Audiences for Future Efforts

While many professionals in public health and medical preparedness circles have been introduced to the concept of CSC over the past 10 years, there are still several relevant groups that are likely less than familiar with it. Hodge saw a need for targeting the entrenched legal actors who consistently “put up a shield” about what can be done within their organization because they either do not understand what resources are available or do not want to deal with the size of the challenge. It can be hard to convince legal counsels in organizations and companies to switch their thought process from “will this leave my client liable?” to “will this save lives in our community?” Patel added that there is a need to refresh what this message looks like and expand it to other areas more tangential to health, such as critical infrastructure. The principles will remain the same, but a lot has changed in the past 10 years of progress and discussion, she said, and we need to adapt the message moving forward, along with refreshing and re-socializing the concepts.

She also brought up the current public health challenge of lung injury from vaping, and the response of CDC, along with the 2019 outbreaks of measles in the United States, saying that we learned very clearly from these events that younger generations absorb information quite a bit differently than most of us in this room and in our offices. CDC’s target audience for lung injury is ages 18–35, she said, and they are not looking at CDC’s website or reading its well-written reports. To truly reach different audiences, especially younger ones, there is a real need to think through changes in communication by the public and how people access information.

Little thought it was also necessary to engage leadership at the point-of-care level, such as medical directors of clinics, executive directors, and hospital system leads. If we truly need to flip to a “crisis” standards scenario, he said, they could be potential roadblocks or valuable accelerators in getting the right pieces in place. Hick noted that providers in general are in the group that was not really directly addressed in the initial report development in 2009, and Little said the opportunity through the strengthening of health care coalitions could make it easier to integrate this difficult-to-reach population. Little elaborated that, though they will not be able to attend presentations or give up multiple afternoons, they may be interested in functional exercises and be able to participate in valuable information sharing about gaps and lessons.

Leveraging Technology

Dan Hanfling, In-Q-Tel, underscored the technology component of CSC, and how fundamental it is to thinking about these important issues. We have the tools and enabling technologies in the 21st century to give us real-time information and inputs to fine-tune many facets of our daily life. But, he asked, where are the barriers to actually implementing and using these within public health and health care? We know that companies like Amazon and FedEx are able to leverage digital tools and advancements to appeal to their customer base but why is it, Hanfling asked, that health care is struggling to catch up technologically? Little agreed that this is an abundant area of opportunity for the future, because the current technology and legacy systems in place yield poor data that require lots of cleaning and checking for errors. “For example,” he said, “the bed board in our hospital in theory should tell me the number of open beds available, but it often misses nuances in patient status or other glitches that lead to a number that is not accurate. Because it doesn’t take other important pieces into account, it yields no useful information for me as a provider.” Hick suggested some of this may be a lack of motivation by some players, saying they have better prognostic information available in electronic health records (EHRs), but they have not dug into it yet. Hick also observed that, unless they are able to bring together stakeholders from EHRs, providers, and hospital groups to develop new questions and standards, the potential insight and wealth of data that EHRs can provide will be left unrealized.

Patel concurred with the important role of technology but saw it as three important areas to break down. First, there is the titanic component of how massive the challenge of health care technology is. Health care systems have been around for a long time and have even been built in a piecemeal fashion, so any efforts to change EHRs and make systems more usable would require a total overhaul, she said. Secondly, technology continues to change so rapidly that many sectors—especially government and health care—are not able to move fast enough to implement the upgrades and advancements. Having interoperability and integrating into older systems is a challenge that needs to be considered. Outbreaks move faster than the data, she explained, and this is no different. She even gave an example of the media curve for lung injury, which was a perfect match for CDC’s epidemiological curve—but it was published 1 week earlier. Finally, she said, there is the generational aspect of technology, which she hinted at in her previous comments. The difference between those who are using the tools and those who have the information to share is sometimes two to three generations apart. This mismatch adds to the difficulties in leveraging technology successfully to relay accurate information. In conclusion, Hodge said, technology is a tremendous tool, but it can also create its own crisis, and we have to be ready for how the nation uses technology to respond to misinformation. For example, he highlighted the anti-vaccination issues affecting several countries around the world, including the United States.