It doesn't look like much from the lobby outside HHS Secretary Tommy Thompson's office-just two adjoining doors that open with the flash of a security badge to a card reader. It could be a copy center or a conference room.
On the other side of those doors, however, is neither a Xerox machine nor a mahogany table for high-level government meetings. Instead the doors lead to the first HHS command center, a communication super hub where Thompson can literally monitor the world.
When he walks into the room he had built just footsteps from his office shortly after the Sept. 11, 2001 attacks, Thompson presides over one of the federal government's most powerful-and technologically eye-popping-tools for coordinating disaster response.
Visiting the HHS command center is a techno geek's dream. Situated on the sixth floor of the Hubert Humphrey Building about four blocks from the U.S. Capitol, the room immediately boasts a 10-screen "video wall" that projects an image 7 feet high and 24 feet wide. During a video conference call, several remote participants can be displayed at once, or a single image can be magnified to cover the wall.
Nine 60-inch-wide plasma screens on the opposite walls stand ready to show live news feeds from 4,000 media outlets spanning four continents. Thirty computer workstations enable staff members to listen by phone to the audio of any screen selected so as to prevent a crosscurrent of broadcast noises from filling the space.
In many ways the room is a snapshot of the central command post at NORAD's Cheyenne Mountain facility, the global-monitoring station tucked deep into the Colorado Rockies and set up during the Cold War to track intercontinental ballistic missiles.
To those who manage and work in HHS' command center, the mission they attend to each day is no less significant.
"The No. 1 thing we have to overcome in a public health emergency is communication," says Dean Ross, the command center's director. On this particular day the command center's screens display a detailed street map of the Houston area, which was preparing for the 2004 Super Bowl; a chart listing the most recent count of SARS victims; and an innocuous world map to cover what Ross describes as classified information reporters aren't allowed to see.
Smaller screens are filled with news programs from Europe, Latin America and the Middle East. CNN, Fox News and MSNBC are on, too. A few staffers in addition to Ross file in and out of the room, which aside from occasional voices duplicates the quiet of a doctor's waiting room.
For Thompson, who stops by the command center as many as a dozen times per day when he's in town, the facility represents the one decision-making point where the activities of HHS can be coordinated with international, federal, state and local public health authorities-where Thompson can interact with the foot soldiers at the site of a hurricane or get a real-time briefing from officials monitoring a new flu strain at the Centers for Disease Control and Prevention.
Despite assurances from HHS that he would participate in an interview about the command center, Thompson did not make himself available to Modern Healthcare.
Assistance or interference?
The command center was completed in 59 days for a price tag of $3.7 million. It is regularly staffed with cartographers, political scientists, toxicologists and a host of other professionals who contribute their expertise to the day's challenges.
"This is the benchmark of command centers in the U.S. and perhaps the world," Ross says of the facility, which operates 24 hours a day and employs triple redundancy to back up every major system-from air circulation to data storage.
There are few if any outright critics of the command center, but some are concerned about its implications in the larger effort to prepare for and respond to a disaster such as last September's Hurricane Isabel.
There's always the potential for a federal organization like HHS to use such a facility to interfere with efforts under way on the state and local levels, some observers say. Add to that potentially clumsy situation the ongoing battle to maintain sufficient levels of funding for local emergency response capability; no matter how modern and efficient the command center is, inadequate resources on the local level can make or break how well a disaster is handled, observers say.
Although some $500 million was set aside in 2003 to help hospitals prepare for a bioterrorism event, less than half that money has actually reached medical centers that need it for such priorities as building contamination facilities, tracking rapidly changing data in a crisis situation and upgrading clinical and telecommunications equipment.
Under the budget proposal President Bush submitted to Congress, even less, about $475 million, would be available in 2005.
"The cut for '05 is worrisome," says James Bentley, senior vice president of strategic policy planning at the American Hospital Association. "We're not at a state anywhere near as prepared as I'd like to see us. And even when we get there, we have to sustain it for years."
State officials are concerned as well. "A federal funding cut could also impact (states') ability to provide the best and most comprehensive training available for healthcare providers and emergency responders on biological, radiological and chemical agents," says Robert Stroube, Virginia's health commissioner.
As the debate over funding continues to unfold in Congress, communities and hospitals go about the task of readying themselves for whatever incident might unfold. Hurricane Isabel was one such incident, testing not only the effectiveness of local response teams but also the usefulness of the HHS' command center.
During Isabel, whose 150-mph winds were responsible for at least $500 million of damage in North Carolina alone, HHS dispatched teams there and to Virginia as Thompson kept an eye on their activities from his perch at the command center at HHS headquarters on Washington's Independence Avenue.
"As it turned out, there was not a lot of major public health problems that (North Carolina) couldn't handle without federal assistance," says Marc Wolfson, an HHS public affairs specialist.
Even so, "It was a good experience for our team to go down there and go through the process of gearing up for a big one and working with states to get them used to the new command center structure we now have here at HHS," says Wolfson, who joined the eight-member HHS team sent to Raleigh, N.C., in advance of the storm.
As the convoy of HHS-rented sport utility vehicles made its way to Raleigh, officials back in the command center, including a staff meteorologist, closely watched the storm's path. When it became clear that Isabel posed more of a threat to Virginia than previously thought, Thompson dispatched a second team to Richmond.
From his workspace in the basement of the Raleigh Capitol building, where HHS set up shop, Wolfson used a secure Web site to file reports to the command center and stay connected with his counterparts in Washington.
For hospitals, the command center may become a valuable resource when emergencies require careful and constant monitoring of available beds and medical supplies across a given region. During Isabel, however, many affected hospitals had no contact at all with HHS even as they fielded inquiries from personnel in the Homeland Security Department.
If HHS was assisting hospitals and helping manage the overall response, "It was not apparent to us at our hospital," says Jim Riggs, administrator of safety and infection control at 745-bed Pitt County Memorial Hospital in Greenville, N.C.
To those who study disaster readiness, a major concern is the unwelcome chaos that can result when the feds jump into a situation already being handled by state and local authorities.
"If there's any risk in the command center, it's if the feds get so far ahead of the next two tiers, there will be a temptation to micromanage," Bentley says. "What I hear from local health departments, hospitals and other community organizations is a worry that if the feds get capabilities that allow them to be ahead of and intervene at the local level, local people are going to get directions from multiple sources."
'Connecting the dots'
Some of Bentley's concerns played out during Isabel. If its information technology is state of the art, some of HHS' logistical planning may still need tweaking. North Carolina officials, for instance, were surprised and a bit confused about HHS' role during the hurricane.
"This was a new capacity for HHS that we had never used before and didn't know it existed," says Steve Cline, chief of epidemiology for North Carolina's Department of Health and Human Services.
"We weren't exactly sure what we could ask the (HHS) people to do." HHS did help "connect the dots" as resources and planning were coordinated across state and agency lines, he adds.
Federal health officials argue that central points of contact and information during a crisis can and do minimize the mayhem.
"Having a formalized structure allows us to react to emergencies and make the public health contribution in a better way," says Jeff Cook, director of the CDC's emergency operations center in Atlanta, a facility built at roughly the same time as Thompson's slightly slicker model.
At 9: 30 every morning, Cook participates in a 30- to 45-minute briefing with CDC Director Julie Gerberding or her designee, who then personally transmits important information from the meeting to HHS' command center.
"Our goal is to improve our respective departments' and agencies' ability to support the states and locals. That's what we're in this business to do," Cook says.