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<title>Health IT passes first big test with Hurricane Harvey - POLITICO</title>
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<style type="text/css">.cms-textAlign-left{text-align:left;}.cms-textAlign-center{text-align:center;}.cms-textAlign-right{text-align:right;}.cms-magazineStyles-smallCaps{font-variant:small-caps;}.cms-playbookStyle-rubric{color:#b70000;font-weight:bold;font-family:sans-serif;}</style><p>Policymakers and health care providers can celebrate one quiet success in the wake of the Houston storm: the computers are still running.</p>
<p>The preservation of patient health records represents a partial vindication for the HITECH Act, the 2009 EHR stimulus package that was conceived, in part, as a way to ameliorate natural disasters like Hurricane Katrina by replacing waterlogged paper with modern technology. </p><p class="story-continued">Story Continued Below</p>
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 <p>Now comes the hard part: using IT to manage the health of patients whose lives will be disrupted and scattered by the storm. </p>
<p>Several Houston hospitals contacted by POLITICO — including MD Anderson, Houston Methodist, and Texas Children’s — as well as area providers said their EHRs and technology had functioned without pause through the deluge. </p>
<p>“We are doing well,” said health IT researcher Hardeep Singh, who was working at Houston’s Michael E. DeBakey Veterans Affairs Medical Center during Harvey. “Only thing needed is food for residents and I'm about to go pick up some pizza for them from the only shop we found open.” </p>
<p>Singh’s calm was shared by the other providers, who reported uninterrupted connectivity throughout the storm. Texas Children’s had a close call; a leaky closet could have imperiled the organization’s communication equipment were it not for some well-deployed sandbags, said the organization’s CIO, Myra Davis. </p>
<p>The intact records represent a success for HITECH, which passed partly as a response to Katrina, the devastating 2005 storm that left health care systems struggling to manage patients blown across the country. Their medical records, often destroyed by flooding, did not follow them. </p>
<p>Before Katrina, the costs of EHRs seemed prohibitive, former Surgeon General Regina Benjamin <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1007785#t=article" target="_blank">wrote</a> in a 2010 New England Journal of Medicine article. After the storm, she changed her mind. “Whereas I had previously decided against installing an EHR system because I couldn't afford one, I now realized I couldn't afford <i>not</i> to have one,” she wrote. </p>
<p>During Katrina, the nascent ONC collaborated with state Medicaid and Blue Cross Blue Shield organizations to create a site, KatrinaHelp.org, which used claims data to provide doctors some information on patients’ drug regimens and medical history, said David Brailer, the ONC’s chief at the time. </p><aside class="story-related cl-l db ">
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<p>The website was helpful and the experience of Katrina “was one of the paving stones on the road [to HITECH]. … It was one of the first times we were able to demonstrate to the public why their electronic information was important,” he said. Legislators frequently cited Katrina while designing the HITECH Act. </p>
<p>The VA — with its pioneering VistA EHR — was able to retain records and access them much more rapidly than its private-sector peers during Katrina. A September 2005 VA <a href="https://www.va.gov/opa/publications/archives/vanguard/05sepoctvg.pdf" target="_blank">magazine</a> pointed out that the organization restored access to records from 40,000 New Orleans-area veterans within days; it would take years for the private sector to reassemble its records. </p>
<p>The VA’s records ended up being widely used by Gulf Coast natives in diaspora — their records were accessed by doctors in 48 different states, a 2007 American Journal of Public Health study <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1854987/pdf/0970136.pdf" target="_blank">showed.</a></p>
<p>This time around, IT specialists in the private sector were ready. In Houston, continuity preparations began years before Hurricane Harvey. When Houston Methodist built its data centers six years ago, it made sure they could withstand hurricane force winds, said Robert Eardley, the hospital’s chief information officer. </p>
<p>A steel lattice roof was erected to protect electric generators powering the center, which also has a backup data center in Austin. </p>
