In the wake of two recent hurricanes that caused major damage in some U.S. regions, health information exchange (HIE) leaders around the nation, even in those areas that were not affected, watched with eager eyes how their colleagues took a hands-on role during the emergencies.
Indeed, the two storms—Harvey, which severely impacted Texas and some surrounding areas, and Irma, which similarly affected several Southeast states—had wide-ranging healthcare implications in these pockets of the U.S. Thousands of residents throughout the regions were displaced from their homes due to the massive flooding, with an estimated 10,000 people living in shelters in Houston alone, including nursing home and hospital patients. Many pharmacies, hospitals, clinics and doctor’s offices were closed and prescribing patterns disrupted, leading many patients needing to reconnect with their care regimens, often in new settings. As a result, HIEs can play a large role in disaster relief efforts.
While HealthlinkNY, which operates the HIE connecting providers and patients in 13 counties in the Hudson Valley and southern tier of New York, was not directly involved in either of the two hurricanes (read here how Texas HIE leaders helped with Harvey), its president and CEO Christina Galanis fully understands how much support HIEs— which store thousands of patient records and can provide the data emergency medical personnel need—can provide.
Galanis was actually at an annual meeting of HIE organizations at the same time when Hurricane Harvey hit. There were nearly 60 members at the meeting, but two of the HIE leaders could not attend since they were providing disaster relief efforts from their HIEs in Texas. One core use case for HIEs in these moments, says Galanis, is to be able to jump right in on the ground level at an evacuation center that has a medical area, where there are segregated patients who don’t need to be admitted to a hospital, but still need some medical treatment or supervision. “People with cardiovascular disease or a respiratory illness are particularly prone to health problems after a storm,” explains Galanis. “But emergency medical personnel can’t get their health records from their doctor's office or a hospital, which are facing emergencies of their own.”
This is why Galanis advocates that HIEs take a hands-on role during emergencies, as HealthlinkNY did when Tropical Storm Lee forced hundreds of people into shelters in 2011 in Broome County, N.Y. HealthlinkNY set up workstations at shelters so personnel could quickly access their records. Today, HealthlinkNY is part of Broome County Health Department’s emergency response plan.
Speaking from her experience during that storm, Galanis notes how many patients’ records were not available in real-time, and some pharmacies were flooded so that medication lists were not easily accessible either. “We stepped in and set up a server system on the fly, got in front of the triage line, and we were able to pull and print records, and put them on clipboards,” she says. “We ended up saving [doctors] 15 to 20 minutes per patient, as before they were handwriting everything out and interviewing the family and the patient. Having accurate information is important, and you’re also bringing a level of confidence to the providers so that they won’t inadvertently hurt a patient if they didn’t know he or she was allergic to latex, and the patient didn’t tell them, [for example].”
Galanis notes that family members and patients are not always together in disaster situations, and often don’t have their medications on hand, yet still need them right away. “So, it can be difficult. As we saw during Hurricane Sandy [in the New York region], hospital systems got flooded out. Luckily, everyone is building their server house above ground these days, but back in the day, a lot of hospitals [originally] put their IT department down in the basement, so some of them are still there today.” Says Galanis, “Those floods, in the Binghamton area, were nowhere near what we saw today, but in a small community they can be debilitating.”
During major storms such as Harvey and Irma, patients sometimes are evacuated from a nursing home into one of multiple hospitals that can actually take them, explains Galanis. “So you have people calling the Red Cross asking where their mom is. But the Red Cross doesn’t know. We are the ones who know; we’re getting their ADT [admission/discharge/transfer] as long as the hospital is up and running. And now we give that to the Red Cross as well.”
In addition, HealthlinkNY is working with home health agencies to identify certain patients by address and zip code and flag them in the HIE’s data, notes Galanis. These might be patients who are dependent on electricity for things like oxygen, and other folks who need to be evacuated sooner than the “walking well,” as Galanis puts it, “so we can intervene when the power goes out.” She adds, “Also, we have the ability to [simply] check on the elderly so that we know where they are. Our data allows us to do that; we work with EMS agencies to actually do the retrieval.”
What’s more, Galanis explains how the patient-centered data home project—a model based on triggering episode alerts, which notify providers that a care event has occurred outside of the patients’ “home” HIE, and confirms the availability and the specific location of the clinical data—is also playing a part. She notes that 17 HIEs are currently trading information across state boundaries, with 30 to 35 more slated to join the project by next summer, and right now the focus is primarily on notifying providers when a patient has been admitted into any of the participating hospital ERs.
Essentially, explains Galanis, “You are ‘casting out’ who has the zip code among the participating HIEs, and the provider can send a response saying ‘yes we have patients with that zip code’ and then they can do a specific query. And then you return the data if your consent model allows it in your state,” she says, noting that not every state has the same consent model across the U.S. “And some of us also have [42 CFR Part 2] data, which requires specific consent. So we are work on designing some additional features as a group of RHIOs across the country by building a consent store and then have the patients get a text to approve the movement of their data, assuming they are awake. It would be great if we had a national patient identifier, or had everything the same across every state, but we don’t,” she says.
Galanis further articulates that New York is an opt-in state, meaning patients have to be asked by each organization they cross paths with if they give consent to have their HIE data accessed by providers at that organization. To be clear, patient data is already contained in the HIE—but patients have to give each organization consent to access it. Some 95 percent of patients say “yes,” but nonetheless, notes, Galanis, HIEs in opt-out states likely have more data flowing in situations like these since patients are automatically “in” unless they specifically opt-out.
In the end, when a hurricane or other natural disaster hits a region that an HIE operates in, Galanis says the first step for HIE leaders is to, “Get a plan, get your teams together, collaborate with other responders in the community, figure out how to help, and [run] drills.” She adds, “We have ‘bug out bags’, with MiFis and extra batteries, and if we even think something might happen, we do a drill over the weekend where people take the bags with them. Make sure you have a very tight and coordinated process. You are part of the first response team—if you want to be.”