Two months ago, as Hurricane Harvey approached Southeast Texas, healthcare provider organizations around the Houston area made preparations to try to mitigate overall disruptions to care in the midst of what was forecasted to be a devastating storm.
VillageMD-Houston, a primary care medical group operating 11 clinics across Houston with approximately 80 to 90 physicians, saw an opportunity to use its health IT tools to communicate with its more than 160,000 patients across Houston, in advance of the storm. Dan Jenson, chief financial officer of VillageMD-Houston, says health technology can play a critical role before a storm, and in the wake of disaster, keeping patients not only informed, but also with access to care.
“Even before the storm, we have done a lot of work around identifying high-risk patients and reaching out to those patients and building a relationship with those patients. So, as the storm was approaching, we had those high-risk patients in mind, as well as all our other patients,” Jenson says.
“We first stepped back and thought about the different scenarios that could play out,” Jenson says, noting that the medical practice leaders had a historical view of the flooding caused by Tropical Storm Allison in June 2001. “We thought about the different scenarios—if we lost power at the main clinic site, if we lost our phone system. What would it look like if we had multiple days of people not being able to get into the clinics? We really played out each one of those scenarios and thought about ways that we could mitigate the loss of patient care,” Jenson says.
In the days before Hurricane Harvey was forecasted to make landfall, which it did August 25, VillageMD leaned on its cloud-based electronic health record (EHR) system to send out messages to all the practice’s patients to alert them of the severity of the storm and inform them about how they could get in contact with their provider, or an on-call physician.
“If our phone lines were up, that we gave them our normal on-call physician number that they could call in. We also let them know that if, for any reason, our phones went down, we’d still have our answering service line available for folks to call in and be able to speak to an on-call physician. And then, we did our best to get facilities ready for the storm, so we could recover as quickly as we could following the storm.”
As Hurricane Harvey was churning its way up the Gulf of Mexico, Jenson credits the group’s EHR vendor, athenahealth, for working with medical practice leaders to get messages out to patients, whether via text, email or phone calls, two days before Hurricane Harvey’s forecasted landfall. “athenahealth has a pre-built way, through its communicator application, to reach 10,000 of your patients a day through campaigns. We’ve got over 150,000 active patients that we needed to reach out to at one time. So, we called athena on Wednesday, and overnight, by Thursday, they built an application for us that could process all of our patient applications, so we could get out more than 150,000 messages via text, email and phone."
He also notes that the practice used the tools available within its EHR to reach out to high-risk patients with specific needs.
“We have that high-risk patient list; a cohort of patients that we know have complicated, multiple chronic diseases. So, they might need special assistance, such as they might need oxygen or they are on dialysis, and it’s a situation where, once a month, we are reaching out to these patients anyway to see how they are doing. We reached out to those patients before the storm, telephonically, to give them some words of comfort and let them know what numbers to call to reach a provider. I think that was really helpful, just getting our patients ready,” Jenson says.
In the Aftermath of Hurricane Harvey
Electronic communication and cloud-based tools enabled many healthcare providers to continue to deliver patient care, whether in-person or remotely, during and after the storm.
Advanced Diagnostics is a small, eight-bed hospital and specialty surgical center in east Houston that operates an active emergency room, and organization leaders made the decision to stay open throughout the hurricane. “We saw patients in the ER as well as the inpatient operations and we ran the operating room all the way up until Friday (August 25) and then shut the ORs down due to travel, but our inpatient and ERs stayed opened throughout,” says Rob Turner, CEO of Advanced Diagnostics Hospital and Clinic System and chief operating officer of Advanced Diagnostics, the parent corporation.
Turner stresses the importance of preparing and reviewing disaster preparedness plans and then carefully evaluating the options—whether to close or stay open—when faced with a severe weather threat. Based on the local geography, Turner and other organization leaders felt confident that the facility would not flood or be an issue for patient safety.
