Technological Interoperability

Human-to-human communication includes face-to-face communication, wireline and wireless telephones, and computers while human-to-computer interaction includes databases, modelling and simulation technologies, computer assistance, alarms, security systems, and monitoring technologies such as cameras, satellite systems, robotics, and broadcast and print media. ^{Reference Sagun, Bouchlaghem and Anumba6}

The technological solutions affecting the interoperability are heterogenous, for example triage by laser scan codes, Global Positioning Systems (GPS), geographic information systems, and Personal Digital Assistants (PDA), to name a few. The wireless solutions are reported to integrate clinical data to other organizations data (rescuers but also administrative, logistic, and financial systems), mobile technologies to alert people (sending individual messages to mobile telephones), and to provide effective two-way communication during relief activities. ^{Reference Marres, Taal, Bemelman, Bouman and Leenen13–Reference Van der Togt, Beinat, Zlatanova and Scholten15}

These technologies have applications also in terms of enhancing mass-casualty field care, provider safety, field incident command, resource management, informatics support, and regional emergency department and hospital care of disaster victims. ^{Reference Chan, Killeen, Griswold and Lenert14}

The Information and Communication Technology (ICT) focusing on enhancing interoperability is particularly relevant for health staff that should take trainings, compare means of communications, and share protocols with others emergency agencies.

Technology can be also very handy as the case of a dedicated software that provides a system for early, unique registration of victims in the impact site. In this case, the online application is used by the different chains and systems in the disaster relief phase, promotes interoperability, and patient tracking and tracing. It offers a real-time overview of victims to all involved disaster relief partners, which is necessary to generate an adequate disaster response. ^{Reference Marres, Taal, Bemelman, Bouman and Leenen13}

It’s important to stress that the information systems which are used with the purpose to support processes during disasters must resemble information systems which are used in daily situations. For the users, it is very hard to switch to other systems when a disaster occurs, especially if not used routinely, and in a moment when they must work under high pressure. ^{Reference Van der Togt, Beinat, Zlatanova and Scholten15}

A common belief is that the lack of coordination and communication is linked to technical problems, but even if this sometimes is true, this axiom is not always confirmed. For example, some authors have noticed that information challenges and the lack of communication between the field and the operation center may be due to inaccurate, incomplete, or too much information, which causes, in some cases, delays in decision making as well as insufficient information. ^{Reference McEntire16}

A compromise on “human versus technology interoperability” is found with the Intelligent Disaster Collaboration System (IDCS) that aims to support and enhance the collaboration process and information flow during DM, ^{Reference Sagun, Bouchlaghem and Anumba6} and in some way, to fill the gap among the two components.

The IDCS concentrates on three main types of collaboration: collaboration of tools for detection; collaboration in decision making; and collaboration of resources for implementation. ^{Reference Sagun, Bouchlaghem and Anumba6}

The ICT tools used in the DM process are declined in an IDCS as a conceptual model for integrating ICT tools into the DM process and improving data interface and collaboration. The IDCS presents a bottom-up approach that can also enable international collaboration if applied by different countries. ^{Reference Sagun, Bouchlaghem and Anumba6}

In particular, the presence of suitable data filtering networks offers a means of minimizing common problems with information flow during the DM process. ^{Reference Sagun, Bouchlaghem and Anumba6} The filtering process gives the opportunity to categorize the information as clear or unclear and can ease the decision-making process because reliable information is highlighted ^{Reference Sagun, Bouchlaghem and Anumba6} and the ICT can work properly.

Five critical information categories when receiving and sharing the information were formulated by some authors: incident data, mission status, area status, safety at work, and tactics. It is also highlighted the importance of focusing to essential information needs to obtain and maintain situational awareness. ^{Reference Norri-Sederholm, Paakkonen, Kurola and Saranto17}

In addition to ICT, Health Information Technology (HIT) standards address the challenge of integrating information from disparate health care resources (eg, devices, people, and information systems) to support not only the effective handling of emergencies, but also their analysis for long-term resource planning. ^{Reference Chronaki, Kontogiannis, Panagopoulos, Vourvahakis, Koutentaki-Mountraki and Katehakis18}

The cooperative use of interoperability standards in HIT are investigated from the Health Level Seven (HL7; Ann Arbor, Michigan USA), the Organization for the Advancement of Structured Information Standards (OASIS; Burlington, Massachusetts USA), and the European Committee for Standardization (CEN; Brussels, Belgium) to harness the power of ICT in emergency preparedness and response. ^{Reference Chronaki, Kontogiannis, Panagopoulos, Vourvahakis, Koutentaki-Mountraki and Katehakis18}

