Taxi Driver to Health System: Time for EMR Availability

June 24, 2013
Sometimes the best stories come from the most unexpected sources. I had that kind of experience this past weekend as I entered a taxi en route to my hotel from the airport ready to attend my first HIMSS Conference.

Sometimes the best stories come from the most unexpected sources. I had that kind of experience this past weekend as I entered a taxi en route to my hotel from the airport ready to attend my first HIMSS Conference.

My cab driver was an older man who was a New Orleans native. After some initial small talk, I started sniffing around about his experience during Hurricane Katrina (I have a weird interest in natural disasters) and if he had faced any particular hardships. The next 30 minutes of our conversation really made me take a step back and realize the importance of this movement towards the new healthcare.

A father of two and husband of a woman who had survived Hurricane Betsy, a category 4 storm that killed 76 people in Louisiana in 1965, my taxi driver was just like anyone else at the time of Katrina, wanting to do best by his family. Leaving the state seemed like the easiest option, but there was one major complication: the man had Crohn’s disease, an inflammatory bowel ailment that can lead to abdominal pain, severe diarrhea, and even malnutrition.

Treating the disease on the run would be a struggle as is, but to make matters even worse, my cab driver was particularly worried about his health records not being accessible at any other hospital, if he were to leave the state. He felt comfortable in his hometown hospital in New Orleans, knowing they had complete access to his health history and medical records.

Sticking to his guns, the hardheaded man decided to stay put, despite mandatory citywide evacuation orders being implemented. Then, early in the morning on Sunday, August 28, 2005, he got a call from his pastor, who just happened to hear of six rooms opening up in a hotel room in Tennessee. Normally impossible under circumstances such as these, the pastor said he would be able to hold one of the rooms for this man and his family, but he had to leave New Orleans immediately.

Still torn between leaving the state and staying, believing that his disease would not get the proper treatment at a hospital that couldn’t access his records, the desperate family man did what any of us would do, gathering his family and a few belongings, and began making his way to Tennessee.

Without knowing the city he ended up in Tennessee, I did a quick MapQuest search of the drive from New Orleans to the state. It turned out to be just shy of a nine-hour drive, which ended up taking him twice that due to all the traffic leaving Louisiana, not to mention road closures and the general mass chaos that occurs with an impending natural disaster.

In hindsight, the man made the right call for both himself and his family. He was able to get by without too many major complications with his Crohn’s disease, and more importantly, one might never know if his family would have been included in the Katrina death toll, which totaled more than 1,800 people, according to its Wikipedia page.

After hearing the entire story, the first thing I asked myself was, why did this have to be such a tough choice? Shouldn’t medical records be able to be transferred from one hospital to the other seamlessly? In a matter of life and death, as this situation was, can the lack of interoperability among hospitals really cause this much hesitance and internal struggle?

Unfortunately, the answers to those questions aren’t that easy. In 2005, when Katrina struck, an estimated 25 percent of office-based doctors in the U.S. reported using fully or partially electronic medical record (EMR) systems, but electronic records certainly weren't the norm in New Orleans prior to Katrina.

Instead, paper charts and records were lost in several hospitals and physician offices across the state, something that could have been avoided had EMRs been implemented. And even as health information exchanges (HIEs) make progress on improving the quality of healthcare,  the nation’s ability to respond to natural disasters through the use of HIEs still has room for improvement.

In the wake of Katrina, the Office of the National Coordinator for Health Information Technology (ONC) convened the Southeast Regional HIT-HIE Collaboration (SERCH) project in November 2010. The consortium included representatives from Alabama, Arkansas, Florida, Georgia, Louisiana, and Texas, with a goal to develop a strategic plan for sharing health information data among the Southeast and Gulf States during and following a declared natural disaster.

SERCH released a report in July 2012, which made recommendations to improve how the nation’s ability to respond to natural disasters through the use of HIEs, which among other suggestions, includes developing standard procedures to share electronic health information across state lines before a disaster occurs.

Additionally, the University of Pittsburgh Medical Center (UPMC) published a report in 2006, “Systemic Collapse: Medical Care in the Aftermath of Hurricane Katrina,” that sourced a New Orleans Health Department physician who had stated that one of the biggest public health problems that medical providers faced in the wake of the storm was the lack of access to patient health information. Ten days after Katrina made landfall, the U.S. Department of Health & Human Services (HHS) instituted a program to make pharmacy data from Gulf Coast residents affected by the storm available online on a secure database accessible by doctors.

Is it too presumptuous to ask whether or not my cab driver would have faced the same internal struggle if EMRs and sharing of patient data had been more prevalent in New Orleans in 2005? My answer is no; in fact, these are the challenges the industry needs to overcome to prepare for future disasters before they arrive.

As my taxi driver dropped me off at my hotel that night, I told him that I was an editor attending HIMSS, and I cover health IT. He asked me if the sharing of patient health records has gotten any better since Katrina. I told him yes, but there is still plenty of room for advancement. He then told me to “bring that up to the people in charge.” 

So at HIMSS, I told that story to anyone who was willing to listen. And hopefully, as we proceed towards the new healthcare, we’ll keep in mind people like my cab driver, and continue to recognize how healthcare IT truly affects lives.

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