Topic Collection Cover Page

Information Sharing
Topic Collection
August 1, 2023

Topic Collection: Information Sharing

The timely and effective sharing of information within and across jurisdictions, disciplines, and organizations is critical to an effective public health emergency and disaster response. Much progress has been made since 9/11, and best practices indicate that those communities with solid, daily, consistent public health and homeland security collaborations respond better to critical incidents. These resources highlight guidance and lessons learned on information sharing that can help emergency health planners identify stakeholders to incorporate into the information flow, develop rules and elements for sharing, and exchange information to ensure a common operating picture. This Topic Collection concentrates on the information shared, and not on the actual “hardware” or physical elements of the information sharing systems.

Planners may also wish to access several other related ASPR TRACIE Topic Collections for more information. The Communications Systems Topic Collection emphasizes the physical aspects of communications systems including promising practices, reports, evaluations, and overviews of programs focused on creating and maintaining resilient emergency communication systems. The Cybersecurity Topic Collection can help stakeholders better protect against, mitigate, respond to, and recover from cyber threats, ensuring patient safety and operational continuity. Emergency Public Information and Warning/Risk Communications includes lessons learned; education and training modules; results from studies conducted on the effectiveness of risk communications; and plans, tools, and templates that can be tailored to meet the specific threats and needs of healthcare and medical professionals.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

Must Reads


Association of State and Territorial Health Officials. (2013). Public Health and Information Sharing Toolkit: Legal Barriers Project.
This toolkit includes links to resources that focus public health agencies' authority to collect, use, and share information to prepare for and respond to a public health emergency. Resources include “executive overviews,” fact sheets, issue briefs, state analysis guides, and supplemental resources.
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  • Sayeshi Yeshu https://www.phe.gov/Pages/PageNotFoundError.aspx?requestUrl=https://www.phe.gov/preparedness/legal/guidance/syndna/lists/screening%20framework%20guidance%20for%20providers%20of%20synt/summary.aspx
    9/12/2019 4:18:26 AM
Booth, C. and Stewart, T. (2003). Communication in the Toronto Critical Care Community: Important Lessons Learned During SARS. Critical Care. 7(6): 405–406.
The authors describe information sharing during the critical care response to SARS. Some of the initiatives that helped the healthcare community exchange information include regular teleconference calls, web-based training and education, and the rapid coordination of research studies.
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Centers for Disease Control and Prevention. (2017). Division of Health Informatics and Surveillance.
This website contains links to disease surveillance programs, information systems, and other related resources. Links to recent messages are included on this website as is a legend that explains types of messages disseminated by the system (alerts, advisories, updates, and general information).
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Centers for Disease Control and Prevention. (2019). Health Alert Network.
The Centers for Disease Control and Prevention use this network to share cleared information about pressing public health incidents with public health professionals.
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Crowther, K. (2014). Understanding and Overcoming Information Sharing Failures. Journal of Homeland Security and Emergency Management. 11(1): 131-154.
The author reviewed the common information sharing failures that caused or exacerbated major catastrophes – the attack on Pearl Harbor, the 9/11 terrorist attacks, and Hurricane Katrina. His analysis revealed several categories of failure: partnering, communication, synthesis and decision-making, and awareness. Suggestions for future research and improvements are included.
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Workshop participants noted several essential elements of disaster information sharing: reliable systems that can be used by all involved during an incident; improved coordination between agencies and entities that would lead to better public messaging; the use of Scientific Response Units, which would provide an avenue for experts to contribute their knowledge to specific types of incidents; and identifying and using the right “amplifiers” for messages. Case studies from recent events are included.
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This webinar is approximately 1.5 hours long and includes presentations on: the practice and roles of health departments in preventing and controlling infectious diseases; public health information sharing during a public health event; priority knowledge, skills, and abilities (KSAs) needed by the public health workforce to prepare for and respond to infectious diseases; and additional information from national partners.
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The authors conducted a literature scan and conducted legal and technical workshops to determine the requirements necessary to enable interstate exchange of clinical data using Health Information Exchanges (HIE) following a disaster. The report suggests that the best way to ensure that health information can be easily accessed during a disaster is to ensure that this can happen every day and during more common emergencies and describes a multi-state existing system and policy and operational issues.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). 2017-2022 Health Care Preparedness and Response Capabilities.
The guidance specific to these capabilities highlights what healthcare delivery system (e.g., hospitals, healthcare coalitions, and emergency medical services) have to do to effectively prepare for and respond to emergencies that impact the public’s health. Objective 2 (Information Sharing) under Capability 2 (Health Care and Medical Response Coordination) includes three activities and related guidance: develop information sharing procedures; identify information access and data protection procedures; and utilize communications systems and platforms.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). GeoHEALTH.
GeoHEALTH is ASPR's secure Geographic Information System (GIS) based, electronic, interactive mapping application. This application incorporates information from other federal and public agencies (e.g., NOAA, USGS and NGOs) into a single visual environment for enhanced situational awareness, assessment, and management of resources for planning, response to natural, man-made or pandemic events. This system supports functions such as policy analysis, planning, course of action comparison, incident management, and training.
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U.S. Department of Homeland Security. (2014). National Emergency Communications Plan: 2014.
The 2014 edition of the plan is organized into three sections: Emergency Communications Landscape, National Emergency Communications Plan Strategic Components, and Implementation and Measurement.
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U.S. Department of Homeland Security. (2019). Homeland Security Information Network.
This network, referred to as “HSIN,” allows federal, state, local, territorial, tribal, international, and public sector partners in emergency services, intelligence, law enforcement, and other fields to share Sensitive but Unclassified information through an invitational password-protected system.
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The authors highlight common concerns shared by law enforcement and public health: early identification of an outbreak, whether outbreak is naturally occurring or intentional, and protection of the public. The handbook highlights components of both fields and how they interact and complement each other; discusses investigational procedures and methodologies for a response to a biological threat; identifies challenges and solutions for improved information sharing (p. 55-60); and provides templates that can be replicated or customized.
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This guidance document encourages the integration of public health and medical providers into fusion center activity. Guidance is provided by fusion center capabilities and by management and administrative capabilities.
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Essential Elements of Information


