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Electronic Health Records: Maybe a Matter of Life and Death
December 1, 2007
On Monday, Aug. 29, 2005, Katrina overwhelmed New Orleans' hurricane protection structures, exposing the city to the waters of Lake Pontchartrain and the Gulf of Mexico. By mid-week, 80% of New Orleans was under feet of water and would remain so for weeks.
To the west, lakefront Jefferson Parish was flooded when pumps designed to prevent it were not operated. The resulting disruption of the city's health care delivery systems with loss of paper medical records (or access to them), displacement of physicians, closure of hospitals, and evacuation of its citizens was unprecedented.
Only three of the area's 14 major hospitals were left functioning and only one large medical group practice was quickly able to open its clinics and provide vital ambulatory services soon after the storm.
With loss of the area's only Level 1 trauma center and closure of a majority of its hospitals and their emergency rooms, remaining area residents had few options for urgent care. Patients presenting to one of the functioning hospitals waited for hours to be seen and often found themselves in unfamiliar places. Neither the facilities to whom they presented nor the physicians they saw knew them or had access to any information that would inform their care.
Emergency department physicians at Ochsner Foundation Hospital automated their visit documentation over a decade ago. Soon after, all Ochsner emergency room visit documentation was integrated into Ochsner's clinical repository, which has recently evolved into our electronic health record. When patients return to their primary care providers complete emergency visit records are available.
Of equal importance, up-to-date clinic and hospital documentation, including all ancillary test results, are available to emergency room physicians. Before Katrina, only Ochsner physicians were able to access this information as it was available only from a terminal attached to Ochsner's network.
Katrina, of course, interrupted any planned medical visit or intervention. A friend with a significant cardiothoracic problem had scheduled corrective surgery, which was canceled because of the storm. Several weeks after Katrina, he experienced an acute problem and presented to one of the functioning non-Ochsner emergency rooms. The hour was late, it was during the weekend, and the physicians there were confused by the presenting symptoms.
Without access to their new patient's health record they were forced to begin from scratch. After 11 hours in the emergency room the results of a CT scan finally revealed the source of the problem. Surgery was begun promptly thereafter but too late for my friend. Prompt access to CT scan results done earlier at Ochsner would have resulted in a different course and might have prevented his death.
While this example is extreme, it emphasizes the point that prompt access to all available health care information is always important in emergency situations and may be life-saving. Immediately after Katrina, providers in south Louisiana worked together to create effective electronic health information exchange. Led in this endeavor by visionary physicians in the Louisiana Department of Health and Hospitals, the group achieved consensus around governance and a working HIE model. Now, two years after Katrina, the group is working to build a sustainable functioning facility and to extend the possibility of an information exchange across the entire state.
Ochsner for its part recognized the need to be able to access its electronic health records from anywhere. Requiring just a browser and access to the Internet, Ochsner's electronic health record has been revised to support universal access. Resolving potential compliance, health information management and legal concerns, Ochsner is now offering its electronic record, including PACS images, to any physician with whom we share patients. Our next steps will include enabling personal health records so that our patients can manage and access important clinical information without our direct intervention.
Health care in Louisiana was not prepared to deal with a Katrina. Our efforts to insure access to critical health care information, particularly in the context of disruption and emergency, have and will further improve this situation for this state's citizens.
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