Hurricanes and Health IT

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?

Functional innovation and knowledge innovation -- two key contributions of Project HealthDesign

Wendy Swanberg, Communications Coordinator, Project HealthDesign National Program Office

A few weeks back, I had the privilege of coordinating (and then watching) Project HealthDesign’s webinar, “From the iPhone to the EMR: Can patients’ personal health data improve their clinical care?”  The hour-long webinar provided a good, succinct summary of this seven-year project.  As someone who had recently joined Project HealthDesign as it enters its final months, I gained a lot of insight from the reflections of those who have shepherded the project from its inception.

I’d already come to understand the significance of Observations of Daily Living (ODLs), the main discovery to have emerged from the work of PHD’s fourteen grantee teams.  But until the webinar presentation by Michael Christopher (“Chris”) Gibbons, I didn’t appreciate how Project HealthDesign’s seven-year evolution fit into the larger portrait of technology-enhanced health care. 

Dr. Gibbons joined PHD’s National Advisory Committee in 2006 when the project was first defining itself.   “I have been able to be with the project from the beginning,” Gibbons said in the webinar, “and had the opportunity to look at not only the internal growing pains, but how the project has evolved through broader changes that were happening in our society . . ."  Among those societal changes are:

• Prevalence of chronic disease
• Burgeoning of the senior population
• Increasing longevity
• Rising healthcare costs
• Growing population of minorities, immigrants & underserved

Looking at our second round of grantee work from that perspective: The dwellSense project is relevant to every one of these changes.  Both the iN Touch project focusing on inner city teens struggling with obesity, and Estrellita’s work on care for premature infants, show how technology might help mitigate the cost and improve the effectiveness of health care among growing populations of the underserved.   And the research conducted by BreathEasy on people with asthma and Chronology.MD on patients with Crohn’s disease showed how attention to ODLs can make real contributions to the management of chronic conditions.

Yet beyond those real-time contributions, Dr. Gibbons pointed out how the project has helped to shape two broader trends in health care. “In my mind, as the Project HealthDesign project moved forward over these years with Robert Wood Johnson [Foundation], they really contributed in two main areas to help shape the broader trends.”   Gibbons calls these trends functional innovation and knowledge innovation.

Even before Project HealthDesign was launched, the healthcare industry had begun to embrace the function of personal health records (PHRs), primarily as repositories for data that clinicians found important.  “What we found is,” Gibbons said, “while that is important, there are other types of information that patients think important that traditionally and historically clinicians have not necessarily considered as important.“   The project’s timing is important here -- it was able to help define the function of PHRs while that function was still in flux.  “Project HealthDesign helped [clinicians] to broaden the perspective on the types of information, the types of data that could conceivably be important and that should go into a personal health record, and also pushed the envelope on the types of platforms and tools, devices to use to collect this information.” 

In the realm of knowledge innovation, Dr. Gibbons points to the project’s focus on Observations of Daily Living as “the key innovation in this area as we go forward.”  By folding ODLs into the healthcare mix, patients across the socioeconomic spectrum can enrich the quality of their health care.  “We had underserved populations, we had low-income populations.  We had elders, seniors, who many think are not in line in any way.” 

Through the work of fourteen teams of grantees, this seven-year project has employed technological innovation to address new healthcare challenges raised by changes in the socioeconomic contour of our population.  By doing so, Project HealthDesign has made important contributions to the future direction of modern health care. 

Dr. Gibbons' final comment was a perfect summary of the webinar, and maybe of the project over all as it enters its final few months:  “I think the Project HealthDesign project over time, in the context of these broader changes, has really now set the bar for developers to make vastly improved tools that will help both clinicians, and lead to better outcomes for patients.”

Thoughts from Project HealthDesign's student assistant (and future physician)

Madhu Rajendran, student assistant, National Program Office

I am Madhu Rajendran, a sophomore here at University of Wisconsin-Madison and a student assistant at Project HealthDesign. I am currently studying biochemistry and math, as both fields are of great interest to me. My plans are to go to medical school when I am done with my undergraduate studies.  I started to work at Project HealthDesign in the beginning of October 2011, when I was looking for jobs that had some relation to helping patients.

Like a lot of pre-med students, one thing I would like to change is the way patients get treated. My experience as a student assistant with the NPO has given me the chance to be a part of an effort to make those changes happen.

Before working with Project HealthDesign I had a very different view of the physician-patient relationship. My belief was that in order to better aid the patients, the patients would talk to the physician about their medical problems, and the physician would provide solutions to solve the medical problems.  Throughout this process, the patients would follow the physician’s guidelines, no questions asked!

But my work with Project HealthDesign has done more than just shatter my view about the physician-patient relationship; it has also helped me to see who plays a bigger role. Even though the physicians are experts in healthcare, patients are experts in their own lives. The patients know much more about themselves than the physicians do. So the patients play a bigger role, and the role of the physicians is to cure the patients based on the information that they provide.

Project HealthDesign’s grantee teams’ work on identifying Observations of Daily Living, or ODLs, has also influenced my thoughts on how I could be a better future physician.  Since ODLs are recorded by the patients themselves, they tell a better story about what has been going on in the lives of patients, additional to the patient’s verbal reports.  Even though ODLs are defined by patients and are most commonly used for self-management of health, ODLs can play a vital role during clinical decision making.  As someone who plans to become a physician, I hope ODLs will become part of the medical picture by the time I start my career.  I think ODLs will provide me a more complete and holistic view of the patient as a whole person.

Working as a student assistant for Project HealthDesign has been a great opportunity for me, as it has changed the way I could better serve my patients.  Because of my experience here, I hope to be part of a new generation of physicians who enter the field with the knowledge that patients belong at the center of their own health care, not on the periphery.