Each year, millions of people are displaced by natural disasters such as hurricanes, wildfires and floods. According to the Internal Displacement Monitoring Centre, nearly 1.7 million people in the United States had to evacuate their city or region in 2017 because of a natural disaster.
During a disaster, health care providers must treat evacuees who are far away from their usual hospital or clinic. Having secure access to a person’s health information is critical to be able to respond effectively. The most routine aspects of care, such as seamlessly continuing a medication or treatment regimen, may become a challenge if providers cannot access a patient’s health records.
The value of health information exchanges and national networks during natural disasters
Health information exchanges (HIEs) and/or national networks, such as CommonWell, can make a life-saving difference in times of disaster. HIEs and national networks empower users to securely transfer and view patient data across electronic health records. State and regional HIEs help organizations meet localized patient data exchange goals. These HIEs typically include shared storage of a core clinical data set that is separate from the health system, minimizing the risk of data access interruptions during emergencies.Likewise, connectivity through national networks empowers providers to make patient data queries inclusive of multiple care locations and regardless of where care occurs – both during times of calm and active emergencies when patients have evacuated and the health system’s data center (local, in the cloud or from a disaster recovery site) remains accessible.
While health information connections can be set up in emergency situations, ideally, the best time to establish local, regional or national connectivity is prior to a crisis. Here are three proactive steps that organizations can take to be prepared when disaster strikes:
1. Anticipate emergency evacuation paths and destinations
Like a chess game, heath care organizations need to think ahead about all the potential situations that could influence evacuation plans. The following questions are important to consider:
• What if evacuation extends beyond the territory covered by the regional HIE?
• Does the HIE store critical clinical data when the system is offline?
• Is the HIE connected to a national network and/or other HIEs in expected evacuation destinations?
• How can the organization proactively connect through another HIE?
Evacuation plans come in all varieties: inpatient, long-term assisted living or families leaving home to stay out of harm’s way. Regardless of the medical attention that an evacuee requires, ensuring connectivity to patient records is paramount.
Prior to Hurricane Florence in 2018, health care organizations in the forecasted areas proactively collaborated as the storm approached the southeastern coast. These time-sensitive preparations resulted in either the implementation or re-activation of connections with more than 10 sites representing a national network and state and health system HIEs. Patient information was available across the most likely areas where patients would evacuate, empowering providers to care for evacuees as needed.
National health information networks help health care systems avoid making and maintaining numerous point-to-point connections. As such, HIEs begin to serve as a portion of a health system’s emergency back-up plan by storing core clinical data. If a health system located in an area affected by a natural disaster is offline, the HIE can serve as a source of essential patient data. This national network connectivity would not replace a full disaster recovery capability (as it would not serve all areas of operational support) but in a dire emergency, it can supplement data access while the health system works to get back online.
2. Pre-negotiate sharing agreements with health systems in anticipated evacuation areas
To prepare for a crisis, health care organizations must prepare internally and look outside of the organization—collaboration is key. Interoperability is critical to ensure that health information follows the person, but organizations must proactively setup connections to get the data.
Attempting to establish sharing agreements during a time of crisis only compounds the complexity of an already tense situation. It is best to work through the intricacies of the agreements in advance—including making connections with other health care facilities and calling lawyers to draw up paper work—so that when a disaster occurs, the care team can focus on triaging patients. The connections can be deactivated until they’re needed.
Health care organizations that are in potential emergency zones should establish connections to an HIE and/or national network that encompasses the health care organizations directly (same HIE or national network) or indirectly (connected HIEs or networks) in the areas where patients are likely to relocate. It’s most effective when disaster recovery location(s) are also connected to those networks or if those connections are part of the disaster recovery plan.
3. Consider all the types of data the organization may need to access during a disaster
While HIEs, which typically maintain a shared data set that is accessible to their members, cover many of the critical data elements necessary for informed patient care, they don’t cover all the data. An organization can proactively think through all the needed connections and create a directory of primary and back-up sources.
Health care organizations should align with each other on the types of standards that will be used for document and data exchange. They should also proactively address opt-in versus opt-out challenges to empower sharing for more patients.
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