Health information exchanges facilitate care coordination by making people’s vital health records easy to transmit and share. And while that’s useful day to day, it may be even more beneficial in a disaster, a pair of government speakers told HIMSS attendees Wednesday.
HIEs are timely and efficient, said Thomas Novak, Medicaid interoperability lead for the Office of the National Coordinator for Health IT, well-suiting them to enhance medical operations in a crisis. In fact, they already have: After the 2015 Philadelphia Amtrak derailment, with casualties farmed out across multiple hospitals, authorities used a local exchange to enable family reunifications. And last year an HIE in western New York provided backup data after a ransomware attack on Buffalo’s Erie County Medical Center.
To maximize their benefit, do some planning now, urged Sam Schaffzin, technical director for health IT with the Centers for Medicare & Medicaid Services and a commander in the U.S. Public Health Service. Priorities should include ensuring the privacy and security of health information; ensuring access back outside the disaster zone; and overcoming state barriers to mutual aid.
There are several approaches the HIEs, including EHRs and secure messaging. And while this supports state customization for purposes like Medicaid, it can create technical problems and is one reason why there’s little data exchange across state borders.
Emergency Support Function #8 puts the Department of Health and Human Services in charge of disaster medical planning, Schaffzin noted, and gives it the authority to set up temporary organizational infrastructure, but that has to start locally. ESF-8 doesn’t specifically discuss healthcare IT, so identify your state lead agencies and establish seats at disaster planning tables now.
That’s one of several key recommendations the speakers offered:
Understand your state’s disaster response policies and align with ESF-8 leads;
Develop standard procedures with necessary approvals to share electronic health information across state lines;
Consider a mutual aid MOU to waive liability for releasing information in an emergency and default all state privacy/security laws to HIPAA;
States should consider using DURSA (the Data Use and Reciprocal Support Agreement) to address patient privacy and data-sharing concerns;
Assess your state’s availability of health information sources and ability to share data electronically via HIEs and other means.
Novak and Schaffzin then described a pair of additional data resources that may be useful to local medical responders in disasters. PULSE is the Patient Unified Lookup System for Emergencies. A new effort being piloted in California (where it currently operates in 58 counties), PULSE has a target population of those displaced by disasters or impacted by medical catastrophes. Credentialed providers—EMS, ED docs, nurses, pharmacists, and others—can enter and retrieve patient records from the system as they begin treatment.
PULSE was used during the state’s recent wildfires, to good reviews from first responders. The goal now is to expand it nationwide. “If you ask clinicians,” Novak said, “they really feel it’s the gold standard.”
emPOWER (previously discussed here) identifies the 3.8 million Medicare recipients who rely on electrically powered medical equipment and will need assistance if they lose power in a disaster. CMS and the Office of the Assistant Secretary for Preparedness and Response (ASPR) worked together in 2013 to validate their data in New Orleans and found 93% of those identified as having powered equipment actually did. However, just 2.4% of those patients were listed in the city’s special-needs registry; just 1.3% were in the power company’s registry; 41% had no emergency plan; and 55% said they’d need help in an emergency.
emPOWER has three levels of access: The first, available to anyone, shows the aggregate number of at-risk persons by zip code. The second, accessible to public health providers and their partners, breaks down the number of monthly claims by zip code. And the third, restricted to public health only, contains individual data for response outreach and planning.
A virtual assistant will be launched this spring to get emPOWER data into the hands of first responders. That will be available through Alexa and Google Assistant. And at least three states are eyeing a similar resource for Medicaid patients: Nevada’s kicked off in December, and Florida and Virginia are in development.