Oklahoma Tornado: Coping With AftermathHow Clinicians Relied on EHRs, HIE to Provide Care
The disaster recovery experience of a small Oklahoma hospital hit by a devastating tornado illustrates the value of storing electronic health records offsite and participating in a health information exchange.
A week after a devastating tornado destroyed Moore Medical Center and two nearby physician offices, local patients are still being treated at other facilities operated by owner Norman Regional Health System.
That's made possible, in part, through Norman Regional's use of EHRs maintained offsite and its participation in the SMRTnet regional health information exchange.
Amazingly, none of the more than 200 staff and patients that were at the hospital at the time of the storm were killed or seriously injured. Thirty Moore Medical Center patients were transferred to two other Norman Regional hospitals in the hours following the May 20 tornado.
The Value of Redundancy
Physicians at those other facilities were able to access patients' health data related to their Moore hospitalizations because the records was stored in two offsite Norman Regional data centers, not on servers at Moore Medical Center. "We try to do as much redundancy as we can afford," says John Meharg, director of health IT at Norman Regional. "Disaster recovery is always top of mind."
Business continuity issues are critical for 45-bed Moore Medical Center because it's located in the city of Moore, an Oklahoma City suburb that's "a bulls eye for tornadoes," Meharg says. A devastating twister hit the community in 1999, several years before the hospital was built and later purchased by Norman Regional.
Moore Medical Center's inpatient records system from Meditech, and the eClinicalWorks e-health record system used by its physician practices, enabled other Norman Regional hospital clinicians to care for the transferred patients. The transition of patients from Moore to the two other Norman Regional hospitals was handled much like other, far less dramatic, transfers, he says. Records for hospitalized patients were accessed from the data center servers via Norman Regional's network, as usual.
Health Information Exchange
In addition to caring for the patients relocated from the devastated Moore Medical Center, the two other Norman Regional hospitals also treated more than 130 other patients from the region who were injured in the storm.
When patients showed up at a Norman Regional facility for the first time, their records typically were accessible from various area providers via the SMRTNet regional HIE.
SMRTNet records for patients are available "with one click" through a member healthcare provider's EHR, says Joanna Walkingstick, the HIE's director of member services. With that click, which delivers a query to SMRTNet, authorized clinicians gain access to an individual's diagnoses, lab results, medications, allergies, vital signs, radiology reports, and other information culled from SMRTNet members, she says.
More than 180 healthcare facilities are SMRTnet members. The HIE provides access to about 2.6 million patient records.
"The one-click is the key," Walkingstick says. "In a time of crisis, this data isn't just available, but it's streamlined for a clinicians' workflow, which is a great tool," she says. "This is the real world situation [the HIE] was meant to address."
Although Norman Regional's use of the HIE gave clinicians access to patient records from other area providers, Internet access to the HIE was down for several hours due to the storm, Meharg says. The health system was able to switch over to a backup Internet service provider, but that process "wasn't smooth," Meharg says.
SMRTNet's Walkingstick says some connectivity to the HIE was disrupted in the early hours after the tornado due to damaged infrastructure, including towers used by communications providers. "It depended where you were," she says. While voice communication was more spotty, text communication was more dependable in the immediate aftermath, she says.
Looking ahead, backup Internet services is one area of Norman Regional's disaster planning that will get tweaked, says Meharg. "Live and learn," he says.
About 15 Moore physicians in two medical offices that were also destroyed by the tornado have been able to temporarily relocate to extra space in a new cardiology office that Norman Regional recently opened. Those doctors are able to access their patient's eClincalWorks EHRs from a virtual desktop, he says.
Norman Regional also rerouted calls from Moore Medical Center's IP-based phones so that calls from patients about prescription refills and other matters could be handled, he says.
The health system's facilities have two back-up generators, although those at Moore Medical Center suffered extensive damage, Meharg explains.
Another important disaster planning lesson that Meharg says his team learned is that "you can't always count on having all your key people available," he says. So that needs to be built into future business continuity plans, he says. Some staff members suffered damage to their homes, preventing them from being immediately available after the storm.
In addition to relying on offsite servers and health information exchanges to help with business continuity, healthcare providers should take several other critical steps, says Deborah Kobza, CEO National Health Information Sharing and Analysis Center, which supports national critical infrastructure protection.
"Every hospital should have a satellite phone," she says. Also, communication systems should be programmed so that texts and e-mails can be quickly sent to first responders.
"And as you're bringing your systems back up [after a disaster], you'll be in a hurry," Kobza says. Nevertheless, it's important that security is adequately addressed, she stresses.
"When you bypass good cybersecurity [habits], that's when the bad guys will take advantage."