* U.S. Department of Homeland Security. (n.d.). Draft Guidelines for Publishing and Sharing Information. (Accessed 8/13/2019.)
This report—while slightly dated—highlights Capstone 2014, an exercise conducted to develop, codify, and share a set of Essential Elements of Information (EEI; Table 1). Guidance for sharing information through various means (e.g., incident management information systems, geospatial tools) is also included.
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Guidance


This white paper describes the importance of geographic information system (GIS), as a scalable technology, and the role GIS plays in situational awareness.
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In this slightly dated, yet useful testimony to the United States House of Representatives, the author shared findings from a study conducted on disaster responder information sharing needs. The four requirements he listed were: information about the hazard environment; information on the responder workforce; information on evolving safety issues; and information about safety equipment. Related recommendations are included.
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* Lipsitch, M., Finelli, L., Heffernan, R., et al. (2011). Improving the Evidence Base for Decision Making During a Pandemic: The Example of 2009 Influenza H1N1. Biosecurity and Bioterrorism 9(2): 89-115.
The authors synthesize discussions held just after the 2009 H1N1 outbreak with a focus on surveillance needs specific to pandemic decision-making. They specific the necessary quantitative evidence and describe the sources of surveillance, interpretive tools, and other population-based data that can serve as the basis for such evidence.
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The goals of this workshop were: examine strengths and limitations of different models; identify best practices of information sharing; learn more about examples and lessons learn; explore various policy and performance measures; and share real-life scenarios that highlight the value of collaboration and information sharing. Chapter 2 includes examples shared by federal agencies and Chapter 3 highlights state experiences and tools.
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The authors conducted a literature scan and conducted legal and technical workshops to determine the requirements necessary to enable interstate exchange of clinical data using Health Information Exchanges (HIE) following a disaster. The report suggests that the best way to ensure that health information can be easily accessed during a disaster is to ensure that this can happen every day and during more common emergencies and describes a multi-state existing system and policy and operational issues.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). 2017-2022 Health Care Preparedness and Response Capabilities.
The guidance specific to these capabilities highlights what healthcare delivery system (e.g., hospitals, healthcare coalitions, and emergency medical services) have to do to effectively prepare for and respond to emergencies that impact the public’s health. Objective 2 (Information Sharing) under Capability 2 (Health Care and Medical Response Coordination) includes three activities and related guidance: develop information sharing procedures; identify information access and data protection procedures; and utilize communications systems and platforms.
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This reference describes the systems, access, and policies around sharing threat information between critical infrastructure and public safety. It also includes information on the various tools stakeholders can use to share different types of threat information.
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The authors highlight common concerns shared by law enforcement and public health: early identification of an outbreak, whether outbreak is naturally occurring or intentional, and protection of the public. The handbook highlights components of both fields and how they interact and complement each other; discusses investigational procedures and methodologies for a response to a biological threat; identifies challenges and solutions for improved information sharing (p. 55-60); and provides templates that can be replicated or customized.
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This guidance document encourages the integration of public health and medical providers into fusion center activity. Guidance is provided by fusion center capabilities and by management and administrative capabilities.
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Information Sharing Systems


