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Context Matters: health data access that helps our First Responders

National Health IT Week is a time to reflect on the impact of health IT in the U.S. – on the system and the individuals we serve. What struck me about the role of HIT this year was the poignant plight of evacuees in the face of disaster. From wildfires in Montana and California to Hurricanes Harvey, Irma and Maria throughout our southern states and territories, adversity forced thousands of Americans out of their homes and their communities.

During natural tragedies like these, we immediately think about the loss of life, property and basic amenities like power and water. We don’t usually think about the loss of access to data, because it seems like a relatively minor inconvenience. But when individuals are in acute life situations – whether their health is impacted directly by the tragedy or whether they are physically displaced because of it, that’s actually the time when that loss of data access can be the worst (hidden) danger.

Having grown up in the Caribbean and thus lived through many a hurricane, I know that, given a few days lead time, a lot of people get their affairs in order to weather the storm: access to food, water, some cash, current medications and other medical supplies. With this year’s unprecedented level of meteorological mayhem, individuals were placed in unpredictable situations for which they simply could not prepare. So many people barely had the time to evacuate or hunker down for the oncoming onslaught, much less gather the information necessary to carry them through a lengthy stay away from home or weeks without electricity and gas. And that’s despite the fact that you can actually track hurricanes; when it comes to disasters caused by fires, tornados and earthquakes, there is rarely even a spare minute to print or secure paper copies of the medical chart.

These large-scale disasters highlight the absolute necessity to be able to find and access each individual’s medical documents, seamlessly and in real-time, when and where it is needed. The combination of record locator services, cross-vendor interoperability, and nationwide data access services can enable this to happen.

While I feel for everyone involved in the at-times frustrating efforts to locate medical records for informed care after the dangers had passed, I can’t help but think about all those individuals who needed unforeseen medical attention while in transit and in the immediate aftermath – away from their homes, away from their own family physicians.

Imagine a personal story much like the ones that we heard every day on the news over the last few weeks: a man, let’s call him John Smith (yes, there are probably hundreds in every U.S. community), evacuates from Naples, Florida to Charleston, South Carolina to get out of the Irma’s path. John feels intense chest pain somewhere on the state’s main evacuation route of I-75. He pulls off the road and frantically makes his way to the nearest emergency room. Short of breath and highly agitated, he can’t recall all of his medications and he’s not sure if they’re packed in the cooler with bottled water, in his suitcase or if he even brought them. When hospital personnel start the search for his records they find several other individuals with his name from the same area – many with the same description, birth date and other demographics. He is in immediate need of care, but the treating physicians aren’t sure if he has any preexisting conditions, what medications he takes and what, if any, allergies he has.

These are trained emergency personnel – they do the best that any human can possibly do to stabilize this unknown patient with this unknown condition. They know that, to some extent, they are treating him blindfolded. They have knowledge of medicine in general and emergency medicine in particular, but little knowledge about John. They take the probabilistically best actions they can take, and then monitor John to determine whether they guessed correctly. It’s an understatement to say that they could more confidently make medical decisions if they had the knowledge that comes with having a complete medical record readily available.

If John and his providers had already enrolled in CommonWell, John’s records could be available when needed, regardless of where the care occurs – even en route to an evacuation destination. The Alliance’s record locator service (RLS) functions like a search engine, determining where John has data and creating a comprehensive table of contents of the locations where John received care in the past.

With just a little help from John – or none, if he is incapacitated, the CommonWell Service helps the emergency personnel to link his current and past providers. This single step enables CommonWell to make John’s records immediately available within the provider’s software, whether the hospital EHR, the emergency room information system, or the physician’s favorite medical record mobile app. In that moment, the CommonWell Service becomes invaluable by providing immediate data access from all relevant previous care locations.

The real beauty of CommonWell, however, goes beyond that single visit and enables John to have a truly positive long-term outcome. That is because the CommonWell Service gets smarter with each visit: since the emergency personnel “linked” this episode of care to John’s other care encounters in our RLS “table of contents”, all of John’s subsequent medical visits – e.g., to his PCP back in Naples or any other caregivers in his temporary stay in Charleston – will include access to the information from this encounter here on the side of I-75. John won’t be forced to remember the details of this anxious episode from memory; his other caregivers won’t have to guess which “John Smith” they need records for the next time he shows up for care; and all of his records are tied together in order to ensure that his providers can give him informed, personalized care. And the best part is that John and his providers have the controls to link (and unlink!) any of his episodes of care at any time – truly empowering John and his caregivers.

America’s hospitals learned a great deal about emergency preparedness over the past several years, building flood walls, moving utilities to higher floors and training personnel. It is our job as health IT professionals to match those quality improvement efforts by making medical records ubiquitous, accurate and easy to locate – especially in times of unanticipated emergency.

During National Health IT Week, it feels pretty good to say we’re making progress. We still have work to do and our commitment cannot waver, but we’ve recognized the need and we’re making it happen.

The original posting of this blog can be found on the HIMSS National Health IT Week blog.

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