Medical infrastructure continuity is goal of Houston command center
As Houston’s hospitals continue to struggle with operational challenges in the wake of Hurricane Harvey, a command center is helping with disaster response coordination to support the resource needs of these facilities.
Established by the Southeast Texas Regional Advisory Council, the mission of the Catastrophic Medical Operations Center (CMOC) is to ensure the continuity of healthcare infrastructure and that the care needs of the region are being met.
Co-located in the City of Houston’s Emergency Operations Center, a staff of about 10 people—drawn from emergency medical services, healthcare and public health—work together in the CMOC, which is filled with workstations and large screens displaying real-time data on medical infrastructure in the area.
The center helps coordinate hospital closures, patient evacuations, placement and transport to healthcare facilities based on capacity, as well as patient tracking and reporting. In addition, the CMOC assists hospitals with resource requests and guidance during natural disasters.
“Among its functions, the CMOC receives bed availability reports from more than 120 hospitals in a 25-county area,” says Darrell Pile, CEO of the Southeast Texas Regional Advisory Council. “We then know at a glance what beds are available if patients need to be transferred from a hospital that is in harm’s way.”
According to Pile, more than 20 hospitals have been evacuated as a result of flooding, and about 1,500 patients have been moved to other facilities in the Houston area as well as in Austin, Dallas and San Antonio. Hospitals that need to relocate patients submit requests to the CMOC, which finds available hospital beds.
When it comes to transferring patients, CMOC is directly involved in facilitating the means of transportation through a “staging area” for ambulances and other types of vehicles outside of Houston, putting them into action as calls are received for help.
“Our staff is overwhelmed with incoming calls and needs,” says Pile. “The number of calls requiring ambulances exceeds that which local resources can handle. At this time, flood waters continue to rise, and there could be additional hospitals that are forced to evacuate.”
On Tuesday afternoon, West Houston Medical Center made the decision to begin evacuation of critical care patients and to suspend services because of rising water and safety concerns. As part of this partial evacuation, 11 patients were being evacuated to various HCA Healthcare sister hospitals in the Medical City Health system based in Dallas-Fort Worth.
At around the same time, Houston’s Ben Taub Hospital—which had issued an evacuation call on Sunday for its patients because of flooding—announced on Tuesday that “they have determined ways to continue to meet the needs of their patients and that the evacuation originally planned is not necessary,” according to Pile, who says that “flood waters have gone away in the Texas Medical Center area, allowing additional staff and supplies to arrive.”
Among the key information that hospitals share with the CMOC are any potential resource challenges they are experiencing or anticipate, including fuel for emergency generators. Thankfully, Pile reveals that so far during Hurricane and Tropical Storm Harvey the area has not experienced power outages of the type that were commonplace with Hurricane Ike in 2008.
One critical need that remains unmet is the inability of kidney failure patients to receive dialysis, he observes. “We do not have a complete list of those individuals but, if needed, high-water rescues will be conducted to help get those patients into a facility that can provide the dialysis,” Pile adds.
On Monday, Memorial Hermann Health System took the “proactive step” of temporarily closing Memorial Hermann Sugar Land Hospital and transporting patients to nearby Memorial Hermann Southwest Hospital.
According to Kathryn Williams, director of corporate communications, Memorial Hermann hospitals have an integrated electronic health records system that is accessible at all its facilities. As a result, she notes that if a patient is transferred from one facility to another their medical record “travels” with them.
“The patient’s record can then continue to be updated as they receive additional care,” says Williams. “Due to this system, the evacuations and flooding should not impact continuum of care, and there should be no need to update records at a later date.”
However, some patients have been evacuated to other hospitals in different health systems, not sister facilities. In those healthcare settings, the EHRs are not shared between the originating hospitals and the receiving facilities, which can pose challenges in terms of documentation.
Nonetheless, Andrew Gettinger, MD, chief medical information officer in the Office of the National Coordinator for Health IT, says there are EHR workarounds that can be used in those situations to—at a minimum—provide “read access” to clinicians at the receiving facilities.
“If you’re in a hospital using an EHR and because of an evacuation move a patient to another facility, you can create a document from the electronic health record that is machine-readable—so that you can burn a CD or DVD, which is a whole bunch better than taking hundreds of pages of paper,” according to Gettinger.
“Depending on the nature of which EHR is being used in both hospitals, sometimes you can actually have the actionable data so that it goes into the new hospital’s EHR in the appropriate slots—which is obviously the desired solution,” he adds.
Pile notes that the CMOC “receives a manifest of patients to be evacuated and from that we have some basic clinical information that we’re able to share with hospitals.”