As the confusion that followed Hurricane Katrina dissipated, two things quickly became clear: Electronic medical records have a better chance of surviving a hurricane and flooding than paper records, and the Veteran Affairs Department's EMR system -- known as VistA -- came through the disaster with flying colors.
"The point to remember is that our VistA system never failed," said Robert Lynch, network director of the South Central VA Health Care Network. "We didn't lose anything and made information accessible as patients were transported across the country. ... If someone showed up at your site, you could find out what he needed."
Louisiana's nonveteran population, which was scattered throughout 30 different states, wasn't so lucky. It's estimated that at New Orleans' Charity Hospital alone some 450,000 patient paper records were destroyed.
With the dispersion of its residents, the wholesale loss of paper records and the VistA system prominently displaying its resilience, Louisiana and other Gulf Coast areas devastated by the hurricane have become a proving ground for EMRs, and the federal and state governments are pushing to make them an integral part of rebuilding the region's healthcare system. So far, these efforts appear to be moving forward at varying speeds.
Tami Duplantis, New Orleans district manager for the healthcare consulting firm Sourcecorp, said that most paper records more than 5 years old were stored off-site, but recent records were stored at hospitals and were destroyed in the floods.
Some lab, pharmacy, vaccination and transcribed records were stored electronically and were salvageable but, according to Roxane Townsend, deputy secretary of the Louisiana Department of Health and Hospitals, even some electronic records were lost when stored on computers not remote enough or safe enough.
"We're in the 21st century now; we have to stop handling all this paper," she said.
The experience itself was valuable as the VA used the Katrina episode to prepare for hurricanes Rita and Wilma that followed.
"Now we have satellite uplinks to send records, e-mails and telephone messages. It won't be as fast as a landline, but it will be just as effective," Lynch said. "We also provided redundancy and diversity so there is less risk of losing the network and alternatives if we do."
In the months after the storms, numerous other initiatives were launched, including the Louisiana Health Care Redesign Collaborative, in which Townsend is participating. "One thing they already decided on was that health information technology will be part of the backbone of the new system," she said. Townsend is also active in the Louisiana Health Information Exchange that was launched with the help of $3.7 million from HHS to develop a prototype electronic health-record exchange between providers in the New Orleans and Baton Rouge markets. "We don't use the term `RHIO' (or regional health information organization), but you could define it as such," she said.
Initial progress was somewhat slow, Townsend said, as the new organization needed to collect its funding and process contracts. Still, she said to accomplish the same tasks would have taken three years under normal conditions. Now the project is about to bear some fruit, Townsend said. Testing is set to begin soon on sending data back and forth in anticipation of a September demonstration consisting of transmitting continuity of care record-level data between eight different healthcare facilities.
As part of its Katrina Phoenix Project, the Healthcare Information and Management Systems Society assembled donated software and hardware and a team of advisers and physician mentors to help nine practices in Alabama, Louisiana and Mississippi, and it's also working on getting EMRs implemented at a Mississippi community clinic with 11 sites.
One local health IT expert said the regional efforts are a positive sign, but he remains skeptical about how much national impact they will have.
"Until we get to ubiquitous, interoperable standards, all we will be doing is rearranging the deck chairs on the Titanic," said David Graser, senior vice president and chief information officer at West Jefferson Medical Center in Marrero, a suburb just south of New Orleans that escaped the post-hurricane flooding.