In Northern California, Leaders at One FQHC Leveraged Technology to Help a Community in Crisis

In early October 2017, wildfires ravaged Northern California communities, destroying homes and businesses, displacing residents and resulted in the deaths of at least 43 people. All told, the October wildfires burned more than 245,000 acres in Northern California and forced 20,000 people to evacuate.

According to local news reports, on Oct. 8 and into Oct. 9, small fires fueled by extreme winds merged into six massive fires, with the biggest fires in Sonoma and Napa counties. The most deadly and destructive of the fires was the Tubbs Fire in Santa Rosa, and it took 23 days before the wildfires were contained. During the wildfires, two out of three hospitals in Santa Rosa, as well as many other medical facilities, were forced to evacuate patients and could not resume medical services.

A building destroyed in Sonoma County

Just 17 miles south of Santa Rosa, Petaluma Health Center, a federally qualified health center (FQHC), remained open and served as a safe haven for the local community, providing ongoing medical services to those in need. Leveraging a number of technology tools, Petaluma Health Center providers were able to quickly and effectively communicate with patients during the crisis and provide quality patient care, even to evacuees housed at a dozen local shelters, throughout the disaster.

“It was a Sunday night when the fires began, coming across from Calistoga over the mountains to Santa Rosa, and in the middle of the night people were started to be evacuated and the fires were quickly approaching two of the three major hospitals in Santa Rosa. So, even from the middle of the night, we knew there would be a big impact in terms of people being able to access care,” says Danielle Oryn, D.O., chief medical informatics officer at Petaluma Health Center, and a family physician.

Petaluma Health Center provides health care services to 35,000 patients in Sonoma County each year and was a recipient of the 2017 Community Health HIMSS (Healthcare Information Management and Systems Society) Davies Award for its use of electronic health record (EHR) analytics to improve health outcomes.

“As a FQHC, we do have a focus on serving the underserved and we focus on serving the entire community. About half of our patients are non-English speakers, and a good percentage of our patients are at the 200 percent of federal poverty level or below. So, we’re a typical community health center, and we have two big sites, one in Petaluma and another one in Rohnert Park and smaller sites, one at a homeless shelter and a couple of school-based health centers,” she says.

Oryn and her team of physicians knew that there would be both short-term and long-term healthcare needs as a result of the wildfires and the resulting smoke. From asthma and hypertension to the straining of evacuating and rebuilding, thousands needed medical and psychological help.

“With two hospitals being closed and much of the outpatient care in Santa Rosa, including Kaiser and many of the health centers and private offices, being closed, people would need healthcare, whether they needed refills because they were evacuated from their homes and didn’t get to bring everything that they needed, or simply because of the heavy smoke in the air,” Oryn says.

While the Rohnert Park site had to close for two days, the Petaluma site remained open to provide outpatient care. “We were ready to receive patients, but we needed to get the word out to the community that we were here, we were open,” she says, crediting many of the features and tools within the health center’s eClincalWorks EHR system with facilitating effective communication. Using a tool within the EHR, Petaluma Health Center staff were able to send out messages to 50,000 patients in its database with a message informing them that the health center was open and capable of providing medical care.

“What we noticed after that is that people were posting on social media, saying, ‘I just got a text message from Petaluma Health Center, they’re open, if anybody needs care, go there.’ So it had a ripple effect, which was really important to our community, to be able to get the word out that we have staff and are able to take care of patients,” she says.

Danielle Oryn, D.O.

The health center’s waiting room soon filled up, mostly with patients in need of medication refills. Armed with iPads, providers went out to the waiting room and utilized a feature within the eClinicalWorks EHR to refill prescriptions on the spot.

“As a direct effect of the fire, we saw a lot of people with exacerbation of asthma, respiratory complaints, irritation from smoke in way or another. We also saw a lot of people who were temporarily, or even potentially permanently, displaced from their homes, and they had to leave their houses in a hurry and didn’t take much with them. So, we saw a lot of people who simply needed medication refills and to be reconnected to some kind of primary care for a temporary time period,” Oryn says.

Petaluma Health Center clinicians also leveraged a local health information exchange (HIE) operated by the Redwood Community Health Coalition to access patients’ health records from other health centers. The RCHC’s Redwood Community HIE is a private query-based HIE hub that facilitates health center access to data sharing. Currently, eight RCHC health centers populate records into RCHIE, which contains close to 200,000 continuity of care records.

“The private HIE connects all the community health centers throughout the region, and so we were able to access records from the health center that was damaged and closed, and we were able to access prescription records from SureScripts. I can look up at a patient within the EHR at Petaluma Health Center and bring in parts of that record or view parts of that records and that enables me to provide continued primary care,” Oryn says, “We were really able to maximize use of all those tools in order to take care of this influx of people from outside our normal area.”

At the same time that physicians on-site at the Petaluma Health Center were treating patients, clinicians also went out to local emergency shelters, of which about a dozen were set up during the crisis, to take care of patients who may have been evacuated from long-term care facilities or hospitals. “We were trying to help to take care of whoever we could, so that the emergency rooms would be a little less impacted,” she says

Another health center in the East Bay loaned Petaluma staff a medical van so providers were able to get out into the community to provide medical services.

“We took our laptops and our hotspots on to that van and were able to go out and provide care, such as flu shots to first responders and people who were in shelters. We used our EHR to help provide that care working from that van,” Oryn says, adding, “For the physicians working out in the shelters, the one thing that was really beneficial was using the provider portal associated with our HIE. Providers at the shelters were accessing a couple of different portals; we were able to see one for the hospital system in order to see the hospital records and then another portal for our system to view primary care records and understand patients’ chronic medical conditions, medications and allergies.”

As people across the community were scattered in those first few days and even the first week, Oryn credits Petaluma Health Center as being instrumental in setting up a more coordinated approach to ensure people were getting care during a stressful and anxious time. What’s more, technology and health IT tools played a crucial role in enabling Petaluma Health Center providers to respond quickly and efficiently.

“The experience definitely underscored the importance being connected and interoperability,” Oryn notes. “I think often HIE in the outpatient world is a back burner-kind of issue or project, not for those of us who work in IT, but for clinical people, generally. I think having this experience of a disaster, it really led to a greater understanding of how beneficial being connected and interoperability really is. It brings up the question of, ‘Wouldn’t it have been even better had we been connected to those private doctors as well?’”

For five weeks after the wildfires, the health center saw a spike in patient visits due other healthcare facilities being closed.

“Now that operations have resumed and people are able to resume care at their primary care medical home, we still know there’s going to be longer-term impacts to health and healthcare from the wildfires; the trauma from people losing housing and the trauma from experiencing the wildfire,” Oryn says. “At this point, we’re all trying to look at ways to increase behavioral health services that health centers provide to be there and be ready for the community.”