By October 18, Hurricane Michael, the strongest U.S. storm in terms of maximum sustained wind speed since Hurricane Andrew in 1992, left 35 people dead and displaced over 300,000 people in Florida, Georgia and Alabama. In preparation for the storm, the Strategic Health Information Exchange Collaborative (SHIEC) connected HIEs throughout the Southeast to make sure providers in surrounding states had access to patient records, taking into consideration the needs of evacuees who were injured from the disaster or needed to be transferred from their home-based healthcare facilities.
“This hurricane in particular came very quickly after Florence. There just was not as much time to prepare for this one as there was for Florence,” said Kelly Thompson, CEO of SHIEC. “So in terms of the arrangement between the states and things that we have done, we have been very focused on disaster preparedness, the planning, and the response.”
The Georgia Regional Academic Community Health Information Exchange (GRAChIE) and Alabama State HIE, One Health Record, collaborated closely to build up connectivity between providers in and beyond these two states within 24 hours after SHIEC set them up for connection in response to Michael. The HIEs’ effort in establishing a provider network lies in leveraging the existing data centers and ensuring providers have access to patient records.
“We actually don’t follow a different set of protocol for moving data around than we do for our day-to-day business operations. It’s the same kind of connectivity. What we’re doing now is broadcasting a much wider net,” said Tara Cramer, executive director of GRAChIE. “We set up emergent connections so that as people relocate for a period of time, we’re hopefully able to capture some of their data (to provide care when) they arrive in an emergency room or an urgent care center or need a medication refilled, anything like that.”
The connection would spread out into Alabama, North Carolina, South Carolina and Florida for data. And it’s not just the record itself that can be accessed, updated and resubmitted by providers, but a Continuity of Care Document, which is an HL7 standardized document that has various types of summaries of information on each patient.
Basically, what HIEs do is register patients with some demographic information and link these patients with their records and documents in a registry in the form of an index. For ease of use and for quick response and recovery, HIEs initially query the indexes to see which patient the provider is looking for, and then the related documents are queued off to let providers see what patient information has been stored in the HIE database.
“Alabama has a hybrid model, which means that we have a centralized repository that can be leveraged for the storage of data,” said Gary Parker, the director of Health Information Technology for One Health Record. “In cases between GRAChIE and One Health Record, because of that hybrid model, we can allow queries to pass through bidirectional from GRAChIE to One Health Record through the EHR systems or through our portal (if they do not have an EHR), that are connected on either side.”
But there are also challenges in terms of implementing the existing framework for connectivity. Since giving providers access to patient records and building up connections among HIEs in surrounding states are not the main concerns for HIEs, thanks to the experiences they have for disaster response and the protocol they are practicing on a day-to-day basis, the difficulty sometimes is the buy-in that they need from facilities and providers to provide them with the patient information in the exchange.
Out of the consideration of keeping patient’s privacy, providers tend to be cautious of how patient information is being shared, even though they understand the benefit of HIEs in terms of disaster response and recovery. “It’s the education as well and outreach that we’re going to do a better job of promoting going forward,” said Parker.
Based on the previous experience of dealing with hurricanes, HIEs such as GRAChIE see the important role that HIEs are playing in natural disaster preparation, response and recovery, and are opting to be involved in a wider network to help providers deliver better care.
“Let’s not wait for these things to be coming before we start talking to our neighbor HIEs about how we’re going communicate during the times of the disaster. Let’s get the plans in place now,” said Cramer. “We will likely maintain all of these connections. We may not keep them active all the time. But instead of having to build them when we need them, we can just turn them off and on as needed.”
And it’s not just in hurricanes that HIEs can ensure access to patient records, but also in tornadoes, fires or anything of that nature where patients are moving to other locations. For better outcomes, HIEs should partner with state officials, whether it’s an agency at Department of Health and Human Services, EMS, the Federal Emergency Management Agency, the American Red Cross or anyone else that is involved in planning and response effort.
“We just feel so strongly that accessing their medical information should not be one of those stressors. We can do better than that,” said Cramer.