Published article about the impact of a natural disaster electronic health records

2. NCPC
T he National Center for Primary Care (NCPC) has the
unique distinction of being the only congressionally
sanctioned center in the country dedicated to promot-
ing optimal health care for all, with a special focus on
serving underserved communities. Headquartered at the
Morehouse School of Medicine, the NCPC is committed to
the pursuit of a healthier nation.

3. Table of
Contents
Letter from Principal Investigator......................................................1
By Dr. David Satcher
Tracking the Community’s Health............................................4
By Richard A. Gooden
Community Health Editorial.....................................................6
By Ayanna Buckner
EXPORTing Solutions.................................................................8
By Morna Gailor
Lights, Camera, Treatment........................................................11
By Richard A. Gooden
Preventing the Disaster After the Disaster..........................13
By Henrie Treadwell
Setting the Record Straight.....................................................15
By Bahati Banks
Prevention Plus Promotion Equals Lives Saved ................19
By Reyna Jones
Disaster Proofing Our Health Care Infrastructure..................22
By Dominic Mack
Acknowledgements....................................................................23

4. 1

5. Setting the
Records
Straight
A fter Hurricanes Katrina and Rita pounded
the Gulf Coast last year, countless
numbers of hospitals, community healthcare
centers, and doctors’
offices were destroyed
by Katrina’s fierce Electronic Health Records (EHRs)
wind and flooding. are digital medical records of the
Even more
physical and mental health of a
devastating was that
most of the 1 million patient. The data includes patient
residents displaced by demographics, progress notes,
the storm were left physician notes, medications,
with no medical vital signs, past medical history,
records.
immunizations, laboratory data
Flooding from the
and radiology reports.
storm and the
breaching of levees in
Louisiana damaged or
destroyed paper medical records stored in boxes
in hospitals, clinics and physicians’ offices.
For the Regional Coordinating Center for
Hurricanes Response at the National Center for
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6. Primary Care at the Morehouse School of Medicine, Hurricanes Katrina personal health profile stored on it.
and Rita have been the loudest wake-up call for supporting the need for Using a statistical model, RAND researchers, a nonprofit research
electronic health records (EHRs). organization in Santa Monica, CA, recently tabulated that the cost savings
“We must have a sustainable model for transitioning our community of implementing EHRs system that included 90 percent of hospitals and
health centers and hospital to electronic health records. This model must doctors could save $81 billion annually and improve the quality of care.
also be a replicable system that will benefit the entire nation and serve as a U.S. Department of Health and Human Services Secretary Mike Leavitt
safety net for future disasters, man-made or natural,” said Dr. Dominic recently selected 16 commissioners to serve on the American Health
Mack, director of the Regional Coordinating Information Community. The federal
Center for Hurricane Response at the National commission will advise Leavitt on how to
Center for Primary Care. WHY SHIFT TO EHRs? achieve the President’s goal of making health
Ultimately having a web-based solution that • Reduces Medical Error information digital and having most of the U.S.
everyone can access is optimal. Initially however, health care system using interoperable
“increasing the portability of health records and • Improves Quality of Care electronic health records within 10 years. If
giving more control of healthcare to patients achieved, the hope is that the patients’ medical
• Lowers Long-Term Costs
should be the number one priority for community information can be accessed immediately and
health centers in the regions affected by Hurricane efficiently, helping to reduce medical errors,
• Eliminates Paperwork Hassle
Katrina, according to Dr. Mack. improve quality, lower costs and eliminate
When emergencies and natural disasters arise, • Can Offer an Alternative Secure paperwork hassle.
safety advocates advise people to prepare survival Location to Back-up Records in Switching from paper-based to digitally
kits that include, in addition to food, water and the Event of a Disaster encoded medical records offers several practical
clothing, important health records and a list of advantages. It not only ensures data recovery in
their medications/vitamins. the event of a natural or man-made disaster,
“There are two sides to the digital healthcare equation, EHRs and personal EHRs can also streamline practice operations, allowing the flow of the
health records (PHRs)”, says Dr. William Alexander, director of the office or practice to run more efficiently. EHRs also have multiple clinical
Health Policy Institute at Morehouse School of Medicine. The short-term implications for improving the quality of care of patients.
goal for people displaced by Hurricane Katrina is to equip them with their “EHRs allow for data integrity, data recovery, decreases data redundancy
PHRs.” This was a major initiative undertaken in partnership with the and provides tools to manage information more efficiently,” says Dr. Steve
