The mission of the U.S.Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) is to save lives and protect Americans from 21st century health security threats by leading the nation’s medical and public health preparedness for, response to, and recovery from disasters and public health emergencies. To accomplish this mission, ASPR collaborates with hospitals, healthcare coalitions, community stakeholders and groups, state, local, tribal, and territorial governments, the private sector, and other partners across the U.S. to improve readiness and response capabilities.
Healthcare system preparedness has evolved significantly over the past decade to accommodate the diverse needs of communities, to be flexible and compliant with various government and private sector requirements, and to effectively respond to various emergencies and disasters. Multiple reports and stakeholder feedback since 2010 led to a call to expand healthcare system preparedness information availability. In response, ASPR designed and launched an innovative program in 2015 to advance and enhance healthcare system preparedness and response across the nation comprised of three domains:
- Technical Resources (TR)
- Assistance Center (AC)
- Information Exchange (IE)
ASPR TRACIE is a comprehensive, one-stop, national knowledge center for healthcare system preparedness that provides technical assistance (TA) and facilitates the efficient and effective exchange of information.
As a planning resource and in the dynamic environment of a disaster, ASPR TRACIE simplifies access to resources and experts, serving as a force multiplier through improved information sharing while reducing duplication of effort. ASPR TRACIE continues to be a unique, key federal assistance source for healthcare system preparedness across the country.
A December 2020 white paper highlights the development process and quality of ASPR TRACIE TA provided across the spectrum of healthcare disaster preparedness and response activities. The program’s growth and success are attributable to their ability to:
- Anticipate stakeholder needs
- Capture user feedback to influence the TA model
- Meet the needs of stakeholders during real-world incidents, including the COVID-19 pandemic
Operationalizing a Concept
ASPR TRACIE was developed through a collaboration between multiple HHS operating divisions, other federal government departments/agencies; local, state, tribal, and regional government agencies; national associations; nonprofit organizations; and private sector partners. Early outreach with these stakeholders elicited ideas, comments, and recommendations for ASPR TRACIE’s development process, services, and resources. With this support and input, the ASPR TRACIE program was able to develop and launch a website focused on healthcare system preparedness resources, receive requests for information, and promote peer-to-peer discussion boards through the IE. The ASPR TRACIE program strives for continuous quality improvement and maintenance of a high level of customer service satisfaction. Today, the program maintains a 99% overall customer satisfaction rating and 99.5% satisfaction rating for timeliness of TA responses.
Understanding the Healthcare System Preparedness Landscape
The ASPR TRACIE team had to first understand stakeholders’ needs and how to best meet them, while simultaneously adapting as expectations, needs, and threats evolve. To meet these needs, one of the first tasks was to identify and categorize healthcare system preparedness and response topic areas. Together with partners, stakeholders, and subject matter experts (SMEs), the ASPR TRACIE team identified 57 topic areas and developed Topic Collections (TC), showcasing medical and healthcare preparedness plans, tools, and templates curated by ASPR TRACIE staff and vetted by the SME Cadre.
Providing a Forum to Address Critical Issues
In 2020, visitors to the ASPR TRACIE website topped one million, monthly visits broke records (311% increase over 2015-2019), and IE membership rose 122%.
The ASPR TRACIE Resource Library contains thousands of resources from numerous contributors that can be easily accessed and downloaded. All ASPR TRACIE content is free and publicly accessible from the Resource Library, TCs, and AC sections. ASPR TRACIE also has the ability to quickly disseminate information through a robust listserv, which has a reach of more than 1.5 million healthcare professionals.
The ASPR TRACIE Information Exchange is comprised of nearly 10,000 members and serves as a unique, near real-time peer-to-peer discussion area that facilitates quick conversations, collaboration, and resource sharing on a wide range of healthcare system preparedness topics.
Utilizing Subject Matter Experts
The key to achieving ASPR TRACIE’s goals is the assemblage and utilization of a unique cadre of vetted SMEs who volunteer their time to the project to curate and review resources, provide input on TA requests, and collaboratively develop new resources when topic gaps are identified. This cadre is composed of more than 1,000 professionals in the fields of healthcare, disaster medicine, public health, and public safety recognized for improving and advancing their field of expertise.
Growing Knowledge Through Technical Assistance
The Assistance Center can be accessed by phone, online form, and email and is staffed weekdays between 9:00 a.m. and 5:00 p.m. Eastern Time, excluding federal holidays. The AC is managed by experienced ASPR TRACIE staff with knowledge of healthcare and public health preparedness and response. Since 2015, the ASPR TRACIE AC has received over 8,300 TA requests from users in all levels of government, healthcare, and the private sector. Requests for TA increased by 138% in 2020 over previous monthly averages. Nearly 75% of TA requests in 2020 were related to COVID-19.
