Learning from disasters

Twenty-five years ago, the only groups leveraging an electronic medical record (EMR) were the U.S. Department of Veterans Affairs and the Department of Defense. Today, the number of U.S. physicians using EMRs in some fashion has passed 90 percent, and nearly half of the doctors polled in a recent survey said they use health information exchange (HIE) technology – an increase of 32 percent.

In addition to initiatives driven by the U.S. government, catalysts for increased EMR adoption include the desire for access to data (immediately and from anywhere), analytics, proactive medical care and patient demand. But perhaps the most powerful catalyst is the knowledge our industry gained after two of our nation’s largest natural disasters.

Hurricane Katrina is one of the best examples of why our country needs to move to EMRs. In 2005, prior to
Katrina, only 1,002 health systems were using some form of an EMR. Katrina went on to destroy nearly a half-million paper patient records. Patients lost most if not all of their
medical histories and had no access to prescription information, allergies, test results or immunization documentation.The drastic circumstances forced healthcare providers
to act as historians, working to piece together each patient’s medical past.

EMRs could have prevented such compromised patient safety and possibly saved lives, while simultaneously adding value of business continuity and protection for benchmarked data. As citizens, the visuals of Katrina’s devastation haunted us. As a medical community, the fear and realization of what took place ultimately became one of the strongest drivers for EMR adoption.

October 2012 brought us Hurricane Sandy, a storm that resulted in 147 fatalities and destruction spread over 25 states. Once again, we watched footage of patients being carried out of healthcare facilities in the storm’s path.

The big difference in what we saw had to do with the medical care and information exchange taking place in the storm’s aftermath. Hurricane Sandy essentially proved the success of EMRs and, more importantly, the need for HIEs across the country. HIEs enable medical facilities to share data electronically. Even if each facility is running another EMR application, the exchange provides a level of interoperability that gives the viewer the information needed to provide care.

In New York alone, the State Health Information Network – New York (SHIN-NY) HIE connects 78 percent of hospitals in the state through one data center in New York and a redundant site in Texas.

Hurricane Sandy caused power outages, failed back-up generators, flooding and forced the evacuation of patients. The HIE enabled complete data exchange and helped to spread the patients over several facilities, preventing one facility from being overwhelmed with too many patients. It also enabled providers to divide and redistribute patients based on their care needs.

With the SHIN-NY HIE, new providers had access to patient records even before receiving those patients at a new facility. This resulted in proactive behavior and preparedness at each new site, where extra staff, supplies and medication were ready and waiting. Despite the chaos of Hurricane Sandy, new providers received patients quickly and efficiently, and had real-time access to medications, vitals and patient histories.

HIEs are crucial for disaster preparedness and the ability to respond quickly. Access to data anytime, anywhere is instrumental in providing care and saving lives when there is little time to spare.

Backing up an exchange is just as important as having it. These precautions ensure redundancy and confirm that the HIE can provide immediate transfer to a secondary site without loss of critical time and data.

Just like EMRs, data exchange is on the rise in healthcare. As of April 1, 2013, there were 222 HIEs in the United States – yet our nation’s IT infrastructure is still inefficient and lacking in many ways. Scalability, interoperability, sustainability, the high cost of partnering and even political challenges cause many HIEs to struggle.

There are many opinions on how to overcome these challenges, but the clearest method for resolution is open communication between all stakeholders involved. Application vendors need to come together to support universal access, and insurance companies need to promote submission platforms and reimbursement policies. But perhaps the most important HIE champion is the consumer. Patients need to be involved and act as advocates for their own care. Rather than wait for reform, patients must work to make their voices heard. If they do, they too can become a catalyst for EMR and HIE adoption.

Most natural disasters can’t be stopped or prevented, but the lessons we learn from them can help us better prepare for the next one. Two devastating hurricanes seven years apart played a remarkable role in changing how we provide healthcare in this country. Hurricane Katrina taught us how unprepared we were; Hurricane Sandy taught us how much further we can go. Yet from all of the chaos, we will continue to move forward, adopting new ways of thinking, communicating and providing care.