Reflections from a Health IT Perspective on Disaster Response
Andrew Gettinger, M.D. | November 15, 2017
Health information technology (health IT) has come a long way since Hurricane Katrina came roaring ashore in 2005. At that time, few hospitals in the region had adopted electronic health records (EHRs). To address some coordination issues, a national foundation comprised of several private businesses, national physician organizations, and other health professionals stood up a basic system to share medication history with providers in a matter of hours. This system, KatrinaHealth.org, was helpful in limited circumstances; however, the reliance on paper records uncovered a woefully unprepared health care system.
Today, virtually all hospitals use EHRs. The widespread adoption and use of these systems better equips the healthcare system to quickly respond to emergency events including mass shootings, hurricanes, and wildfires. We believe that we are better prepared today than when Hurricane Katrina struck. Here are some reasons why:
Electronic Health Records. During Hurricane Katrina, many patient medical records were physically destroyed. In August, during and after Hurricane Harvey, several Houston hospitals (i.e., MD Anderson, Houston Methodist, and Texas Children’s) and other providers affected by the floods, were able to continue to use their EHR systems. Because records are now electronic and are typically backed-up remotely, providers feel confident that their patient records will remain accessible and not be permanently lost in flood waters or other catastrophes. The increased use of EHRs has also led to advancements in public health. As we learned during the Ebola and Zika pandemics, public health agencies were able to work effectively with EHR developers to help better identify patients at risk and to direct providers to current Centers for Disease Control and Prevention guidance for further testing.
Sharing health data across systems. Building interoperable systems across healthcare will pave the way for communities to better respond to and recover from future disasters. This past summer, the California Emergency Medical Services Authority (CalEMSA) established the Patient Unified Lookup System for Emergencies (PULSE) to provide selected healthcare professionals, while volunteering during a disaster, the ability to search and return personal health information about patients they are treating in the field. PULSE, developed by ONC and supported across HHS, proved through an emergency exercise that it was able to successfully integrate the California Trusted Exchange Network (CTEN), California’s Disaster Health Care Volunteers (DHV) system, and four health information exchange organizations. Although PULSE is currently operational in parts of Southern California, the vision is to grow PULSE statewide and eventually nationwide in time for the next emergency.
Stronger public health surveillance. Over the past few years, it has become more routine, automated and timely for public health agencies to receive health data, for public health surveillance purposes, from a variety of healthcare provider settings. Syndromic surveillance is an important tool in disaster response and is often responsible for first detecting health hazards such as carbon monoxide poisoning (as identified in Florida), influenza, foodborne illnesses, and diseases such as Leptospirosis from contaminated water, as we are seeing in Puerto Rico. Health IT systems and EHRs are instrumental in improving early detection and preventing the spread of disease.
Improved IT situational awareness. Health IT situational awareness means ensuring that basic infrastructure needs are met at the community level first. The National Health IT Collaborative for the Underserved launched the NHIT Care Campaign to help the Federally Qualified Health Centers (FQHCs) in Puerto Rico immediately access power, medical supplies, communications, and telemedicine support. The NHIT Collaborative partnered with public and private agencies and organizations to deploy 80 bi-directional radios to the 20 FQHCs and their affiliated health centers for basic communication. This is an important first step to re-establish connectivity between the FQHC networks and the greater healthcare system.
Community resilience systems. Developers today design Health IT systems with a bigger picture in mind — community resiliency. The HHS emPOWER Map 2.0 uses Medicare data to help identify, down to the zip code, those who rely on electricity-dependent medical and assistive equipment such as infusion pumps, ventilators, and cardiac devices, just to name a few. With this knowledge, emergency planners can be informed about at-risk populations who may need additional assistance prior to, during, and after an emergency.
Hurricanes, forest fires, mass shootings and other disasters in 2017 posed extraordinary challenges for communities and first responders. The healthcare system is better equipped than it was in 2005 to provide access to patient records in emergency situations. Progress remains incremental as we work to provide secure access to patient health data when and where it is needed, particularly during disasters.
Many Americans are safer today and our healthcare system is more resilient thanks to new, innovative tools offered by the availability of health information technology.