In early September 2017, Hurricane Irma forced more than 6 million Floridians to evacuate from their homes. I was one of them.
I witnessed first-hand the devastating impact of this storm on our communities, and especially on our healthcare system. Nearly 12% of Florida's hospitals closed as precautionary measures in advance of the storm's arrival, and more than 2,000 patients were transferred to other facilities.
When a natural disaster hits, it places incredible pressure on healthcare organizations. They often face an increased demand for services while managing shortages of resources and manpower.
At HIMSS18, I participated on a panel called Learning from the Devastating Effects of Three Hurricanes: The Critical Role of Health IT along with Jose Abrams, CIO/CTO of Servicios de Salud Espicopales and James Langabeer, Ph.D., FHIMSS, Professor of Health Informatics at University of Texas School of Biomedical Informatics.
Puerto Rico: Total loss of power and communications cause long-term challenges
Because of its location, Puerto Rico has historically been susceptible to hurricanes. Abrams' organization had prepared a contingency plan, but it didn't anticipate facing Hurricane Maria two weeks after Hurricane Irma had irreparably damaged Puerto Rico's aging power infrastructure.
“We lost 100% power, water and communications,” Abrams said. “Our biggest challenge during and immediately after the hurricanes was that we had no information.” During the long recovery period following the hurricanes, Puerto Rico continues to experience intermittent electricity and communications failures.
Abrams advises organizations to prepare for the worst-case scenario, and anticipate how to manage impact beyond a two-week timeframe. He also suggested considering a regional repository of patient data for cases when access to the EHR is lost, and careful evaluation of cloud versus onsite data centers.
“Improvisation is necessary during emergencies,” Abrams said. “Technology allowed us to redesign during the recovery process.”
Texas: Need for communitywide data coordination
Hurricane Harvey pummeled Houston with five feet of rain within two days, displacing 40,000 people and flooding the area's largest hospital. There were more than 1,000 shelters hosted by social services, churches and other resources throughout the area.
“We had a great response through shelters and volunteers, but these emergency systems relied heavily on paper notes, emails and texts that never made it back into patients' home health information systems,” Dr. Langabeer said. “Nationally, health data exchange needs to be much more standard and we need a better community wide data coordination plan for these events.”
Dr. Langabeer also noted that people were generally getting their news from social media and news channels. He advised providers to consider how to incorporate a social media strategy into contingency plans.
Florida: Emerging technologies hold promise during relief and recovery efforts
Florida's primary challenges in the wake of Hurricane Irma were similar to those in Puerto Rico and Texas: Loss of power, storm surges and interrupted communications. The disaster affected a diverse population of people who speak different languages, and represent tourists as well as seasonal and permanent residents.
Despite their differences, patients are unified in expecting health IT to be “always on” – during an emergency. Several organizations found success in meeting patient needs by offering telehealth options, many of them at no cost.
A couple of emerging technologies showed promise during this disaster relief and recovery period. The cloud, for example, enabled healthcare providers to have access to data that may have been unavailable if it had been in a compromised hospital location. We're also in the exploration stages with blockchain to see how we can create a minimal shared view of data that is viewable from multiple locations.
Comprehensive plans for a comprehensive response
Admittedly, it's difficult to anticipate all the potential contingencies required for every emergency situation. Other problems – such as behavioral health needs, contaminated water, safely transporting patients – can have long-term devastating effects on healthcare organizations. Each panelist reiterated the importance of preparing as comprehensively as possible.
Secure, accessible health IT systems that work well with one another are essential to responding effectively in a crisis. By learning from experiences in Florida, Texas and Puerto Rico, hopefully we will be better prepared when the next disaster strikes.