Centers for Disease Control and Prevention. (2017). Division of Health Informatics and Surveillance.
This website contains links to disease surveillance programs, information systems, and other related resources. Links to recent messages are included on this website as is a legend that explains types of messages disseminated by the system (alerts, advisories, updates, and general information).
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Centers for Disease Control and Prevention. (2017). National Notifiable Diseases Surveillance System.
This system is used nationwide and allows public health agencies to share notifiable disease-related health information (and monitor, control, and prevent the occurrence and spread of state-reportable and nationally notifiable infectious and noninfectious diseases and conditions).
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Centers for Disease Control and Prevention. (2018). Epi-X.
Health professionals can use Epi-X to share preliminary health surveillance information rapidly and securely. Subscribers can also choose to be notified of breaking health news as events occur.
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Centers for Disease Control and Prevention. (2018). FluView.
The CDC FluView interactive report provides weekly influenza surveillance information in the United States. These applications were developed to enhance the weekly FluView report by better facilitating communication about influenza with the public health community, clinicians, scientists, and the general public. This series of dynamic visualizations allow any Internet user to access influenza information collected by CDC’s monitoring systems.
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Centers for Disease Control and Prevention. (2018). National Electronic Disease Surveillance System (NEDSS) Base System (NBS).
This information system helps local, state, and territorial public health departments manage reportable disease data and send notifiable disease data to CDC. This tool can support the public health investigation workflow and can also process, analyze, and share disease-related health information. Reporting jurisdictions receive a compatible information system they can use to transfer epidemiologic, laboratory, and clinical data securely and efficiently over the Internet.
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Centers for Disease Control and Prevention. (2019). Health Alert Network.
The Centers for Disease Control and Prevention use this network to share cleared information about pressing public health incidents with public health professionals.
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Centers for Disease Control and Prevention. (2020). National Syndromic Surveillance Program (NSSP).
This platform allows health officials to quickly share and analyze syndromic data over time and across geographic boundaries. It features standardized tools and procedures that facilitate information collection, sharing, evaluation, and storage.
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This fact sheet describes ESSENCE, a system that allows users to monitor certain worldwide Department of Defense outpatient healthcare data and provides alerts for unusual or rapid increases in the incidence of outbreaks and infectious diseases.
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Office of the Director of National Intelligence. (n.d.). National Counterterrorism Center. (Accessed 8/13/2019.)
The National Counterterrorism Center (NCTC) is staffed by personnel from multiple departments and agencies, including the U.S. Department of Health and Human Services. The Center produces items for the President’s Daily Brief and the daily National Terrorism Bulletin, helps coordinate interagency collaboration, and disseminates a weekly update to senior policymakers regarding threats to the nation. NCTC also serves as the shared knowledge bank on known and suspected terrorists and international terror groups.
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U.S. Department of Homeland Security. (2016). National Biosurveillance Integration Center.
This Center focuses on providing early warning and situational awareness of biological threats and works with federal, state, local, territorial, and tribal partners to analyze and share related information.
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U.S. Department of Homeland Security. (2019). Homeland Security Information Network.
This network, referred to as “HSIN,” allows federal, state, local, territorial, tribal, international, and public sector partners in emergency services, intelligence, law enforcement, and other fields to share Sensitive but Unclassified information through an invitational password-protected system.
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This statewide syndromic surveillance system allows authorized users to view data from emergency departments, the Carolinas Poison Center, and the Pre-Hospital Medical Information System. The web site includes links to data and reports and a frequently asked questions tab.
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Lessons Learned


