Sharing Patient Records During Natural Disasters
The patient sitting before you has been evacuated from a devastating hurricane. His is 75 years old and has no access to his medication, and you are scrambling to locate a list of what he is prescribed. He attempts to relay his most recent health issues, allergies, and treatments, but he is shook up from the disaster and has brought nothing with him from his home but his clothes on his back. You do you best to ascertain what he needs, draw as many conclusions as you can, and make your best educated guess to form his treatment plan.
This scenario is not that uncommon, whether it occurs after a wildfire, a flood, a hurricane, or an earthquake. Thousands of Americans are evacuated every year, sometimes to surrounding cities, or, in more extreme cases like Hurricane Katrina, to surrounding states. Injuries from the disaster notwithstanding, many of these people bring with them pre-existing conditions needing care, treatment, and medication, and the link to their previous medical records and providers is often broken.
However, American health care providers and leaders in data technology are making progress in creating more reliable connections and disaster response plans by proactively sharing digital patient records. These electronic healthcare records (EHRs) and electronic patient care records (ePCRs) – when securely accessible by providers in other states and cities – can go a long way in bringing receiving hospitals and providers up to speed in treating evacuees.
Numerous projects – called health information exchanges (HIEs) – are currently underway, piecing together handshakes between various hospital networks and agencies. For example, the Patient Unified Lookup System for Emergencies (PULSE), a platform specifically designed for disaster response, was utilized during the 2017 and 2018 California wildfires, and is now working to scale to a national level. Additionally, several hospital systems in the south proactively prepared for this year’s major hurricane events by expediting the process to grant secure access to other nearby systems. This would allow their current patients to more easily receive treatment from new providers during and after the natural disaster, by allowing the new provider to view the patient’s ePCR.
These efforts to develop and distribute more robust HIEs do face numerous challenges and questions ahead. For example, a key limitation of an HIE is its dependence on power and an Internet connection; without these two elements – which are often disrupted during natural disasters – HIEs cannot be accessed and are useless.
Additionally, while many commercial ePCR systems are becoming increasingly more open and standardized, even small system differences can create big challenges for connecting and sharing data. Some systems choose to share information as “read only,” meaning that providers can access patient records, but not update them or send information back to the original provider. In that case, new providers are often left printing out patient records and reverting to handwritten notes which may or may not make their way back to the original provider. Bidirectional data sharing is the ultimate goal for an optimized HIE system.
Finally, data integrity and patient identification is a key concern. New providers must be sure that the person they are treating, and for which they are obtaining previous records, is actually who he or she claims to be. Similarly, systems must be able to run adequate verification checks to ensure that patient information is protected from being distributed to unauthorized persons.
Despite the challenges still ahead that must be slowly worked through and resolved, the goal of accessible patient records during and after an emergency is a valuable and potentially lifesaving exercise. As progress is made and more buy-in in garnered from health care providers across the nation, standardized plans for securely sharing helpful information can make treatments more efficient and effective in the most stressful times of a patient’s life.