Disaster Preparedness and Health Information Exchange
Last month, we watched with great concern as Hurricane Isaac approached the Louisiana coast. By an almost unbelievable coincidence, it was raging toward New Orleans and expected to hit on the exact day of the 7th anniversary of Hurricane Katrina, the precedent-setting natural disaster of our time. While there was much confidence in new levees and improvement to infrastructure, we were once again reminded that man cannot battle nature, we can only prepare.
The morning after landfall, I couldn’t believe the news reports of people once again on rooftops and stuck in attics in Plaquemines Parish; nature conquered the best efforts of engineers once again. This was disheartening enough, but I then wondered if these evacuees were likely to access their health records if they were displaced to a neighboring state? Are we ready? Incredible progress has been made over the past three years, and I knew we were in a better place than we were in 2005, but there is more work to do.
To address this gap, ONC convened the Southeast Regional HIT-HIE Collaboration (SERCH) project on Health Information Exchange in Disaster Preparedness and Response in November 2010. The consortium included representatives from Alabama, Arkansas, Florida, Georgia, Louisiana, and Texas. The consortium’s goal was to develop a strategic plan for sharing health information data among the Southeast and Gulf States during and following a declared natural disaster. The consortium members carefully assessed the challenges of accessing medical records and coordinating health care information for patient populations displaced due to a disaster. This process included a detailed legal analysis to determine what laws might govern the exchange of health information during a disaster and whether different protections apply in the event of a declared disaster. Similarly, the consortium assessed the current and planned technical infrastructure in the six participating states with the goal of incorporating disaster planning earlier with health information exchange projects. Finally the consortium considered what related governance issues would need to be resolved prior to a disaster, including delegation of authority, resource allocation and management, and continuity in the event of changes in state or local government leadership.
Health Information Exchange and Disaster Preparedness
The final report from the project [PDF - 4,770 KB] includes an actionable plan for incorporating health information exchange into disaster preparedness efforts. The phased approached suggested by SERCH supports immediate progress in the absence of routine, widespread health information exchange. It also addresses key legal, technical, and governance issues and offers a list of steps that states can take to align their health information exchange planning activities with ongoing emergency preparedness activities.
The SERCH report considers the legal, technical, and governance issues associated with the exchange of health information during a disaster and offers the following five recommendations:
- Understand the state’s disaster response policies and align with the state agency designated for Emergency Support Function #8 (Public Health and Medical Services) before a disaster occurs.
- Develop standard procedures approved by relevant public and private stakeholders to share electronic health information across state lines before a disaster occurs.
- Consider enacting the Mutual Aid Memorandum of Understanding to establish a waiver of liability for the release of records when an emergency is declared and to default state privacy and security laws to existing Health Insurance Portability and Accountability Act rules in a disaster. States should also consider using the Data Use and Reciprocal Support Agreement in order to address and/or expedite patient privacy, security, and health data-sharing concerns.
- Assess the state’s availability of public and private health information sources and the ability to electronically share the data using health information exchanges and other health data-sharing entities.
- Consider a phased approach to establishing interstate electronic health information-sharing capabilities.
Taken together, these recommendations offer a path forward for other states that wish to integrate disaster planning and health information exchange efforts. Combining these two important health care functions will help ensure that when a disaster strikes, patients and providers will have better access to information and providers will be better able to provide appropriate care.
For More Information
For more information on emergency preparedness and the National Coordinator’s perspective, please read the 2011 blog post he co-authored with Dr. Nicole Lurie, Assistant Secretary for Preparedness and Response.
To learn more about health information technology and health information exchange, visit HealthIT.gov.