Robert Belfort, Manatt, Phelps & Phillips, LLP, Project HealthDesign Regulatory and Assurance Advisory Group
As you are probably aware, we’ve been having some severe weather events back here on the East Coast. First Hurricane Sandy, then a Nor’easter (named Athena), which dumped snow on top of an already soggy eastern seaboard. While the 24-hour news was replete with stories about Hurricane Sandy’s devastation, including downed subway lines, flooding and widespread power outages, some of the most disturbing stories were of New York City hospitals forced to evacuate patients in the middle of the storm.
Storied Bellevue Hospital, probably the most widely known hospital in New York City’s public hospital system, had to evacuate hundreds of patients to other hospitals after sustaining damage to its backup generators. Bellevue is located at 1st Avenue and 27th Street in what was, at the time, flood-stricken lower Manhattan. News reports showed hospital staff taking patients down scores of flights in dark stairwells in a perilous effort to move the patients to safety. New York University Langone Medical Center undertook a similar, dangerous exercise when a transformer cut power to the facility and its backup generators failed due to flooding.
A key point that commentators have been making with regard to the value of health IT is that a natural disaster or other crisis in one part of the country does not have to place a healthcare facility’s data in jeopardy. NYC’s Health and Hospital Corporation (“HHC”), operator of Bellevue Hospital, among others, proved the point during the storm. HHC’s hospitals use electronic health records (“EHRs”) and HHC runs two redundant data centers, at Jacobi Medical Center in the north Bronx and in Carlstadt, NJ. At one point, the Carlstadt site had four feet of water in the parking lot, so HHC relied completely (and successfully) on the Jacobi data center. NYU Langone Medical Center’s EHRs were also backed up at a remote location and were not lost in the storm. This is a contrast to Hurricane Katrina, in which so many patients’ medical records were still on paper and were lost during the storm. These contrasting experiences suggest that fully redundant data centers should be established in geographically dispersed locations so that if one data center is affected by a storm or crisis, operations can be immediately transferred to the other data center with little to no interruption or loss of data access.
Another key lesson learned from Sandy is that emergency patient transfer problems can be minimized if hospitals participate in electronic health information exchange (“HIE”). Many of the patients that had to be evacuated to other institutions in NYC were critical care patients for whom the evacuating hospitals likely had detailed EHRs chronicling their ailments and treatment regimens. In the harried evacuation process, it is unlikely these records traveled with the patients. Had all of the hospitals been participants in an active HIE network or otherwise been linked up to exchange information electronically with one another, clinicians in the receiving hospitals could have easily accessed the health records for the displaced patients. Furthermore, facilities that still had power but lost access to EHR data for one reason or another could potentially have retrieved electronic records on their own patients via an HIE during the storm.
The Executive Director of the New York eHealth Collaborative, the non-profit organization charged with building New York’s statewide health information network, summed up the situation well. He said that, looking back seven years, Hurricane Katrina became the storm that demonstrated the need for digital health records because so many paper-based medical records were lost. When the flood waters inundated hospitals, their patients’ medical histories pretty much vanished. Now, Hurricane Sandy could be the storm that underscores the importance of having a health information exchange and a tested emergency plan.
What were your thoughts watching the news reports during Hurricane Sandy? How could health IT and HIE have helped ease or prevent some of the health care-related hardship caused by the storm?