The ASPR TRACIE team administers TA through written products, toolkits, phone calls, emails, and webinars. TA responses are customized to meet the needs and timeline of the requestor. The ASPR TRACIE team reviews and develops an individualized work plan to provide a comprehensive response to each TA request. The team works with partners and the SME Cadre, as appropriate, to assist with fulfilling TA requests. Figure 1 illustrates the top 10 TA request categories since 2015.
If the request is outside of ASPR TRACIE’s scope or resource availability, the requestor is notified and connected to the proper entity as practical. ASPR TRACIE does not provide formal policy recommendations and refers all grant-related questions to the appropriate ASPR or federal government personnel.
Identifying & Filling Gaps in Healthcare System Preparedness
To continuously meet stakeholders’ evolving needs, the ASPR TRACIE team regularly determines areas for future work by assessing TA requests, monitoring IE discussions, and noting knowledge gaps identified during conferences, webinars, or meetings. These assessment methods enable the team to consider the best format to develop new, original, user-friendly resources (e.g., tip sheets, tools, templates, webinars) and prioritize next topics. Producing resources in various formats helps to meet diverse stakeholder needs and modes of learning.
The team is both flexible and adaptive to time-sensitive requests. For example, during the COVID-19 response, ASPR TRACIE was quickly able to respond to an influx of TA requests and provided direct assistance to interagency partners by creating new online resource collections, hosting webinars, and reviewing hundreds of resources to include the most up-to-date information on the website. The team created over 100 products in 2020, including new tip sheets and other resources specific to COVID-19 preparedness, response, and recovery, as documented in a Calendar Year 2020 Resources Digest.
The Future of Technical Assistance
The HHS 2019-2022 National Health Security Strategy emphasizes that, as the healthcare systems threat landscape transforms and the global public health of communities continues to expand in diversity and complexity, the potential for disruption to both public health and healthcare systems increases. The tremendous expansion in the volume of website visitors and TA requests received during the COVID-19 pandemic clearly demonstrates the critical need for the services ASPR TRACIE provides. It also substantiates how healthcare and public health practitioners rely on this federal source as a key component of their daily work.
The growing frequency and complexity of TA requests requires more innovative solutions to produce the right information for the right stakeholder at the right time. This includes developing resources that serve as “just-in-time” guides for both planners and responders, more effectively sharing knowledge and efficiently capturing lessons learned from SMEs, while anticipating and addressing the needs of stakeholders before disaster strikes. For example, the February 2021 Healthcare System Cybersecurity: Readiness & Response Considerations is one of the few available documents that addresses a comprehensive approach to clinical, financial, and system planning for the consequences of information system downtime. One of ASPR TRACIE’s most downloaded documents, the EMS Infectious Disease Playbook, synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies.
In the years ahead, ASPR TRACIE will continue to exemplify the “art and science” of providing TA through continued collaboration, innovation, and closing identified knowledge gaps in healthcare system preparedness.
Acknowledgements: The authors would like to acknowledge the ASPR TRACIE Program Director, Shayne Brannman; Meghan Treber, ICF TRACIE Program Director; Corina Solé Brito, ICF TRACIE Communications Lead; Bridget Kanawati, ICF TRACIE Assistance Center Lead; Jennifer Nieratko, ICF TRACIE Special Programs Lead; Alicia Livinski, National Institutes of Health Library Informationist supporting HHS ASPR; and project team partners and SMEs.
Audrey Mazurek, MS, has worked at all levels of government for nearly 20 years in public health and healthcare preparedness, emergency management, and homeland security. She was a program manager with the National Association of County and City Health Officials (NACCHO) Project Public Health Ready program. She supported the U.S. Department of Homeland Security in the development of an accreditation and certification program for private sector preparedness. She also served as a public health emergency preparedness planner for two local public health departments in Maryland, where she developed over 30 preparedness and response plans, trainings, and exercises. She is currently a director of public health preparedness with ICF, primarily supporting the U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response’s (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) program as the ICF program director.
John Hick, MD, is a faculty emergency physician at Hennepin Healthcare and a professor of emergency medicine at the University of Minnesota Medical School. He serves as the associate medical director for Hennepin County Emergency Medical Services and medical director for emergency preparedness at Hennepin Healthcare. He served the Minnesota Department of Health as the medical director for the Office of Emergency Preparedness and currently works part-time for U.S. Health and Human Services as an advisor to the director of the National Healthcare Preparedness Program. He is an expert on hospital preparedness and crisis medical care issues and has published over 50 peer-reviewed papers dealing with hospital preparedness for contaminated casualties, disaster standards of care, and surge capacity.