After Katrina

Neil Versel

Within a week of Hurricane Katrina making landfall along the Gulf of Mexico on 29 August, numerous vendors and industry organisations had contacted government officials or otherwise publicly offered to help build electronic medical records for individuals whose paper records had been destroyed or lost amidst the storm and subsequent flooding.

“We wanted to act immediately and just get going,” says Glen Tullman, chairman and chief executive of Allscripts, a vendor which has donated electronic prescribing technology to health centres receiving patients evacuated from the Gulf Coast.

After several days of meetings and conference calls, it was decided that a co-ordinated relief effort should focus on piecing together medication histories rather than trying to create full EMRs for people showing up at hastily assembled shelters without their medical records or even their medications—and often little idea about the drugs they had been taking.

“We were getting calls from EMR vendors about setting up networks at these shelters,” explains Dr Edward Fotsch, CEO of Medem, an online physician-patient communications portal that has become central to the effort. “An emergency situation is not necessarily the best time to be training people” about how to run an EMR.

“The whole goal is to create a medication list,” he says. “Most people have not even the lightest-weight electronic health record,”

Having this basic information would reduce the chance that a patient would be face-to-face with a doctor who had not a clue about the patient’s medical condition or history. “It would be the equivalent of going to the bank and having someone hand you a clipboard and ask you to write down how much money you have,” Dr Fotsch says.

By 22 September, more than 150 companies, organisations and governmental entities had banded together to launch KatrinaHealth.org http://www.Katrinahealth.org/ , a Web portal for clinicians anywhere in the US to search for medication records of people evacuated from the states of Louisiana, Mississippi and Alabama.

This coalition of interests contacted first responders and American Red Cross personnel, who expressed interest in this sort of service, according to the Markle Foundation, a New York-based charitable organisation that promotes technology as a means of improving health and national security. The Markle Foundation is leading the KatrinaHealth.org project, with help from the US Department of Health and Human Services.

A week later, the site was expanded to include individuals scattered by Hurricane Rita, which hit the Gulf Coast near the Louisiana-Texas border and caused a mass evacuation of Houston, where thousands of Katrina survivors had found refuge. By then, records of more than 7 million prescriptions had been re-created, according to Kevin Hutchinson, CEO of SureScripts, a company that is contributing a large chunk of data.

Behind the KatrinaHealth.org site are 90 days of data from pharmacies in affected areas of the states of Louisiana, Mississippi, Alabama, Florida and now Texas. Formulary reference service RxHub added pharmacy information compiled by commercial health insurance companies, while additional data came from the US Department of Veterans Affairs and from Mississippi’s and Louisiana’s Medicaid programmes for the indigent.

Any licensed physician in the US can gain access to the Web portal. Patients have the option of signing up for personal health records so their medical information is readily accessible for subsequent doctor, hospital or clinic visits—more than likely in a different setting because of the fact that evacuees will remain transient until they can secure permanent housing.

“This type of solution makes sense,” Dr Fotsch says of personal health records. “You don’t have to be in a hurricane to find yourself in front of a provider who doesn’t have your chart.”

Hutchinson says that the effort is intended to be only a short-term, regionalised program to get medication histories to caregivers who otherwise would know nothing about the patients they are seeing.

“This is not meant to be scaleable,” says Hutchinson. “It is only to those geographies that were affected.”

US national co-ordinator for health information technology, Dr David Brailer, calls the project “a humanitarian response on the part of these companies and of state and federal government.” Says Dr Brailer, “We didn’t ask ourselves how this fits into the national strategy [to create interoperable EHRs for most Americans].”

However, Dr Brailer promises that his office later will analyse the effort to see how lessons might be applied to the wider goal of providing information-rich EHRs and data-sharing networks across the US.

Meanwhile, Hurricane Katrina gave the US Department of Veterans Affairs (VA) yet another opportunity to demonstrate the value of its Veterans Health Information Systems and Technology Architecture (VistA) EHR, widely recognised as the largest and most sophisticated integrated clinical information system in America.

The New Orleans VA Medical Centre, a large, regional veterans hospital, was forced to close after the city flooded. Other veterans hospitals in the Mississippi towns of Biloxi and Jackson shut down when Katrina knocked out power and telecommunications to those areas.

Fortunately, the VA keeps off-site back-ups of all its clinical records. In the case of the New Orleans hospital, the back-ups were in a fireproof safe in Baton Rouge, Louisiana, some 80 miles to the west and away from the flood zone.

The records could have been back online within one day, but because the hospital’s computer network was still operating internally, VA officials wanted to collect the most recent data, so they waited until the hospital was fully evacuated, three days after Katrina hit.

A single, intrepid employee brought the internal New Orleans records to Alexandria, Louisiana—220 miles away—as he was evacuated in a military convoy, then took the safeguarded backups in a rented car and headed west to Houston on Friday 2 September, where the VA had a hospital with excess IT capacity.

Once the tapes reached Houston, the data restoration took all of eight hours, and records for some 38,000 displaced veterans once again were available at any VA facility in America.