The authors examined whether and how non-traditional data (e.g., tweets and media reports) filled a void in traditional data reporting during the response to Hurricane Isaac in 2012. They also studied the effect of non-traditional data on the timeliness for reporting identified Essential Elements of Information.
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This paper provides an overview of the relevant obstacles and challenges in regards to sharing and coordinating information by examining existing literature and then investigating a series of multi-agency disaster management exercises, using observations and a survey.
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Booth, C. and Stewart, T. (2003). Communication in the Toronto Critical Care Community: Important Lessons Learned During SARS. Critical Care. 7(6): 405–406.
The authors describe information sharing during the critical care response to SARS. Some of the initiatives that helped the healthcare community exchange information include regular teleconference calls, web-based training and education, and the rapid coordination of research studies.
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The authors emphasize the cost of not sharing surveillance data, highlight data sharing processes from various perspectives, and share case studies based on interviews with subject experts. Though the document has a European focus it highlights key issues with both process and policy of information sharing between sectors.
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Crowther, K. (2014). Understanding and Overcoming Information Sharing Failures. Journal of Homeland Security and Emergency Management. 11(1): 131-154.
The author reviewed the common information sharing failures that caused or exacerbated major catastrophes – the attack on Pearl Harbor, the 9/11 terrorist attacks, and Hurricane Katrina. His analysis revealed several categories of failure: partnering, communication, synthesis and decision-making, and awareness. Suggestions for future research and improvements are included.
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Greene, J. (2014). EMS and Information Sharing. Annals of Emergency Medicine 64(2): 15A-17A.
The author describes the challenges and related innovations in information sharing between emergency medical services professionals and the emergency medical care community. Though this emphasizes daily patient care it has direct applicability to the disaster setting and offers significant discussion of issues.
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This report highlights how social media was used by survivors of the 2010 earthquake that struck Haiti and how it was analyzed internationally to mobilize assistance and map damage. The authors note that “the international humanitarian system was not tooled to handle these two new information fire hoses” and discusses strategies for adapting to this type of information sharing to improve disaster response.
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Howland, R., Li, W., Madsen, A. et al. (2015). Evaluating the Use of an Electronic Death Registration System for Mortality Surveillance During and After Hurricane Sandy: New York City, 2012. American Journal of Public Health 101(11): e55-e62.
The authors evaluated NYC’s electronic death registration system for mortality surveillance during and after Hurricane Sandy, demonstrating how daily data systems can contribute significantly during disasters to impact assessment.
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Workshop participants noted several essential elements of disaster information sharing: reliable systems that can be used by all involved during an incident; improved coordination between agencies and entities that would lead to better public messaging; the use of Scientific Response Units, which would provide an avenue for experts to contribute their knowledge to specific types of incidents; and identifying and using the right “amplifiers” for messages. Case studies from recent events are included.
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Workshop participants noted several essential elements of disaster information sharing, including: patient tracking and evacuation; hospital surge with those not acutely ill; and coordination of the expansion of focused task forces, organizations, and coalitions involved in disaster response. Case studies from recent events are included.
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* Lipsitch, M., Finelli, L., Heffernan, R., et al. (2011). Improving the Evidence Base for Decision Making During a Pandemic: The Example of 2009 Influenza H1N1. Biosecurity and Bioterrorism 9(2): 89-115.
The authors synthesize discussions held just after the 2009 H1N1 outbreak with a focus on surveillance needs specific to pandemic decision-making. They specific the necessary quantitative evidence and describe the sources of surveillance, interpretive tools, and other population-based data that can serve as the basis for such evidence.
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Loschen, W., Holtry, R., Hazins, K., and Happel Lewis, S. (2013). Sharing Public Health Information with Non-Public Health Partners. Online Journal of Public Health Informatics. 5(1): e47.
The authors provide an overview of ESSENCE and describe how healthcare stakeholders from across the National Capital Region in Maryland, Virginia, and the District of Columbia worked together to develop it. This information sharing tool is currently used by public health and non-public health partners (e.g., emergency management, law enforcement, and other first responders).
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The authors report findings from interviews with high-level decision-makers, field epidemiologists, academics and individuals responsible for disease surveillance at the national level, in both high income and low-middle income countries. Participants described how data sharing is part of their usual work; they also shared input on barriers to data sharing they have encountered or are aware of and how they overcame them (during routine surveillance and public health emergencies).
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Shapiro, J., Genes, N., Kuperman, G., and Chason, K. (2010). Health Information Exchange, Biosurveillance Efforts, and Emergency Department Crowding During the Spring 2009 H1N1 Outbreak in New York City. (Abstract only.) Annals of Emergency Medicine 55(3): 274-276.
In this article, the authors examine how healthcare practitioners used health information exchange networks to share clinical data among otherwise unaffiliated providers across entire regions during the 2009 H1N1 outbreak.
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Tsai, S., Hamby, T., Chu, A., et al. (2016). Development and Application of Syndromic Surveillance for Severe Weather Events Following Hurricane Sandy. (Abstract only.) Disaster Medicine and Public Health Preparedness. 10(3): 463-471.
After Superstorm Sandy, the New Jersey Department of Health developed indicators to improve syndromic surveillance for extreme weather events in EpiCenter, an online system that allows users to collect and analyze real-time chief complaint emergency department data and classifies each visit by indicator or syndrome. This system was able to recognize indicators in carbon monoxide poisoning, methadone-related visits, and asthma. Recognizing sources of data and the indicators to be followed are important during planning and response.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). ASPR Electronic Medical Record (EMR) Data Share with FL Department of Health. (Contact fusion@hhs.gov for more information or to set up EMR data sharing capabilities.)
ASPR provided a de-identified data share of electronic medical record (EMR) data for patient encounters in the field to Florida Department of Health (FL DOH) from Disaster Medical Assistance Team (DMAT) teams deployed after Hurricane Matthew to provide medical support at Holmes Regional Medical Center in Melbourne, FL. ASPR was able to provide an automated EMR data share (updated every 15 minutes) directly to FL DOH's surveillance system ESSENCE-FL resulting in robust state/federal data sharing.
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* U.S. Department of Homeland Security. (n.d.). Draft Guidelines for Publishing and Sharing Information. (Accessed 8/13/2019.)
This report—while slightly dated—highlights Capstone 2014, an exercise conducted to develop, codify, and share a set of Essential Elements of Information (EEI; Table 1). Guidance for sharing information through various means (e.g., incident management information systems, geospatial tools) is also included.
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Lessons Learned: Ebola