<p>MD Anderson also has a backup center 60 miles outside Houston, said Craig Owen, the system’s interim CIO. Indeed, 70 percent of U.S. hospitals now have cloud-based backups for their data, a recent American Hospital Association survey <a href="http://www.hhnmag.com/articles/8391-most-wired-hospitals-and-health-system-driving-efficiency-improvement" target="_blank">found</a>. </p>
<p>Some providers have gone all the way to the cloud. Dan Jenson, chief financial officer for VillageMD Houston — a population health organization partnering with 11 primary care clinics in Houston — said that athenahealth, the system’s cloud-based EHR, enabled the clinics to access their EHRs through a phone app if internet servers crashed.</p>
<p>Davis, of Texas Children’s, said that staff tweaked a log-in procedure during the storm: Ordinarily, doctors who don’t log in for 90 days have to undergo complex procedures to regain their privileges. With normal scheduling of doctors out the window, the 90-day rule was eased. </p>
<p>The next big test of the region’s EHRs, meanwhile, is to see whether they have enough interoperability to make sure patients scattered by the storm — and their new doctors — can access their records. Brailer is pessimistic.</p>
<p>“It’s no easier to put together a database for emergency response now than it was then,” he said. Identifying high-risk patients requires good data, and ensuring that that data gets to the right persons requires easy transfer. Both tasks have proved challenging. </p>
<p>“My prediction is that there will be a bump in non-disaster deaths that arise from discontinuity of care,” he said. “God forbid that will happen, but it’s happened every time we’ve had a disaster. Many people have missed a treatment.” </p>
<p>Katrina, for example, disrupted treatment for thousands of people. Most if not all diabetic patients lacked records of their care when they were evacuated to shelters, forcing doctors to <a href="http://care.diabetesjournals.org/content/29/1/158" target="_blank">select</a> their drugs based on what was available. </p>
<p>Cancer care was also problematic. A doctor quoted in a <a href="http://content.time.com/time/nation/article/0,8599,1107826,00.html" target="_blank">Time magazine article</a> said he couldn’t tell whether a lesion in one patient’s lung was new or not. The patient would probably have had “a little bit longer and better quality of life” with continuous care, the doctor said. </p>
<p>Houston providers contacted by POLITICO this week, however, said they were using EHRs to do the vital electronic triage work required by the storm. MD Anderson did 50 chemotherapy infusions Tuesday, Owen said, after the IT staff used data to identify patients most in need of that treatment. The center canceled many appointments but hoped to fit in the most at-need patients over Labor Day weekend. </p>
<p>As for patients forced to leave Houston on an indefinite basis, MD Anderson could share data through its Care Everywhere platform with other Epic providers. “If it’s not an Epic hospital, we would have to work with them to transition information,” Owen said. </p>
<p>The storm doesn’t seem to have hurt information exchange for her hospital, said Sarah Maytum, an executive with Texas Children’s with responsibilities in emergency response.</p>
<p>Before the storm, VillageMD called, sent text messages and updated social media to advise high-risk patients about clinic availability and to inform them of a doctors’ call-in line, Jenson said. VillageMD’s clinics are beginning to reopen, with walk-in availability, and care managers are reaching out to make sure fragile patients have medications they need, Jenson said. </p>
<p>The federal government is also stepping in, noted Karen DeSalvo, who as New Orleans health commissioner used Medicare and Medicaid claims data in the wake of a 2012 hurricane to identify patients on oxygen or dialysis. The city contacted them before the storm and tried to expedite the restoration of power to their neighborhoods. The program was later adopted by HHS as a whole. </p>
<p>That program — called emPower — has continued under HHS Secretary Tom Price, she noted. “I was so happy to see it was still being used,” she said. </p>
<p>“Some near 12 years ago, we were living in such a different world,” she said.</p><div class="story-share ">
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                                        <p><i>CORRECTION:  An earlier version of this report misstated Dan Jenson&#39;s title. He is the chief financial officer of VillageMD Houston.</i></p>
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