Storm tests EHR

Med­i­cal records kept safe de­spite dev­as­ta­tion

Modern Healthcare - - THE WEEK IN HEALTHCARE - Joseph Conn

When thou­sands of Gulf Coast res­i­dents fled Hur­ri­cane Ka­t­rina, many of their pa­per­based med­i­cal records were soaked or blown to the winds. Ever since, pro­po­nents of elec­tronic health-record sys­tems and health in­for­ma­tion ex­changes have pro­moted those tech­nolo­gies to keep health in­for­ma­tion se­cure and ac­ces­si­ble when dis­as­ters strike.

In and around Ok­la­homa City last week, that prom­ise was largely ful­filled.

The tor­nado that struck Moore, Okla., on May 20 knocked out In­ter­net com­mu­ni­ca­tions to Moore Med­i­cal Cen­ter, the city’s lone hos­pi­tal, a satel­lite of Nor­man (Okla.) Re­gional Health Sys­tem.

About 30 pa­tients were evac­u­ated from Moore Med­i­cal in the south sub­urb of Ok­la­homa City to the sys­tem’s un­scathed flag­ship, Nor­man Re­gional Hos­pi­tal, and its Health­Plex sur­gi­cal hos­pi­tal, also in Nor­man, both less than 10 miles farther south.

Since the main cam­pus hosts the Meditech EHR sys­tems for all three hos­pi­tals, even with In­ter­net con­nec­tiv­ity knocked out, Nor­man “didn’t skip a beat,” said Dr. Brian Yea­man, a fam­ily physi­cian and prac­tic­ing hos­pi­tal­ist and the sys­tem’s chief med­i­cal in­for­mat­ics of­fi­cer. “And we didn’t have the risk of those pa­per records fly­ing for miles.”

Yea­man also is the med­i­cal di­rec­tor for the Greater Ok­la­homa City Hos­pi­tal Coun­cil and co­or­di­na­tor of its health in­for­ma­tion col­lab­o­ra­tive, a sub­set of Ok­la­homa’s broader Se­cure Med­i­cal Records Trans­fer Net­work, or SMRTnet, a 7-year-old re­gional health in­for­ma­tion ex­change or­ga­ni­za­tion that also was tested by the storm.

Copies of pa­tient records for more than 2 mil­lion peo­ple are stored by SMRTnet at a Cerner Corp. data ware­house “buried in the side of a large, man­u­fac­tured hill in Kansas City,” said Joanna Walk­ing­stick, di­rec­tor of mem­ber ser­vices at SMRTnet. Those records in­clude pa­tient de­mo­graph­ics, vis­its,

pro­ce­dures, lab re­sults, vi­tal signs, his­to­ries and phys­i­cals, dis­charge sum­maries, dis­charge med­i­ca­tions and ra­di­ol­ogy re­ports.

“This is the first time we’ve been tested like this,” Walk­ing­stick said. Net­work traf­fic spiked af­ter the tor­nado hit, and the sys­tem “scaled” and “han­dled the traf­fic load, very, very well,” she said.

There was a weak link: The lines of the fiber op­tic ca­ble provider used by Nor­man Re­gional Health to con­nect to SMRTnet were cut just af­ter 3 p.m., when the tor­nado moved east­ward across In­ter­state 35, the main traf­fic artery be­tween Ok­la­homa City and Nor­man.

The en­su­ing de­struc­tion dis­con­nected Nor­man from the RHIO un­til about 10 p.m., when ser­vice was re­stored.

Links be­tween SMRTnet and other net­work mem­ber hos­pi­tals stayed open, how­ever, Yea­man said, in­clud­ing to the In­te­gris South­west Med­i­cal Cen­ter, 10 miles north of the now-iconic Plaza Tow­ers El­e­men­tary School de­stroyed by the tor­nado.

“Ev­ery­body had ac­cess to the data they needed,” said John De­lano, vice pres­i­dent and chief in­for­ma­tion of­fi­cer of In­te­gris Health, which has five hos­pi­tals in the Ok­la­homa City area.

“We did not lose con­nec­tiv­ity,” De­lano said. “Our (Cerner) elec­tronic med­i­cal record is re­mote hosted in Kansas City. We’ve got two ways to get to that: We’ve got a pri­vate con­nec­tion and we have the abil­ity to ac­cess them via the In­ter­net should we lose that. And, we keep a lo­cal copy of the data. And we’re con­nected to SMRTnet. We also use Allscripts in our am­bu­la­tory en­vi­ron­ment, and we’re in the process of dump­ing that am­bu­la­tory data into that HIE as well.”

In­te­gris providers treated 92 tor­nado vic­tims, 20 of whom were ad­mit­ted, 10 in crit­i­cal con­di­tion, and one of whom died, said Brooke Cayot, me­dia li­ai­son for the sys­tem.

Yea­man said SMRTnet con­nects 90% of the hos­pi­tal beds in the greater Ok­la­homa City area. Re­search by the lo­cal hos­pi­tal coun­cil, he said, in­di­cates that 68% of the area’s pa­tients “touch more than one health sys­tem and 25% see three or more.” That dif­fu­sion of pa­tients was most cer­tainly the case af­ter the storm.

In­jured Moore res­i­dents, who or­di­nar­ily would have sought treat­ment in their city’s hos­pi­tal, did so across the metro area.

“We were able to put that in­for­ma­tion in those providers’ hands (Mon­day night) to make very dif­fi­cult de­ci­sions on some very sick pa­tients and drive care,” Yea­man said. “It’s absolutely mind-bog­gling to think about the cor­ner we’ve turned.”

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