This webinar is approximately 1.5 hours long and includes presentations on: the practice and roles of health departments in preventing and controlling infectious diseases; public health information sharing during a public health event; priority knowledge, skills, and abilities (KSAs) needed by the public health workforce to prepare for and respond to infectious diseases; and additional information from national partners.
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Plain Language and Emergency Codes


Planners from state and local facilities can use this document to develop plain language emergency overhead paging messages.
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New Jersey Hospital Association. (n.d.). Plain Language Emergency Alert. (Accessed on 8/13/2019.)
This toolkit was designed to help state emergency management staff transition alerts to plain language. it includes a step-by-step implementation guide; a poster to inform staff, patients and guests of the new alert system; a PowerPoint presentation; and a 2-minute education video.
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This white paper addresses the implementation of plain language emergency alert code systems in healthcare facilities. The authors discuss how this change can benefit healthcare associates, external emergency responders, patients, and visitors by reducing the amount of confusion and anxiety that is associated with traditional code word or color emergency alerting systems.
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Public Health Communications Collaborative. (2023). Plain Language for Public Health.
This guide provides an overview of plain language principles and includes sections on preparing communications, developing and organizing communications, reviewing and testing, and related resources.
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This document includes recommendations for hospitals to consider when developing clear language codes.
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Plans, Tools, and Templates


