How to coordinate care when disaster strikes: The role of IT
Because disasters are multifaceted, the information networks that support responses must be built with access and flexibility in mind.
Hurricanes, wildfires, floods and other crises are notorious for creating new gaps in care across the communities they affect.
When disasters strike, such as the devastation wrought by Hurricane Ian, populations are displaced and routine healthcare infrastructure is compromised. The patient care burden increases at hospitals, health systems and clinics, necessitating the assistance of medical response teams and the activation of alternate care sites.
Despite advances in healthcare technology, emergency providers often still experience challenges accessing patient health information and providing well-informed care.
Boosting disaster preparedness plans and strengthening partnerships with community emergency networks is a good start to mitigate the risk of care gaps during disaster. But what else can be done? And what role does health information technology play?
Three tactics to consider
Many partners are involved in disaster response, including hospitals, state and local public health departments, emergency medical services, emergency management, law enforcement and more. Access to appropriate levels of patient information is a critical infrastructure component for each of these stakeholders as they work together to deliver emergency care, coordinate treatments, fill resource gaps and reunite families.
Because disasters are multifaceted, the information networks that support the responses must be built with access and flexibility in mind. Here are three innovative ways communities are tapping into technology during disasters.
Locating missing patients and family members
Some state health information exchanges can quickly activate data sharing infrastructures with public health and emergency response partners during disasters. In this way, patients who have been displaced from their routine healthcare providers and/or are unable to be located by family members can be easily searched for in hospitals, emergency departments and emergency shelters that participate in the state network.
Florida’s Agency for Health Care Administration, which serves as the state’s HIE, is one example. More than 95 percent of hospitals and EMS providers in 67 counties participate in its encounter notification system, as well as a growing number of behavioral health facilities, physician groups, urgent care centers and long-term care facilities, the AHCA reports.
During Hurricane Michael in 2018, AHCA used its electronic notification platform to help reunite dialysis and home health patients with their routine care providers. The system was able to locate over 400 individuals within the first hour of use, according to AHCA.
Challenges such as those posed by Hurricane Ian can pose significant damage and loss of life, as well as impact operations at healthcare organizations. The recent event in Florida caused billions of dollars of damage, resulted in the loss of at least 100 lives and resulted in the closure of several large healthcare facilities.
When Hurricane Ida struck the state of Louisiana in 2021, the Louisiana Hospital Association deployed similar technology and was able to support a large dialysis organization in efforts to locate patients whose locations and treatment status remained unknown several weeks after landfall. Within hours, about half of the missing patients were identified as having presented to a hospital or emergency department in the participating network within the previous week, the association reports.
Filling clinical information gaps
Access to national health information networks improves patient care for individuals evacuated or displaced from their routine care environments during emergencies. Tapping into these large, national exchanges, emergency medical personnel can quickly retrieve critical health information, including diagnoses, medications and allergies, to provide more well-informed care to patients they’ve never met.
The emergency response to the 2018 Carr Wildfire near Redding, Calif., demonstrates how clinical data access ensures care is coordinated and delivered. In that disaster, over 200,000 acres were burned including 1100 homes. Thirty-eight thousand individuals were evacuated, including a diabetic patient who was out of insulin and unable to get his prescription filled because the local pharmacy was destroyed by flames, according to members of the California Medical Assistance Team and Medical Reserve Corps.
Leveraging a patient look-up system, emergency responders pulled the patient’s local medication records, connected the patient to an emergency clinician at the shelter, assessed diabetic status and secured the proper insulin dose, according to a report by Leslie Witten-Rood, chief of the Office of Health Information Exchange, State of California Emergency Medical Services Authority. Rapid efforts for this patient – and many others – likely circumvented poor health outcomes and unnecessary transportation or emergency hospitalization.
Ensuring providers have access to ADT Alerts
Care coordination technology, such as real-time admission, discharge, transfer (ADT) alerts, support continuity of care for patients who receive healthcare outside of their routine care environments.
Healthcare providers and care coordinators can “subscribe” to receive alerts regarding their patients during both routine and disaster conditions. These alerts give physicians or other relevant healthcare providers notifications when their patient has been seen at a healthcare facility outside of the patient’s usual radius of care.
Many types of healthcare facilities, including alternate care sites and shelters, can participate in sharing ADTs. In Texas and Florida, a patient look-up system is being used to check individuals in and out of state- and locally run shelters after a disaster. Via ADT messages, the look-up system shares shelter registration information with the routine health care provider network, automatically signaling when a patient has sought care in an alternate care facility and may require immediate follow-up.
What’s next?
While much of the 2022 natural disaster news has focused on wildfires, the devastating hurricane Ian in Florida reminds us that this could be another above-average hurricane season. If so, 2022 would be the seventh above-average season in a row.
So it’s time, once again, to make sure data sharing platforms and community agreements are in place. Disasters can happen at any time and preparation remains the best medicine for everyone involved – especially our patients.
About the Author: Knieser has nearly 15 years’ experience in disaster preparedness, response and recovery work. She specializes in helping to solve the complex challenges related to supporting individuals, families and communities that have been affected by disasters and public health emergencies.