When Disaster Strikes: Preparing to Weather the Storm

The United States healthcare system has learned a lot of lessons in the wake of Hurricane Katrina, which destroyed an estimated 400,000 medical records in a matter of hours, according to a Journal of AHIMA analysis of the event. The rapid adoption of electronic health records (EHRs) in the years since the disaster has helped ensure that the health information of evacuees and individuals who ride out future storms at home will retain access to critical information.

In recent years, the United States has seen a number of devastating storms and resulting floods on its coasts, tornadoes in the Midwest, and unprecedented wildfires in California and other western states. And while disaster response is never perfect, the creation of health information exchange (HIE) and cloud storage systems have made it much more difficult for extreme weather to delay treatment. But plans and procedures must already be in place—before disaster strikes—for these systems to be effective.

The nimbleness with which healthcare providers can respond to disasters has been put to the test recently during Hurricanes Harvey, Florence, and Michael, and at least one survey suggests provider readiness is lacking. According to a survey conducted by the e-prescribing vendor DrFirst, only slightly more than half of healthcare providers believe their organization’s disaster plan is comprehensive enough to cover a variety of disaster scenarios both inside the organization and across the community.

“We must take measures now to address the critical gaps impacting patient care and safety, such as communication challenges and ready-access to medical records and specialty care providers,” G. Cameron Deemer, president of DrFirst, said in a press release.

Disaster preparedness continues to be an important consideration for provider organizations—especially those most likely to contend with natural disasters such as hurricanes. Scientists predict more extreme weather events to increase in the future in line with increasing global temperatures. A major new report from the United Nations Intergovernmental Panel on Climate Change reveals that global temperatures are trending upwards at an alarming rate.

“To avoid racing past warming of 1.5 degrees Celsius (2.7 degrees Fahrenheit) over preindustrial levels would require a ‘rapid and far-reaching’ transformation of human civilization at a magnitude that has never happened before,” a Washington Post analysis of the report states.

While the connection between climate change and extreme weather is complicated, researchers indicate that climate change makes certain kinds of extreme weather-related events more common—such as wildfires and intensified rainfall—and 2018 is on track to be one of the hottest years on record. That results in wildfire seasons lasting longer than the norm—and that, combined with rapid rates of development and urban sprawl in vulnerable geographies makes fires more devastating, National Public Radio (NPR) noted.

“What we see from climate change is that you lose a lot of these very moderate and light rainfall storms and replace it with very intense storms,” Andreas Prein, a research scientist at the National Center for Atmospheric Research, told NPR. For example, the number of large rainstorms has increased by as much as 70 percent over the last 50 years, according to that article.

HIEs and Disaster Preparedness

Health information management (HIM) professionals are in positions that can greatly assist provider response and enable the swift treatment of evacuees and other groups impacted by storms through their involvement with HIEs. HIM professionals are regularly tasked with ensuring data integrity in HIEs and can play a role in advocating that their organizations partner with new and existing HIEs.

The Sequoia Project, the largest HIE network in the country, has spent considerable time preparing its members for disasters, said Mariann Yeager, MBA, CEO of the Sequoia Project. It supports the Patient Unified Lookup System for Emergencies (PULSE), which can be made available in any geographic area to support healthcare professionals and first responders caring for displaced individuals or volunteer healthcare workers who are deployed to a disaster area outside of their normal health IT environment.

Yeager says her organization got involved with PULSE last year and is leveraging its own HIE networks to expand and support it. The system was initially developed in preparation for a major West Coast earthquake, but it was activated this year in response to California’s wildfires.

“What PULSE addresses is if someone can’t receive care in a normal care setting—their hospital or clinic is destroyed or damaged or there’s not enough capacity and they’re seeking care in a tent or parking lot or a school or some other building where they stand up field clinics,” Yeager says.

Emergency workers are given credentials to log in to PULSE through their state’s website so they can access patient documents such as prescriptions and recent test results. The networks they’re linked into have already taken the necessary HIPAA precautions to protect the data. As an article in Wired notes, this could have been useful in scenarios such as Hurricane Harvey.

Yeager says that professionals in the emergency management profession are very attuned to the risks of storms of increasing intensity as well as man-made and natural events. She acknowledges PULSE isn’t a one-stop solution for disaster response, “but it opened our eyes that interoperability doesn’t have to be perfect. Every record means every life. That’s what we’re trying to do—get more universal coverage and make it more accessible across the country,” Yeager said.

Joanna Pardee-Walkingstick, integrations specialist at the Georgia Regional Academic Community Health Information Exchange (GRAChIE), is a lifelong Oklahoma resident, where her region has seen some of the deadliest tornadoes in recent years, including the EF-5 tornado that destroyed the former Moore Medical Center.

“Cloud housing and cloud services have been a true gamechanger in the last couple years. Having the technical infrastructure to access remote servers during a disaster is huge. We haven’t had to worry about complete and total data loss during a disaster,” Pardee-Walkingstick says.

Like others who work for HIEs, she’s had plenty of experience deploying and preparing to deploy HIE connections during weather events. Right after Hurricane Katrina she assisted a group that was one of the administrators of a FEMA grant that helped to maintain medication continuity in behavioral health patients who were Hurricane Katrina evacuees sent to Oklahoma. And now, in her current job, she has helped activate HIE networks in advance of the last several major hurricanes to strike the southeast including Irma, Maria, Florence, and Michael.

She says GRAChIE’s work is focused on doing its best to be prepared to handle and protect the health information of anyone who will be affected by storms in the future, regardless of cause. During discussions in President George W. Bush’s administration that sparked the national push for EHRs, Pardee-Walkingstick says the concept of enabling a person’s medical records to follow them in the aftermath of a disaster has been a long-term priority. Since then, she says, things have come a long way.

“It’s been a long-standing effort to have these tools [HIEs and EHRs] and now we need people to use them. We’re finally hitting the level where there’s a huge adoption of HIEs. Now we’re at that point of that convergence of technology and it’s very real and keenly felt,” she notes.

Mary Butler is the associate editor at Journal of AHIMA.

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