Addabbo Family Health Center provides care during and post Hurricane Sandy, thanks to EHRs
Dr. Jinpin Yin tells the story of how Addabbo Family Health Center in New York City was able to provide care during and post Hurricane Sandy with the help of the EHR.
Overview of Medical Records After Natural Disaster
Addabbo Family Health Center (FQHC, MH Level 3) serves over 38,000 patients amongst six sites throughout New York City. The centers operate with E-Addabbo electronic health record system including patient portal.
How did EHRs help during the storm?
Without an EHR we would never have been able to recover so fast, we’re so thankful we were up and running right after, even in the dark on our laptop. Our doctors all appreciate the EHRs. I consider the EHR another hero in the storm!
In Red Hook for instance, we ran through our database to see which patients needed insulin urgently, and we had easy access to their full contact information, so we went door to door delivering insulin. This outreach would have been impossible if we were on paper records, and many patients would have not gotten access to their medication. Gathering this information from medical records after the natural disaster from the EHR was easy, efficient, and quickly delivered to the people leading outreach efforts in the community.
How did you prepare for the storm?
We prepped with sandbags, plywood, and made sure all staff had a contact list to stay in touch with one another. We secured the buildings as best as possible. We learned many lessons from Hurricane Irene and we lost much more equipment during that storm. We knew that servers or other important IT equipment should not be left on the floor. We ran back up on our database on the Sunday before the storm hit and we also moved the entire data center from the site near the beach to the inland site (#3) in Jamaica, Queens. It will stay there from now on!
What happened to your facilities during the storm?
The first floor of our main site (#1) in Rockaway, Queens is 12 feet higher than a normal first floor, we didn’t think the water would come in, but it did. We have another site (#4) in Rockaway and we pretty much lost the entire building, everything is gone and what’s left is being corroded by salt water. Our site (#6) in Red Hook, Brooklyn lost the first floor, but the second floor is operational. Immediately after the storm these sites closed immediately due to severe damages and power outages. As of November 8th, one of these sites was partially reopened, followed by a second partial reopening mid-November.
We were thinking we had to lay-off employees due to financial hardship. We don’t earn an income if we can’t see patients, and we do not have a cash reserve. But, patient needs and volume increased, so we continued to serve as best as we could. FEMA, AmeriCare, and Direct Relief International have been very helpful, each responded quickly and provided financial assistance. We also got a loan from CitiBank to continue to operate. AmeriCare and NYS Department of Health helped by getting us 2 medical mobile vans. Patients can be seen on the second floor, and now we can continue to serve wheelchair bound and physically impaired patients in the vans as there is only access by stairs to the second floor.
Do you use paper charts at all?
We do, but very little. Many paper charts are from inactive patients. Most of those were damaged.
How did you access your medical records during or after the storm?
We have a cloud based system and a 4G network connection to connect to the internet, it’s a bit limited, but we were still able to access our medical records after the natural disaster and we experienced no data loss. When you put data on a cloud based system you need to be safe. Our EHR is certified and we use a secure channel of communications. We also made sure that each site had at least one fully charged laptop at each site so we would have access. We did a bit on paper records when serving patients, but that data was quickly put back into the EHR on the laptop.
What did you learn from this disaster?
You must be prepared and have a plan. We also learned how important internet and phone access is, and the phone access is the most difficult to recover!
Everyone must know that servers and important equipment shouldn’t be on the floor or in a basement. Major equipment, including printers, should be connected to a surge protector, never straight into the wall. We had a power generator and it was a bit unstable, some equipment was damaged from the surge. Power generators should be tested monthly, like a fire drill. One of our generators wasn’t functioning, and there was another that kept burning out its alternator. You never know what needs attention on that important equipment, so testing is important.
It’s good to keep your website updated, and make sure all staff has everyone’s contact information. We also used Facebook to make sure all staff stayed in touch, which was very helpful. It’s also important to have a clear chain of command among staff in the event of an emergency. At our Red Hook location especially, when employees came back, they didn’t know what to do, they didn’t have a clear set of responsibilities or level of senior management. A supervisor must be assigned to be in control in the event of an emergency. This got to be very confusing during the relief efforts. Occupy Sandy volunteers actually tried to come in and take over that location! So it’s important to designate a staff leader in an emergency, because during those times, everyone will want to lead.
What things would you do differently if a disaster like this happened again?
The IT team needs to be more involved in the preparation process for each site, and they need to be fully trained on the telephone system to be able to respond effectively. I’d rather rely on them than the service vendors. I’d also consider back up communication connections. We don’t rely on a single vendor. It may be a bit more costly, but a worthy investment.