AHA Center for Health Innovation. (2022). The CLEAR Field Guide for Emergency Preparedness.
This field guide encourages emergency management stakeholders to break down silos in the emergency management system by incorporating public health officials, local health departments, hospitals and health systems, fire and emergency medical services, and emergency management leaders into emergency preparedness. The guide lists action strategies, resources, and field examples in four priority areas: e.g., strengthening cross-sector partnerships; building workforce capacity and resilience; sharing information; and normalizing a culture of preparedness.
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Association of State and Territorial Health Officials. (2013). Public Health and Information Sharing Toolkit: Legal Barriers Project.
This toolkit includes links to resources that focus public health agencies' authority to collect, use, and share information to prepare for and respond to a public health emergency. Resources include “executive overviews,” fact sheets, issue briefs, state analysis guides, and supplemental resources.
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  • Sayeshi Yeshu https://www.phe.gov/Pages/PageNotFoundError.aspx?requestUrl=https://www.phe.gov/preparedness/legal/guidance/syndna/lists/screening%20framework%20guidance%20for%20providers%20of%20synt/summary.aspx
    9/12/2019 4:18:26 AM
Centers for Disease Control and Prevention. (2017). PHIN Tools and Resources.
This site includes links to Public Health Information Network tools and resources; this information can help public health agencies to electronically exchange health data and information.
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Centers for Disease Control and Prevention. (2021). Minimum Data Set for Public Health Emergency Operations Center.
This Excel file contains the EOC Minimum Data Set (MDS) developed by CDC and LOINC. This is a technical specification for collecting and reporting situational awareness and other operational data for public health emergencies, including COVID-19.
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HealthIT.gov. (2021). Public Health Emergency Preparedness and Response. U.S. Department of Health and Human Services.
The ONC ISA provides a standardized vocabulary for exchanging public health situational awareness data, including COVID-19, for categories such as: representing healthcare personnel status, representing hospital/facility beds utilization, representing laboratory operations, and representing population-level morbidity and mortality.
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National Information Exchange Model. (n.d.). National Information Exchange Model (NIEM). (Accessed 5/4/2017.)
NIEM was developed by experts from a variety of fields, agencies, and organizations and serves as a common vocabulary that facilitates efficient information exchange. NIEM includes domains for Emergency Management, Justice, Military Operations, Surface Transportation, Biometrics, and Human Services. NIEM provides rules and methodologies around the use of the model as well as a standardized Information Exchange Development Lifecycle that can be reused by everyone. NIEM also includes governance, training, tools, technical assistance, and an engaged community that can provide user support.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2021). National Health Security Strategy. U.S. Department of Health and Human Services.
The goal of the National Health Security Strategy (NHSS) is to strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from disasters and emergencies. This webpage includes links to the full text of the strategy, an overview, the NHSS Implementation Plan, the NHSS Evaluation of Progress, and an NHSS Archive.
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U.S. Department of Homeland Security. (n.d.). Resources for Emergency Medical Services and Fusion Center Collaboration. (Accessed 8/13/2019.)
This document includes agency summaries and contact information for various federal fusion centers and related organizations.
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The authors highlight common concerns shared by law enforcement and public health: early identification of an outbreak, whether outbreak is naturally occurring or intentional, and protection of the public. The handbook highlights components of both fields and how they interact and complement each other; discusses investigational procedures and methodologies for a response to a biological threat; identifies challenges and solutions for improved information sharing (p. 55-60); and provides templates that can be replicated or customized.
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This agency serves as an information sharing tool for critical infrastructure protection (CIP) and the emergency services sector (ESS). The agency publishes “The InfoGram” and CIP bulletins and provides technical assistance and consulting at no cost to ESS leaders.
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Agencies and Organizations


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Centers for Disease Control and Prevention. Health Alert Network.
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Federal Bureau of Investigation. Infraguard.
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Office of the Director of National Intelligence. National Counterterrorism Center.
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U.S. Department of Homeland Security. Information Sharing and Awareness.
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U.S. Department of Homeland Security. State and Major Urban Area Fusion Centers.
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