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Health Information Exchange Connects Docs With EHRs During Disaster

By Alexandra Wilson Pecci  
   April 10, 2018

A health information exchange enabled care for evacuated hospital patients when Hurricane Irma hit.

Hurricane Irma cut a devastating path through the Caribbean and the southeastern United States, leaving 144 people dead and nearly $65 billion in damage in its wake in September 2017.

The terror of such a storm is most certainly magnified for hospitals and health systems, which must continue to care for—and often evacuate—vulnerable patients.   

"During a disaster, chaos is the norm," Phillip L. Coule, MD, MBA, interim vice president and chief medical officer at Augusta University Health System and interim associate dean for clinical affairs at the Medical College of Georgia and Augusta University, told HealthLeaders Media via email.

Part of that chaos stems not only from having to evacuate patients but also having to send everyone with their medical records.

"Imagine trying to evacuate your entire hospital but you can't send anyone until you print all of the records—some of which are hundreds of pages," Coule says.

"With the complexities of EHRs and the amount of data that is tracked and reportable, it's not possible to transform that data into paper and then get it back into the system in a meaningful way at the new location," he says.

Therein lies an irony of EHRs: Although they've eliminated the problem of physical records being destroyed by a disaster, unconnected systems mean that all of that valuable patient information may as well be trapped.

"As a result, information is lost," Coule says.

HIE made a difference

Coule says his organization had experience with "suboptimal" information flow the year before during Hurricane Matthew. But with Hurricane Irma, things were different because of the HIE, Georgia Regional Academic Community Health Information Exchange (GRAChIE), which connects health information across nearly three dozen healthcare providers in Georgia.

"We had established connections with the large medical centers through both GRAChIE and a direct connection between Cerner clients in the larger medical centers along the Coast," Coule says. "We also enabled additional connections where possible, anticipating that large numbers of patients would be displaced."

In fact, many patients were displaced, arriving at Augusta and other facilities from evacuation zones from coastal areas in Florida, Georgia, and South Carolina. 

In anticipation of that displacement and relocation of patients, GRAChIE leadership used the eHealth Exchange participant list to identify specific eHealth participants from predicted evacuation areas in the path of Hurricane Irma and established eHealth connections, a GRAChIE spokesperson tells HealthLeaders Media.

 "When Hurricane Irma hit, Georgia Regional Academic Community Health Information Exchange acted quickly and was able to identify specific eHealth Exchange participants located in the predicted evacuation areas for the storm," Jennifer Rosas, director of the eHealth Exchange, told HealthLeaders Media via email. "They created and tested their connections with the other sites in advance, and as a result, people in Georgia and surrounding states were better prepared at a difficult time."

All that connectivity helped the providers at organizations like Augusta, which received the evacuated patients.

"Our providers at Augusta University Medical Center and other GRAChIE- connected facilities were able to view x-ray and lab results and provider notes from the sending facilities," Coule says. "This allowed for the nearly seamless transfer of [care for] these patients and dramatically reduced the chances for an error to occur."


From a provider perspective, Coule says GRAChIE is "simple and easy to use" because it's embedded within the native EMR application and it takes "simply one click to see what records are within GRAChIE." Key information is automatically transferred and is available in a searchable fashion. Plus, "once the patient is registered they are included within the HIE sharing unless they specifically request to be excluded," Coule adds.

"The provider simply opens an additional tab within the EMR and the system conducts the query and returns a summary page of the results. These results are displayed within a table view that allows easy filtering of external records," Coule says. "The layout and feel of the system is intuitive to the provider and a search function will locate records that contain a specific lab value or word."

Coule says that after the storm the most important lesson learned was that some of the smaller facilities were not connected to GRAChIE, and that "emergency managers, hospital leadership, and elected officials should seriously consider the HIE connections to systems like GRAChIE as an important component of disaster planning and patient safety."

"The more members contributing to an HIE the stronger and more useful it becomes," he says.


Moreover, Coule says he thinks that having a system that can ensure the "continuity of operations" is a benefit beyond only natural disasters because it can help during any downtime, from cyber and ransomware attacks to needing to take a system offline. For example, Coule points to when his organization had a planned downtime of its entire system when it changed from a local to a remote-hosted solution.

"We use GRAChie as a data repository through a web-portal that provided clinicians access to medical histories, medications, and previous lab and radiology data that would not have been available otherwise," he says.

And although Coule says it's "hard to quantify the savings" from such initiatives, he says that there are some; for instance, by eliminating the need for duplicate services.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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