“We did what every hospital should do. We ran our emergency checklist; we checked our emergency power sources, checked our generators to make sure everything was doing what it was supposed to do. We also checked our food supply,” he says, adding, “As far as IT was concerned, we run a redundant infrastructure for the electronic medical record (EMR) and for our Wi-Fi and regular systems here at the hospital that require internet connectivity.”
While many Houston residents were prepared for flooding, rain and wind, Hurricane Harvey brought unprecedented levels of rainfall, almost 52 inches during a five-day period, according to the National Weather Service. Texas state officials reported that at least 42,000 people evacuated to shelters during the storm. As the storm raged on, a nearby tertiary care hospital, East Houston Regional Medical Center, closed due to flooding, and Advanced Diagnostics began to take on patients from that hospital as well, Turner says.
While Advanced Diagnostics' hospital operations continued throughout the storm, many employees either had flooding in their own homes or couldn’t get to work due to impassable roads. Advanced Diagnostics also uses an athenahealth EMR system, and Turner credits the use of cloud technology, and its connectivity, as enabling providers to reliably access patients' records throughout the storm, while also allowing non-clinical staff to work remotely until the floodwaters receded. “We never lost connectivity; at times like that, it’s good to know that your EMR is going to function through it. Our plan was to stay fully functional through the storm and the system enabled us to do that.”
VillageMD-Houston closed its clinics during the storm and reopened that following Thursday, but Jenson says cloud technology provided the on-call physicians, who were working remotely, with the connectivity needed to access critical patient records. “Regardless of whether the patient was from the Southeast side of Houston or the Northwest side of Houston, for one physician to be able to access those records for those patients who were calling was very helpful. Also, because of the mobile applications that athena has through both the iPad and through a cellphone, even if Wi-Fi went down at a physician’s house or even if the power went out, physicians were able to still use cellular data to access the information they needed to provide care,” Jenson says.
What’s more, VillageMD clinicians triaged some patients with minor health issues over the phone. “The emergency lines were overwhelmed with calls throughout the floods, and I think having folks not clog up the emergency lines with issues that could be handled by a primary care physician is beneficial to the system.”
What’s more, in the days and even weeks that followed, access to healthcare remained a significant issue for Houston and the surrounding areas as the recovery process began. Jenson says prescription refills were a significant healthcare need as patients were not able to get into see a doctor during the storm, and health IT helped to mitigate this problem as well. “We’re able to leverage the standing orders that we have within our EMR where our nurses and our non-physicians can work with patients that need to get refills of some of those chronic medications, as opposed to having patients come into the clinic. We were able to really utilize those standing orders to get blood pressure medicine, insulin medicine and other prescriptions out to folks that needed them,” he says.
There were a number of other unique healthcare needs following the storm. Data from athenahealth’s research team, based on an analysis of appointments from 1,000-plus providers in the 44 Harvey federal disaster zones in Texas and Louisiana, indicates that providers saw an increased number of select acute conditions, including injuries (11 percent increase) and respiratory conditions (10 percent increase). The largest increase in injuries were to the lower extremities and the shoulders/arms (both more than a 14 percent increase from the expected), according to the data.
Turner with Advanced Diagnostics Hospital says, “This side of town, there was quite a bit of flooding in small neighborhoods, so we’ve seen some cellulitis (bacterial skin infection) from people spending too much time in the water. We’ve seen mostly some of the lower limb-type injuries; the population is kind of a mixed bag of diabetics and industrial injuries, so you see a lot of that anyway. We’ve seen a small spike in that from all the floodwaters.”
Jenson notes that there have been a few lessons learned in the aftermath of the storm, such as developing a staffing model to quickly mobilize employees to get the clinics back open. “It’s important to have a plan for different outcomes that might occur after a storm or an emergency to get the clinics back up and running quickly, because, from our experience, you will have pent-up demand, not only from your patients, but also the patients that we’re seeing who were displaced from their clinics because those clinics were flooded or are still not operational."