enforcement agencies are incharge of the scene; in all other fire relatedincidents, fire chief is in charge.

Incident category

Emergency Managers

Information sharing in emergencymanagement should be controlled to ensurethat information is distributed amongauthorized personnel only.

Information sensitivity level and personnel security clearance

level

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Semiotics literature

Signs for emergency management

◦ Sign-based language

◦ Non-sign-based one

Symbol design foundation◦ ANSI Z535.2 and ISO3864-2002

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Data Type Casualty

Data Element Injury Severity

Definition Description of the injury level of a victim

Symbol See below

DANGER Signal word indicates the level of the alert

Critically ill. Identification of the reason

Life threatening risk. Consequences of not following the signal

Medical treatment

immediately. Appropriate measures to take

↑ Graphic is used to strengthen the word message

Documents•fire incident response technical data forms; fire incident response dispatch forms; field notes; chronological logs; fire response plans

Experts• Responders in western New York

Systems• fire incident messaging systems

Data Collection

Data Analysis

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Define, type, and structure identified components

Object-oriented structure

Model Specification Model ValidationData Analysis

National Information Exchange Model (NIEM)

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Request for Comment Distribution

Feedback Synthesize and Model Updates

Data ModelFinalization

Overview Diagram

Spreadsheet Specification

◦ Data type

◦ Code list

◦ Symbol collection

XML Schema◦ Data type

◦ Data property

“ASTESF” approach:

Activity theory and semiotics augmented by timeline, environment, state, and feedback perspectives

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Factors Example MeasurementFire Model

(ASTESF)ExampleEvidence

Pro

cess

Theory-based development

The extent to which the data model is developed using theoretical approach

High ASTESF approach

All stakeholders involvement

The extent the relevant stakeholders are queried

High Fire, Police, and HazMat, etc

Incident specificityWhether the data model is for specific incident type

Yes Fire related incident

Support

Transaction support

Whether the data model allows users to administer operation routines

HighPlans, activities, and schedules, etc

Decision supportWhether the data model allows users to make informed decisions

HighFire behavior, ignition, building structure, etc

Change management

Whether the data model allows users to handle changes in the response operation

HighAssociation data of activity, IMS, and organization, etc

Organization management

Whether the data model allows users to manage organization structure and chain of command

HighIMS unit and response organization

Sp

ecif

icati

on Implementability Ease of use by the potential users High

XML based model for varied platforms and technologies

ReusabilityReuse percentage of existing data elements

HighMany elements also serve other scenario

ConsistencyNumber of violations in the relationships among all data elements (reverse)

High Enforced through XML schema

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Principle Brief Explanation Data Model Support

Risk Orientation

Responders adopt sound risk management principles in assigning tasks and resources

Data elements capture the fire hazard and environment threat

FlexibilityResponders use creative and innovative approaches in solving disaster challenges

Data elements capture the dynamic associations among individual, organization, and incident management

Integration

Responders ensure the unity of efforts among all levels of management under collaboration and coordination

Data elements capture the structure and division of labor of incident management system that need to be integrated

ResilienceResponders strive for the success despite of the failures and constraints

Data elements capture the reinforcing feedback and corrective actions in incident response operations

The U.S. Federal Emergency Management Agency (FEMA) and Emergency Management Institute (EMI) -2007

Contribution to theory

◦ Data model development - ASTESF approach

Uses multiple activity systems (i.e., mini- and many-second response); captures activities with the temporal sequence of development, connectivity between multiple states, and internal reinforcing feedbacks (within- and between-state), and endorses semiotic designs for better conveying notations.

Implication to practice

◦ Reduction of communication interoperability barrier

Extension of scope

◦ National standards

◦ Other incidents such as flood

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