42 Months post-Katrina: Where are health records?

I’m getting ready for a week of vacation in my hometown–New Orleans. As some of you who know me well may remember, my 89-year-old mother has been with us in Florida since Katrina-breached levees filled her New Orleans home with 8 feet of water. Our last visit was almost 22 months ago; it is definitely time for Mom to see family and friends who returned to LA after the storm.

Preparing for this trip in the midst of all the hubbub about EMRs and economic stimulus plans reminds me of those first few weeks after the storm. Mom was two months post MI when Katrina threatened and I was on my third post heart attack visit. When the mayor started talking about mandatory evacuation, we left Mom’s house with a change of clothes and her medications, and headed to my brother’s place in Louisville, MS. Three days later, when it became clear that we would not be returning to NOLA soon, we came here to Florida.

The first week post storm was spent buying a few clothes, shopping for doctors and getting prescriptions transferred to a local pharmacy. Fortunately, many pharmacies already shared data electronically in 2005, even when prescriptions were written by hand; but prescriptions were expiring and we needed a physician to write new ones. As we started going to appointments with a new primary care physician and a cardiologist, I was faced with the challenge of recreating 85 years of health history with my mother’s limited memory and my tangential recollections from a 600 mile distance. Mom was about half way through a cardiac rehabilitation program at the hospital at which she had been treated. Our local hospital was willing to have her participate in their rehab program, but they decided not to charge her rather than try to deal with Medicare about incomplete services for which there were no records.

At the end of Mom’s fourth week with us, I headed to Washington, D.C. for a meeting of the Software and Technology Vendor Association (SATVA) and to attend the National Summit on Defining a Strategy for Behavioral Health Information Management and Its Role within the Nationwide Health Information Infrastructure (Summit) co-hosted by SATVA and SAMHSA . When Tom Trabin, Ph.D. (then SATVA Executive Director) and others came up with the idea of a Summit, the need was only an abstraction for me. Of course mental health providers needed to be involved in the gradual move toward EMRs. By the time of the Summit, I had concrete first-hand experience with the reason for the meeting. My 85 year old mother and thousands of other New Orleans residents were completely without health records. Doctors’ offices and hospitals were flooded just as was her home. It was not even possible to reach her doctors, much less get information from them; they were displaced just as their patients were. The Summit pressed me to a concrete conclusion: behavioral health providers and consumers could not afford to be left out in the cold when catastrophe happens, and mental health could not let the general health field get too far ahead in the move to electronic medical records (EMRs).

After all, what physician or psychologist would be able to recreate a record from memory? And how many individuals carry an accurate health history in their head? The best anyone could do in 2005 was use health claim information from insurance carriers, Medicare and Medicaid. Frankly, for most physicians, it was too much trouble to attempt to obtain such information, even though a means of getting that data had been established. In some places that received large numbers of evacuees who had urgent healthcare needs and no family members with them, the network of access that was cobbled together from Medicare, Medicaid and VA claims databases allowed diagnosis and treatment of those with acute needs, but that took weeks to put in place. This destruction of health records became one of the most obvious reasons to press for a national system of electronic health records (EHRs), one that would not simply be washed away in eight feet of water.

So where are we 3 1/2 years later? If another Katrina-like catastrophe occurred tomorrow, would we be in any better position to treat evacuees based on information from an EMR or from a Personal Health Record (PHR)?

My guess is that we would be in just the same position we were in 2005. More physicians and hospitals are now using EMRs. The President and Congress have just appropriated 19 billion dollars for expanding the infrastructure and use of EHRs that we were discussing in 2005; but the reality is that we are nowhere near where we need to be to assure that continued care can be provided for general health or for mental health consumers. For the last 3 1/2 years there has been lots of activity, but today between 13% and 17% of provider organizations use EMRs; and there is still no system in place for sharing information among different organizations. Given a flood and no off-site backup of the electronic data, we would have exact duplication of the Katrina results.

Now that $19 billion that has been made available for meaningful use of EMRs over the next few years, we can expect more frenzied activity and attempts to implement EMRs in more organizations. We can hope that a simultaneous effort will be made to assure that the information in those records will be protected from destruction and can be shared from one organization to another. Where will you be in this process? Is it time for your organization to start to consider implementation of a behavioral health EMR? Are you obtaining the necessary information to qualify for federal funding? How will your clinical records be handled 3 1/2 years from now?

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