The White House Situation Room was established after the Bay of Pigs crisis. Leaders in Washington realized that failures during that crisis stemmed in part from a lack of shared real-time information. That shaped the Situation Room into an integrated conference room and intelligence center used to manage crises. Electronic data fuels its operation and informs White House officials of critical elements to guide decision-making. Decisions about how to respond to the COVID-19 pandemic are being driven in part from within those walls.
Wars are often tracked using comprehensive, geographically specific real-time data from the battlefield. But during the pandemic, critical data remains dispersed across the country instead of being centrally available. Most advanced organizations leverage data visualization to improve situational awareness at a glance. At the heart of that process lies the density of data that surfaces as a dashboard. Why do we not already have a dashboard guiding our national health-care disaster response? Imagine the president, vice president and key advisers, including the White House pandemic task force, gathering daily in the Situation Room to review a real-time dashboard of U.S. critical-care resources.
Data from every hospital would flow into the dashboard displaying occupied intensive-care-unit beds and patients on ventilators. Key data would include the number of available ICU clinicians as well as unused ventilators of all kinds, including anesthesia machines. The status of every city, state or region would be understandable using a digital map of deployable critical-care resources. While some resources remain fixed, such as the number of licensed beds and operating rooms, others, including the number of regular hospital beds that can be converted into ICU beds, are more fluid. Hospitals could report daily their resource availability and capacity via existing federally mandated electronic health record (EHR) systems. Such an approach should require only minor adjustments to the information flow required by the Health Information Technology for Economic and Clinical Health Act of 2009. This would require EHR companies to adopt open-standard interfaces to enable public health authorities to extract relevant data. But a similar approach is already being used to permit patients to access their personal health information under 21st Century Cures Act requirements.
Dashboards allow complex and voluminous data to be visualized and understood. They are, however, crafted using raw data. The power of predictive analytics, perhaps leveraging the power of the National Laboratories, could assess trends and pinpoint areas soon to devolve into crisis, as well as those emerging in success. Understanding such changes could enable officials to direct where federal resources, such as the ventilators and personal protective equipment in the secure stockpile, are most desperately needed. This system should be always ready to avoid delay in an emergency. White House news briefings could feature dashboard data to share the evidence on which critical decisions are based. The dashboard could be viewed as the commander in chief’s war-room map during America’s battle with COVID-19.
This scenario is not a fantasy. But neither is it yet a reality. The components of this real-time dashboard exist at every U.S. hospital; they simply await a data stream for visualization. While many elements are collected by the Federal Emergency Management Agency, and others by the Centers for Medicare and Medicaid Services and certain states, those data are not ready for practical use. Reflecting local resources, emergency and disaster preparedness has been principally planned at the regional or state level, not across the country. But COVID-19’s geographic scope outstrips current emergency preparedness planning. Just like the pandemic spans the entire United States, a dashboard would span — and inform — multiple national agencies. In fact, it could serve as a focal point for FEMA, the Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response, and the Public Health Service, guided by White House leadership.
On April 10, HHS Secretary Alex Azar initiated daily data collection of many of these elements, but not the creation of a real-time dashboard. A resource-displaying dashboard is an essential tool for disaster preparedness, planning and response, and it would have obviated the need for the secretary’s recent request. Durable support for such efforts could be cemented into the next stimulus bill. This critical investment will enable leadership to effectively deliver health-care resources where they are needed most to save lives.
Sadly, this will not be our nation’s last public-health emergency — and we need to be better prepared next time. Honoring the timeless message of former President John F. Kennedy, the visionary for whom the Situation Room is named, we must ask ourselves: How can we not do this for our country?