RESEARCH TRIANGLE PARK, N.C. — In the wake of natural disasters, news of power outages and damages to buildings is widely shared, but what is often forgotten are the problems caused by lost paper-based medical records, which leave many patients and their physicians unable to reconstruct much-needed medical records, particularly prescription histories.
A new report by representatives from six Gulf states, whose work was supported by RTI International under a contract with the Office of the National Coordinator (ONC) for Health Information Technology, offers five recommendations for states to integrate health information exchange procedures with disaster plans.
The report considers the legal, technical and governance issues associated with the exchange of health information during a disaster and recommends:
- Aligning the state’s disaster response policies with the state agency designated for Emergency Support Function (Public Health and Medical Services) before a disaster occurs.
- Developing standard procedures approved by relevant public and private stakeholders to share electronic health information across state lines before a disaster occurs.
- Enacting the Mutual Aid Memorandum of Understanding to establish a waiver of liability for the release of records when an emergency is declared and to default state privacy and security laws to existing Health Insurance Portability and Accountability Act (HIPAA) rules in a disaster. The report also recommends that states consider using the Data Use and Reciprocal Support Agreement (DURSA) in order to address and expedite patient privacy, security and health data-sharing concerns.
- Assessing the state’s availability of public and private health information sources and the ability to electronically share data using health information exchange and other health data-sharing methods.
- Considering a phased approach to establishing interstate electronic health information-sharing capabilities.
The recommendations came out of the Southeast Regional HIT-HIE Collaboration (SERCH) project on Health Information Exchange in Disaster Preparedness and Response, which began in November 2010.
The consortium included representatives from Alabama, Arkansas, Florida, Georgia, Louisiana and Texas. The work was conducted under RTI’s State Health Policy Consortium contract with ONC. The consortium project supports states in developing solutions to challenges preventing or impeding efforts to exchange health information across state lines.
The consortium’s goal was to develop a strategic plan for sharing health information data among the Southeast and Gulf states during and following a declared natural disaster. In developing the recommendations, the consortium members carefully assessed the challenges of accessing medical records and coordinating health care information for patient populations displaced due to a disaster.
“These recommendations offer a path forward for other states that wish to integrate disaster planning and health information exchange efforts,” said Robert Bailey, a health IT project analyst at RTI and the project’s director. “Combining these two important health care functions will help ensure that when a disaster strikes, patients and providers will have better access to information and providers will be better able to provide appropriate care.”
RTI provided project management support and subject matter experts to the consortium. Alison Banger, a health IT analyst at RTI and the SERCH consortium project manager, worked with the states and with a group of consultants and subcontractors that included HLN Consulting, LLP; Health Transactions, Inc.; Manatt, Phelps and Phillips, LLP; Prism Consulting; the Texas Health Services Authority; the University of Houston; and the Vanderbilt Center for Better Health.
The process included a detailed legal analysis to determine what laws might govern the exchange of information during a disaster and whether different protections apply in the event of a declared disaster. Similarly, the consortium assessed the current and planned technical infrastructure in the six participating states with the goal of incorporating disaster planning earlier with health information exchange projects.
Finally, the consortium considered what governance issues would need to be resolved prior to a disaster, including delegation of authority, resource allocation and management, and continuity in the event of changes in state or local government leadership.
The final report from the project includes an actionable plan for incorporating health information exchange into disaster planning.