Regional Coordinating Center for Hurricane Response, the New Orleans Waldren, assistant director for health information technology at the
Health Department and Intel during the week-long health fair in New American Academy of Family Physicians’, Center for Health Information
Orleans in February 2006. Several thousand attendees had their health Technology (Center). The Center collaborates with government, industry,
information uploaded into a database and were given a CD with their and other professional organizations to apply health information
technology to improve patient care and safety, and to increase the
efficiency of health care delivery.
“EHRs create a better plan for treating the health needs of people vs. a
paper-based system.” Dr. Waldren said.
According to Dr. Waldren, EHRs allows physicians to better plan at the
local and state level. “EHRs have the potential to create a community
network across community health centers…potentially enabling physicians
More than 250,000 who practice evidence-based medicine to aggregate data to provide better
evacuees needed
care” and anticipate the needs of the population more effectively and on-
medical attention
and were separated demand.
from their medical Furthermore, it also has the potential to advance “population-based
records.
healthcare by tracking trends (i.e. bio-surveillance evidence) and emerging
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7. diseases (i.e. influenza)” in order to assess the health needs of a specific seeing patients as well as reduces revenue,” said Dr. Waldren. “Loss of
population to leverage health promotion and disease prevention efforts. productivity due to staff training and time off for configuration” are also
Dr. Harry Strothers, assistant professor of gerontology at the Morehouse major challenges one must consider.
School of Medicine says EHRs enable physician’s to manage the “quality According to Dr. Mack, it is most feasible for the Regional Coordinating
of care” of patients. Center to assist community health centers
“CMS (Center for Medicaid and Medicare CHALLENGES TO EHRs located in larger cities to implement a PHRs
Services) and other insurers are asking • Data Integration – ensuring system during the first phase of the grant.
physicians more frequently if preventative compatibility with other Once this phase has been successfully
measures and best practices are being adhered systems completed, the second phase can concentrate
to (i.e. pap-test, mammogram, etc.). EHRs on developing a strategy for a comprehensive
can help you gather the data quickly vs. piece • Demonstrating Value web-based EHRs system.
milling it from paper charts,” said Dr.
– displaying the ability to In order to optimize a EHRs system, there
demonstrate market value
Strothers, who has been studying the benefits must also be a “champion.” An individual
among academic institutions,
of EHRs for several years. who enthusiastically shoulders the
community health centers,
For example, while a patient is visiting their responsibility of acting as the “resident
and primary care associate
physician, clinical reminders can be set-up to expert” and spokesperson on the EHRs
automatically alert the physician to schedule • Data Back-up – securing all system. That champion may be former
their patients’ next appointment. data in clinic to backed-up House Speaker Newt Gingrich. As the
Patient education can also be enhanced by drives off site at a fire-proof founder of the Center for Health
flood-resistant location
creating a program to find educational Transformation - a public/private partnership
materials in text or graphics for low-literate • People – changing the way trying to push technological reforms into the
patients for specific diseases while patients are physicians traditionally health care system - Gingrich is working
in the clinic. In addition, EHRs also allow practice medicine and gather with Morehouse School of Medicine to call
physicians to optimize disease management data may be biggest challenge on Congress to pass legislation that would
outcomes and best practices to ensure they’re protect citizens’ personal information.
following specific guidelines for common chronic illnesses and diseases, Security and privacy are major concerns that practitioners and patients
such as diabetes, heart disease, obesity and cancer. have expressed as being a barrier.
“If you pick the right system, there are lots of benefits”, Dr. Strothers said. “The number one lesson from Hurricane Katrina...paper kills!,” said
If implemented broadly physicians have expressed major concerns, namely Gingrich. “Every American should have an EHR by the end of next year.”
cost and security.
On average, the start-up costs can easily exceed $1M, according to Dr.
Alexander. In addition, the on-going maintenance fees are usually two-
thirds of the initial costs. “The up-front cost is significant and there is
usually not a return on your investment until the end of year three,” said
Dr. Alexander. Given that there are more than an estimated 140
community health centers in the Gulf Coast, implementing EHRs would
be an astronomical expense.
However, the direct cost of purchasing the hardware, software and annual
maintenance alone can be overwhelming for a small office or community
health center. Not to mention the indirect costs of implementing the
system.
“Some physicians have to decrease the amount of patients they see during
the first six months during implementation…this can eat into their time
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