While recent advances in information technologies have contributed to enhancing interorganizational collaboration by offering “electronic bridges” and creating “virtual teams,” ^{Reference Reeves, Lewin, Espin and Zwarenstein19} the use of this technology does not always meet the health care professionals’ needs, nor it is considered an effective tool for their specific environment. ^{Reference Karam, Brault, Van Durme and Macq20}

Personnel Interoperability

The importance for interoperability is not fully understood by today’s crisis managers. While most grasp the necessity for technological systems interoperability, there is insufficient appreciation of interoperable organizations and personnel. ^{Reference Kevin, Bergethon and Reimer21}

Several studies highlighted that the hurdles of interoperability in emergency services and in the humanitarian sector are influenced by the human factor such as lack of trust and competition for funds. ^{Reference House, Power and Alison22} Actually, many government funds are in competition with each other and hinder the establishment of essential relationships to interoperability. ^{Reference Kevin, Bergethon and Reimer21}

Interoperable networks are very demanding in terms of collaboration and individual teams tend to focus on agency-specific behaviors (following instructions, guidelines, and protocols) as opposed to coordinated multi-team functioning and, as a consequence, collective interoperability is not achieved. ^{Reference House, Power and Alison22}

This factor can be decisive in the health sector, particularly characterized by protocols and hierarchies. The hierarchical command structure may inhibit effective decision making when the global structure requiring interoperability is based on single multi-agency hierarchical systems and the accountability chain often is not clear. ^{Reference House, Power and Alison22}

The interoperability challenge is partially achieved when considering the processes and procedures used in the Urban Search and Rescue (USAR) community as tools to improve the operation of humanitarian logistic and interoperability among agencies. ^{Reference Tatham and Spens23,24}

The general approach adopted in Foreign Medical Team guidelines deliberately mirrors the International Search and Rescue Advisory Group (INSARAG; Geneva, Switzerland) model to reach a culture of interoperability. ^{Reference Tatham and Spens23}

Other elements that can enhance the culture of personnel interoperability are training and educational programs. The training process should include evaluation of thinking systems, mental modeling, and symmetry learning as integral components for any proposed interoperability training process. ^{Reference Kevin, Bergethon and Reimer21} It is introduced the concept of “All Disciplines” trainings (administration, finance, and managerial positions) ^{Reference Kevin, Hallock and Bergethon25} because the joint participation to trainings and drills will enable the management’s organizations to understand the most complex mechanisms of interdisciplinarity and they will facilitate the process to create an interoperable system.

As mentioned, the trainings and drills need to involve all the sectors participating to DM such as managers, liaison officers, health care, and rescue staff. The research centers and universities should be involved to constitute a global grid platform to learn from other countries and to introduce new technologies. ^{Reference Power26} This concept of joint training can, therefore, encourage the creation of new mental patterns and an interoperable language that does not require translation among agencies. ^{Reference Power26} The direct consequence is to create interoperable language and interoperable personnel. ^{Reference Kevin, Hallock and Bergethon25} Training should also encompass all aspects of crisis planning, response, recovery, and mitigation. ^{Reference Tierney27}

Due to the emergency team’s tendency to form rapidly during disasters and the involvement of multiple layers of organizations and individuals who are unfamiliar to each other, it is argued that research should primarily focus on identifying solutions to facilitate the team processes that happen during task-related teamwork (eg, an emergency incident). ^{Reference Power26} Team processes enable team members to achieve collective goals by structuring task-relevant behavior, namely: coordination, communication, and cooperation. ^{Reference Power26}

To achieve the correct balance between technology and personnel interoperability, training designed to facilitate multi-disciplinary cooperation and trust among organizations would be desirable. A positive example on how team training has progressed in recent years is the UK’s Joint Emergency Services Interoperability Program (JESIP), whose goal was to enhance interoperability among emergency services. ^{Reference Alison, Power, Van den Heuvel and Waring28} They ran a series of multi-agency classroom-based training days, which brought commanders from the emergency services together to run through incidents and discuss the roles and capabilities of different agencies with the aim to develop an interoperable language. ^{Reference Power26}

Another human-focused solution to ensure a smooth team network and interoperability is via the use of liaison officers: individuals who are responsible for coordinating information and actions during an emergency and who are trained to understand the roles in different emergency teams. ^{Reference Power26} The use of liaison officers removes the need for other team members to fully understand the team structure as they can rely on liaison officers to provide and share relevant information to the right person. Liaison officers can offer a non-technological solution to team processing and multi-agency coordination ^{Reference Power26} because they are a key enabler in fostering functional linkages that are required to gain situation awareness of complex, multi-faceted events. ^{Reference Harrald29,Reference McGuire and Silvia30}