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Coming Inland: Health Information in Hurricanes

On Tuesday attendees at HIMSS heard about a special health information exchange California sets up for disasters. On Wednesday they learned how everyday HIEs in a pair of southern states can fulfill similar needs at extreme times.

The disasters most pertinent to Georgia and Alabama are hurricanes. They can cause enormous numbers of people in their paths to relocate, taking with them their special medical needs and little else. A pair in 2018, Florence and Michael, were especially devastating: Florence dumped up to three feet of rain and caused widespread flooding in the Carolinas; Michael was the strongest storm on record to strike the Florida panhandle. Authorities in adjacent states expected evacuees and got them.

One Health Record is the only HIE in Alabama, covering 323 locations, 14 hospitals, and 3.28 million lives. GRAChIE (pronounced Gracie), the Georgia Regional Academic Community Health Information Exchange, is used by more than 400 locations in that state, covering 2.8 million unique patients. And what their leaders initially realized, GRAChIE Executive Director Tara Cramer said, was that HIEs like these are great backups when hospitals and other institutions require technical downtime.

Hurricanes can cause downtime too, and as Florence approached the U.S. last September, Cramer said, the folks with GRAChIE and One Health Record knew they had to act quickly. Parents with special-needs kids had already started self-evacuating from the Carolinas and arriving at Georgia EDs to establish care.

With both HIEs part of the massive eHealth Exchange—the largest query-based health information network in the country, reaching all 50 states—legal matters were simplified, and they stood up the necessary connections within 24 hours. “We basically just turned on a switch,” said Gary Parker, director of One Health Record and chief data officer for Alabama Medicaid.

Parker likened the HIEs to guardian angels—a silent protection in the background. “We don’t want people to have to worry about where their information is,” he said. And with the Georgia/Alabama networks linked to their neighbors, they were even able to help locate missing patients who turned up seeking care: Florida officials in particular couldn’t locate some 800 high-risk evacuees; 32 were found to have been seen at connected Alabama facilities—a number that’s likely truly higher, Parker noted, as the Mobile area was not yet fully tied into One Health Record.

The storms highlighted some potential areas for improvement as well, including the expansion of exchange levels between tiers of users (hospitals and HIEs to smaller clinics and specialty practices) and getting medical information to first responders working in shelters (part of a pilot program in southern Alabama). Cramer noted efforts to push medical records to identified receiving hospitals so they’re there when the patient arrives.

Awareness is still a problem—even in states with advanced HIEs, too many healthcare stakeholders aren’t wholly aware of their existence and capabilities. Alabama wants to incorporate an opioid registry, because “disasters can come in many forms,” Parker said, and things like syndromic surveillance are well within its capabilities.

Both speakers emphasized the importance of relationships and reaching out to get connections made in advance. “If local folks don’t know about it, you’re missing a huge gap,” noted Cramer.

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