Disasters bring unexpected use cases for HIE

Health information exchanges (HIEs) can be part of an effective response to natural or manmade disasters, according to CMS and ONC officials, but that requires agencies and healthcare organizations have a plan before a disaster strikes.

In a presentation at HIMSS18, Commander Samuel Schaffzin, MPA, technical director for Medicaid Health IT at CMS and Thomas Novak, HITECH & HIE interoperability lead at CMS and the Office of the National Coordinator for Health IT (ONC), said the past several years have illustrated some new use cases for HIE frameworks in disaster preparedness and response.

One example offered by Novak was the response to an Amtrak train derailment in Philadelphia in which eight people died and hundreds more were injured. With patients sent to five different emergency departments around the city, Novak said the emergency alerting through Philadelphia’s HIE was leveraged to set up a call center so families of passengers could find their relatives.

“Because they had all the emergency alerts, they knew where everybody went in all those different hospitals and could tell anybody where your loved one went who might have been in this Amtrak crash, if they went to hospital at all,” Novak said, adding “I never would have predicted the family reunification in a train crash use case.”

In that case, however, the HIE only had to cover hospitals in the same city and state. State borders pose a problem for exchanging data, with variations created by each state’s different standards or the rate of participation in their HIE. This adds technical issues, Novak and Schaffzin said, along with the legal issues of protecting and securing health information following a disaster.

Governance can also be an issue. A lead agency has to take on HIE-related activities in an emergency and a common problem in disaster preparedness, Schaffzin said, is sorting out issues like that in advance.

“None of us should be meeting for the first time during a disaster,” he said.

Broadly speaking, Schaffzin said those involved in disaster response need to improve their communication and use of existing resources, ensure data is protected but available outside the disaster zone and overcome any policy barriers to developing interstate agreements—like a mutual aid memorandum of understanding (MOU).

Some states already have more successful models in place. One example is California’s PULSE (Patient Unified Lookup System for Emergencies) program. Targeted at anyone experiencing a medical or trauma emergency or displaced by a disaster, it includes both a web portal for providers and practices and a message broker system.

It’s worked so well that Schaffzin and Novak believe it will be built out nationwide and connected to Carequality, a national HIE network. Local agencies, however, will still need to be prepared to respond to the disasters and not rely on federal resources to make proper use of the HIE.

“Everything starts locally and should be ending locally as well,” Schaffzin said.