In the wake of Hurricane Harvey, which set a record for the most rainfall from a single storm in the continental US, and Hurricane Irma, which has set new flood records in northeast Florida, many journalists and commentators have looked back to the emergency response to Hurricane Katrina for comparison. It’s interesting to reflect on the progress we have made in emergency response and health care connectivity over the past 12 years.
Mobile services and social media. During Katrina, almost all cell phone communication was wiped out – more than 1,000 cell sites failed. During Harvey, just four percent of the almost 8,000 cell sites in the storm’s path were wiped out – a notable improvement. Major telecommunications companies were prepared with additional fuel delivery for back-up generators, and were ready to deploy emergency repair units. Social media was in its infancy; now, hundreds of millions of people use a wide range of platforms. When they were unable to reach emergency services via traditional methods, many people alerted rescue teams and emergency responders by posting their addresses on social media. In 2014, Facebook launched its Safety Check tool, which allows users in an emergency to mark themselves as safe. Social media platforms also provided a way to recruit and organize volunteers. Airbnb, which people typically use to find vacation rentals, served as a resource to shelter people who were forced from their homes and had nowhere else to go.
Electronic health records. The rising prevalence of electronic health records (EHRs) since Katrina means that tens of thousands more patients may be spared from having their paper records washed away. When Katrina hit, only about a quarter of the nation’s physicians were using EHRs. Seventy-one percent of Texas physicians were using EHRs as of 2016, the same as the national average. EHRs help providers get immediate access to patient information for those evacuated to other parts of the state. The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 and provided funding for EHR adoption, partially in response to Hurricane Katrina. Several Texas hospitals, including MD Anderson, Houston Methodist, and Texas Children’s Hospital, reported that their EHRs and related technology operated effectively through the storm, a positive sign that HITECH is meeting its goals.
Inside Houston’s convention center, which served as a shelter, “virtual clinics” were set up, which allowed physicians to order medications and input patient information. Seventy percent of US hospitals now have cloud-based backups for their data, according to the American Hospital Association. Houston Methodist, for example, began preparing for a natural disaster years before Harvey hit, taking care to make sure its data centers could withstand hurricane-force winds, and erecting a steel lattice roof to protect generators.
However, across the country, interoperability – or the ability for different providers in different networks to exchange and share information – is still limited for many patients. If patients need to go outside of their provider network, they might need to have their records faxed. Health care stakeholders have long recognized this challenge and are working to address this lack of interoperability in an emergency. In the years since Katrina, federal officials have been working on a national solution to EHR gaps in an emergency, called the Patient Unified Lookup System for Emergencies (PULSE). The system, which is still being tested, allows disaster workers to look up patient records, such as prescriptions or recent test results, for anyone who came to an emergency room, pop-up field hospital, or evacuation shelter. In June of this year, officials had completed the first big test of the system, and the drill was successful.
Other recent innovations may have saved lives. These innovations include the sled stretchers that many hospitals now use to transport very large patients, or patients who are tied to a lot of equipment, when elevators are out. These special stretchers are much easier to glide down stairs. Texas Medical Center installed submarine doors to keep out water. Of course, hospitals are only one part of the preparedness equation in health care. Many vulnerable patients are at home or in nursing centers. Federal health officials were able to analyze Medicare claims to help hospitals identify and locate patients at home who rely on ventilators, oxygen concentrators, or electric wheelchairs. For example, CMS identified 130 patients on dialysis on St. Thomas Island that needed to be moved.
The importance of preparation is well-recognized in health care. Quantum computing – which takes advantage of the ability of subatomic particles to exist in more than one state at any time and allows operations to be done much more quickly using less energy than classical computing – could make prevention more of a reality in weather as well. In the coming years, quantum computing may help better predict exactly what areas will be most impacted, so that the most vulnerable areas can better prepare, and health care and other resources can be better targeted and distributed.
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