As the annual conference of SHIEC, the Grand Junction, Colo.-based Strategic Health Information Exchange Collaborative, unfolded this week at the Crowne Plaza Downtown Indianapolis Union Station in Indianapolis, the disaster of Hurricane/Tropical Storm Harvey was unfolding in Houston and southeast Texas. Senior leaders of the SHIEC organization and its affiliates were able to connect Healthcare Informatics Editor-in-Chief Mark Hagland with Texas health information exchange (HIE) leaders, who are right now actively working to support the healthcare providers who are caring for Texans impacted by Harvey.
Hagland spoke with several southeast Texas HIE leaders to find what they’re working on right now. Developments continue to unfold live. Two organizations deeply involved in helping clinicians and patients in southeast Texas this week are Greater Houston Healthconnect (GHHC), the Houston-area HIE; and Healthcare Access San Antonio (HASA), the San Antonio-based HIE whose coverage area encompasses San Antonio and an expanding swath of central Texas, including the Austin and Dallas areas. San Antonio, Austin, and Dallas, are all welcoming residents of Houston and southeast Texas who are fleeing flood-ravaged parts of southeast Texas.
At the moment that Hagland reached Nick Bonvino of GHHC on Tuesday afternoon, he was shuttling between shelters in the Houston area, overseeing the setting up of HIE portals, in order to help clinicians provide care for patients sheltering from the storm. The good news? “Right now, all the electronic health record [EHR] systems at all the hospitals in Houston appear to be in regular working order,” Bonvino reported. “As a result, we’re able, with our laptops and WiFi, to access EHR systems in the normal way.” But, he added, “We’ve just gone live in the Houston convention center, and we’re ready to set up portals in all the shelters in which we’re setting up operations.” Thus, if any of the EHRs of Houston’s area hospitals go down, GHHC leaders will be able to support clinicians in providing care to residents fleeing the storm. At the time that they spoke, Bonvino noted, physicians and nurses were rushing to the George R. Brown Convention Center to care for Houstonians, representing large patient care organizations including the University of Texas Physicians organization, and Baylor Health System, as well as members of the Harris County Medical Society.
Meanwhile, within the HIE realm, one of the most fortuitous things related to the current disaster has been the fact that GHHC and HASA, several years ago, created a durable information exchange connection, so that patient records can be accessed through health information exchange with remote siting (Salt Lake City), thus protecting access to EHRs for patients in need. That came about because of a relationship between the two HIEs, explained Phil Beckett, who is the chief information officer at HASA. Back in the time period of 2011-2012, Becket was the chief technology officer at GHHC, and had developed a relationship with Gijs van Oordt, the CEO of HASA. “Gijs and I created a connection back then, in case anything like this [Hurricane Harvey] ever happened. And the [Austin-based] Texas Health Services Authority”—which helps to oversee and facilitate HIE development and governance across Texas—“had created a statewide hub that technically connected the Texas HIEs to each other. So HASA and GHHEC have been connected since 2015.”
So, Beckett told Healthcare Informatics, “Before Harvey made landfall, we sent out a notification to the hospitals with our phone numbers, to contact us, so we could get records to anyone as easily as possible. So we have all the HIEs connected. And there is a portal. And our data from Houston and San Antonio is stored in Salt Lake City. And that portal already exists. So people who are volunteering may not already have an account with us. So we’ll get them access in a heartbeat or look it up for them and fax it to them, as necessary.”
All of that foundational work has suddenly become highly relevant, Beckett noted, as “We’ve got a lot of evacuees in San Antonio from Houston, and we are taking our information from HASA and coordinating with the GHHC team, to get access to records for individuals from Houston.” In fact, he reported, “So far, we’ve got 17,000 evacuees from Houston, and that number keeps growing. Not all of those patients will have [electronic health] records, and not all will need medical assistance. But you can imagine leaving your house in a crisis like this; you can imagine what will happen when someone comes to rescue you with a boat, and you grab your phone and wallet and go; you don’t have any medications with you or anything. So having a doctor be able to access that to refill your prescriptions, will be critical.”
This is also a situation in which the concept of the patient-centered data home™, which the SHIEC organization is promoting and encouraging, and which has been a topic of discussion at this conference, comes into play, Beckett said. “Just this morning, we were on a call that was sponsored by SHIEC, and were talking about the patient-centered data home, which provides a more accurate, precise way to share data. When we make use of this concept, it means that we’re storing a zip code list of zip codes that each HIE covers, and then if a patient shows up in one of our facilities with that zip code, we will send a notification with the home state of that patient, so that we’re connected across state lines with good demographics, since we don’t have single identifiers. That will help” in situations like this one with Hurricane/Tropical Storm Harvey, he said.
Meanwhile, Beckett said, “It may sound self-interested since I’m part of an HIE, but we’re not-for-profit, and we see ourselves as a community utility. And in normal days, looking at being connected to an HIE, and wondering, should I connect or not? And the reality is, we’re really trying to do this for the community. And in Corpus Christi and Victoria, where they were evacuating babies, it’s critical that those medical records move instantly with them. So my plea to us as a state is, as healthcare professionals, let’s connect everything, even if it costs a little bit of money and there’s not a direct return on investment.”
For his part, van Oordt told Healthcare Informatics, when asked about how all of this is playing out right now in real time in the face of Harvey, “A few thoughts come to mind since visiting shelters yesterday. A lot of the care being delivered right now,” he said, “is actually very acute—people are lined up in the hallways to visit physicians and nurses. These needs stem from physical issues related to evacuation, and also a lot of emotional trauma. And we also understand there will be long-term evacuations planned, where people with chronic conditions will need to be evacuated. And we can play a role in providing more aggregated and historical data at that time. I think we’re still very early on in this process, and a lot of that may unfold over a long time,” he added.
What should the CIOs, CMIOs, and other healthcare IT leaders in hospitals, medical groups, and health systems, be thinking about as they reflect on what’s going on right now in Texas? “A few things,” van Oordt said. “What I saw yesterday in the shelters was reflective of how an emergency can be handled. In one case, I was at a middle school, where 800 evacuees had gone. The technology available at that point and in that place was very minimal. They didn’t have a fax or a PC, so one of the first things that comes to mind is that we need to make access to patient history fit that workflow. Something that comes to mind in that context is a phone-based app, because that’s what most of the nurses already have and make use of. And the thinking is that you have essential information like allergies and medications and recent encounters, available through this phone app, and then later, you could deploy other features in such an app, as needed.
More broadly, van Oordt said, “This situation shows This shows heart and soul where health information comes is critically needed. And this is the first major incident that’s happened in the five years since Phil and I first worked together. My feeling is that patient information should be an available staple for emergency care. This is the ultimate use case for having patient information available. Patients are stressed out and providers are stressed out. This really is a staple of emergency care.”
Meanwhile, Kelly Hoover Thompson, who was named SHIEC’s CEO just over a week ago, told Healthcare Informatics, “This is the ultimate example of HIE’s vital role and value to a community. It is how we support patient care, when a patient is facing some of their most critical and vulnerable life moments. This is why SHIEC exists, to take the greatest minds in HIE across the country, to make it work, and advance it, and educate people.”