Health information exchanges support disaster preparedness

When Hurricane Katrina struck New Orleans in August 2005, hundreds of thousands of patient records were destroyed, leaving residents without a documented medical history. At the Medical Center of Louisiana alone, nearly half a million patient records in basement file cabinets were inundated. At the time, only 25 percent of office-based physicians had electronic health records (EHRs).

Since then, the use of EHRs has grown steadily, which helps provide access during disasters. Information stored in EHRs is still vulnerable if the computer network is down because of loss of electricity or destroyed by physical means, but at least the data can be backed up in another location.

Another factor greatly aiding access to medical records during disasters is an increase in health information exchanges (HIEs), which allow different medical facilities to share digital information. Initially developed with funding from the American Recovery and Reinvestment Act (ARRA) of 2009, health information exchanges are becoming self-sustaining. The intent is to improve health by increasing availability of medical records and to decrease healthcare costs by reducing duplicate testing and other inefficiencies.

Beneficial, even lifesaving

In October 2012 when Hurricane Sandy struck New York City, the New York eHealth Collaborative (NYeC) was as ready as an organization can be, given that the storm was considered a "500-year" event. "As part of our ongoing development, we had been centralizing our servers to facilitate our support activities, and our core HIE servers stayed live throughout the storm," says Paul Wilder, VP of product management at NYeC.

The centralized records are a boon under normal circumstances, but in disasters they can be literally lifesaving. "Doctors could access records for patients who were transferred from one hospital to another when a facility had to shut down due to the storm," Wilder explains. The health information exchange has some limitations, because the level of detail is not the same as that in the provider's system. For example, the HIE server contains radiology reports but not the images. That is evolving, though. "Richer clinical data is coming in now, so we have more complete data every year," Wilder says.

In a Web-based system, connectivity is a major concern, according to Wilder. "It's that last mile of connectivity that can be an obstacle. Even if the core servers are operational, if a provider cannot connect to them, the information will not be accessible," he says. Similarly, some information still resides on edge servers at the provider's location and not in the core servers. In those cases, information will not be accessible from outside if the Internet is down at the provider's location.

Research tool potential

Nine vendors support NYeC, and the speed with which they became interoperable is a remarkable aspect of the health information exchange. "The vendors worked with national standards and got agreement as to how the different systems would interface. There was a national need and a sense of urgency that moved this project forward very quickly," says Lee Stevens, director of the State HIE Policy Office at the U.S. Department of Health and Human Services.

A benefit of the health information exchange is that a patient's records from disparate sources can be accessed within one information system. To create an aggregated record for an individual in the exchange, the system produces a new identifier that is stored in a master patient index. The identity of each individual is verified so that data from different sources can be connected to the individual and presented as a single record. Documents are fed into a viewer that handles the presentation layer, so providers can see just the information they want at that time.

The database also has considerable potential as a research tool to address public health issues. "NYeC has the largest ‘queryable' medical database in the country," Stevens says. "It includes records for 14 million New York residents." The technology allows public health officials to determine whether a certain area of the city has a spike in visits to the emergency room, for example, which provides the opportunity to address health issues sooner rather than later.

What made NYeC's health information exchange so effective during Hurricane Sandy, according to Stevens, is that practitioners were accustomed to working with it. "Whenever there is a ‘break the glass' scenario for an emergency response, no one knows how to do it, and the outcome can be unpredictable," he says. "This system is part of the practitioners' everyday workflow, so in an emergency they do not need to transition."

Regional approach

In the South, disasters such as hurricanes and tornados often send residents to neighboring states. The Southeast Regional HIT-HIE Collaboration (SERCH) project was designed to explore the potential for creating a regional exchange during disasters, including identifying obstacles to sharing information across state lines. Six states (Texas, Louisiana, Arkansas, Alabama, Florida and Georgia) participated in the study.

SERCH is a part of the State Health Policy Consortium (SHPC), which is focused on interstate health information exchange. "Preparing for disasters in a state in this area also means preparing for disasters in neighboring states," says Alison Banger, health IT research analyst for RTI International, which supports the Office of the National Coordinator for Health IT in health information exchange initiatives. "Many individuals from Katrina went to other states," she adds, "but without an integrated system, they could not access their records even if the records were electronic."