News Feature | July 26, 2013

Preparing HIEs For Disaster

Source: Health IT Outcomes
Katie Wike

By Katie Wike, contributing writer


In the event of a hurricane or other wide-spread disaster, 10 states have aligned to ensure their residents’ health information will still be available

According to KMWorld, “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).”

KMWorld further notes, “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.” Paul Wilder, VP of product management at NYeC, is quoted as saying, “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.”

The lessons learned from Katrina played a role in the creation of the NYeC, and also served as a contributing factor that led to the Department of Health & Human Services announcing “four Gulf states have partnered with six states in the East and Midwest to help patients and providers access critical health information when they are unable to visit their regular doctors or hospitals” following a hurricane or other wide-spread disaster.

Farzad Mostashari, M.D., national coordinator for health IT, said the creation of the program came about as a result of learning the “importance of protecting patients’ health records through electronic tools like health information exchanges” in the aftermath of “disasters like Hurricane Katrina and Hurricane Sandy, large tornadoes in Alabama and Joplin, MO, and more recently in Moore, OK.”

The press release notes the program is a joint venture amongst the Department of Health and Human Services Office of the National Coordinator for Health IT (ONC) and health information exchange (HIE) programs in Alabama, Georgia, Louisiana, Florida, South Carolina, North Carolina, Virginia, Michigan, Wisconsin, and West Virginia.” The partnership will “allow for the exchange of health information among providers caring for patients who are displaced from their homes.”

InformationWeek reports, “The plan is to use Direct, a national standard protocol for secure e-mail that has now been embraced by most statewide HIEs. All of the state HIE programs participating in the initiative already have established at least one interstate connection and are working with other states, including Arkansas and Mississippi.”

Direct messaging, according to InformationWeek, “requires the use of a health information service provider (HISP). HISPs are not available everywhere and have had difficulty in communicating with one another, partly because there has been no national governance structure to create conditions of trust. But many health information exchanges have adopted Direct as a shortcut to interoperability, and some statewide HIEs have used it to communicate across state lines. In the event of a disaster, a cloud-based HIE or EHR could theoretically be used to transmit key health information via Direct to patients and providers in other states.”

EHR Intelligence reports, “Playing a major role in the initiative is the Southeast Regional Health IT and Health Information Exchange Collaboration (SERCH), a participant in the ONC-funded State Health Policy Consortium with members in Alabama, Arkansas, Louisiana, Georgia, Mississippi, North Carolina, South Carolina, Kentucky, Tennessee, and Virginia.” SERCH published a report last year analyzing the barriers to HIE and suggested recommendations “for standing up the HIE infrastructure capable supporting disaster preparedness and response. One such recommendation was the use of existing data sources from health plans and state agencies to bridge gaps in HIE coverage across states.”

The US Department of Health & Human Services summarized SERCH’s findings into 5 recommendations:

  1. Understand the state’s disaster response policies and align with the state agency designated for Emergency Support Function #8 (Public Health and Medical Services) before a disaster occurs.
  2. Develop standard procedures approved by relevant public and private stakeholders to share electronic health information across state lines before a disaster occurs.
  3. Consider enacting the Mutual Aid Memorandum of Understanding to establish a waiver of liability for the release of records when an emergency is declared and to default state privacy and security laws to existing Health Insurance Portability and Accountability Act rules in a disaster. States should also consider using the Data Use and Reciprocal Support Agreement in order to address and/or expedite patient privacy, security, and health data-sharing concerns.
  4. Assess the state’s availability of public and private health information sources and the ability to electronically share the data using health information exchanges and other health data-sharing entities.
  5. Consider a phased approach to establishing interstate electronic health information-sharing capabilities.

According to HHS, these steps are for states that are motivated to combine their disaster response and health exchange efforts. Preparedness now ensures that when a disaster happens, both patients and providers will have the information they need to give care to those in need.