The evolution of crisis preparedness: HIEs and the response to public health disasters

Health information exchanges (HIEs) are an important community resource for coordinating care at local and regional levels—in both good times and in bad.

When Hurricane Harvey caused widespread flooding and destruction in Southeast Texas last August, tens of thousands of people displaced from their homes wound up in emergency shelters. As shelters quickly swelled with evacuees, many requiring medical attention, an urgent need arose for immediate access to patient medical information.

The regional HIE, Greater Houston Healthconnect (GHH), quickly deployed an emergency response team to the largest shelters at the George R. Brown Convention Center and NRG Stadium. Coordinating with state and federal disaster response groups, GHH provided real-time look-ups of medical information to healthcare providers, right at the point of care. Moreover, GHH worked with the other regional HIEs to support shelters across the state, and a 24x7 hotline to assist providers delivering care to displaced Texans.

At one shelter, a young boy, separated from his family, was found wandering lost, scared and in need of medical attention. A volunteer took the boy to the staff of Healthcare Access San Antonio (HASA), a HIE collaborative working with GHH. Staff were able to access the boy’s medical records through the online portal, as well as his mother’s contact information, and the two were safely reunited.

This young boy’s story exemplifies the importance of the community HIE in meeting population health needs under the most demanding and dire circumstances. It also illustrates just how far HIEs have come in terms of their ability to support efficient, coordinated care by enhancing connectivity between health systems and providers—an evolution spurred by another natural disaster over a dozen years ago.

A wake-up call
Back in 2005, the transition from paper-based to electronic medical records (EMR) was well underway. However, digital records were essentially siloed—providers throughout healthcare ecosystems were still largely unable to communicate efficiently to coordinate care. Then, in August of that year, New Orleans took a direct hit from Hurricane Katrina.

Eighty percent of the city flooded, displacing most of its residents, damaging much of its healthcare infrastructure, and cutting off traditional pathways to needed medical interventions. In emergency shelters and relief centers, the lack of connectivity among health systems and providers further hampered medical response, deepening the crisis and worsening its human toll.
Hurricane Katrina served as a wake-up call for the industry. Since then, HIEs and EHR vendors have adopted the policies and technological infrastructure necessary for more efficient and widespread data sharing. As a result—and as the recent experience in Houston showed—the resiliency of healthcare ecosystems and their ability to respond in times of crisis has dramatically improved.

Other types of crises
Of course, natural disasters aren’t the only cause of public health crises. Two other recent—and ongoing—large-scale events highlight the leading role HIEs and EHR vendors can play in forward-thinking crisis preparedness and disaster recovery strategies for healthcare organizations:

Flint, Michigan water crisis: Flint, a community of 100,000 people in the Genesee County region—is in the midst of a public health crisis due to lead contamination in the city’s water supply. In response, Great Lakes Health Connect, Michigan’s HIE, and its partners across the state and region, invested $250,000 to bolster information exchange capabilities across the Genesee County region in order to better support residents who may have been affected and ensure they receive timely, coordinated care.

The effort also enhances healthcare connectivity, coordination and communication among providers on behalf of all of Genesee County’s 420,000 residents and bolsters the ability of public health officials to conduct syndromic surveillance and better manage disease outbreaks.

National opioid abuse epidemic: For nearly the last two decades, use of legal and illegal opioid drugs has been rising steadily. Drug overdoses now account for more annual deaths than gun homicides and auto accidents combined, and two-thirds of these deaths are opioid-related. The crisis has severe public health, safety, and economic impacts to communities across the country.

There are no easy answers, but an effective response requires a multi-pronged approach that leverages data aggregation and information sharing across systems and platforms. One health system in California is using data aggregation to determine a baseline of opioid usage across a specific geographic region. The data are then analyzed and insights leveraged to better understand populations at risk for opioid dependency and develop effective treatments, interventions, and outreach and education efforts. The approach holds promise for communities across the country.

A continuing evolution
As these case studies illustrate, today, even if a crisis situation disrupts normal workflows or places other extraordinary demands on providers or healthcare organizations, it’s possible to leverage data to improve medical response and outcomes. The good news is, the industry continues to evolve and next generation interoperability is available that not only aggregates data but enhances its usability. At this level, all relevant patient data—medical history, medications, recent encounters, etc.—is easily and immediately accessible from a single record. And during a crisis, data readiness can make all the difference.
But despite the HIE evolutions that have made this progress possible, the enlightenment of broad interoperability across the healthcare ecosystem is still aspirational. Sharing of information across the community requires broad participation. Information siloed across providers—once a presumed source of competitive advantage—must be replaced with cooperation and a shared community interest in the patients they serve.

Moreover, nationwide initiatives which broadly claim interoperability across all EHRs cannot deliver on the promise. Technical limitations include insufficient patient matching, aggregating to a single record usable by caregivers, viewing data when EHRs are not present, and event based notifications for population health. These initiatives suggest that regional HIEs are not necessary, however, lessons learned from these disasters prove otherwise as care coordination is an intimately community-led endeavor.

Ultimately, our recent experience has shown that the single most important step providers and healthcare organizations can take in their crisis preparedness and disaster recovery planning is to work with local or regional HIEs to coordinate and align strategies. This includes clinician access to patient data during a crisis, and that data is easy to use without extra steps or special efforts.

About the author
As the CEO of Medicity, Patrice Wolfe has more than twenty years of strategic & operational experience in the health care IT and services industry. Her career has been focused on improving organizations’ fiscal health, growth trajectory and strategic direction. Patrice has an MBA from Yale University, School of Management, and a B.S. in Biology and Certificate in Community Health from Tufts University. Patrice holds board positions at several organizations and is on the National Women’s Leadership Council.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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