EHR: Even in a Disaster Environment

First responder tablet computer equipped with EHR softwareWhen the life is upset by natural disaster, war and other events, documenting medical care and saving that information for future reference can be both highly beneficial to patient care and highly problematic. Two recent examples of this situation are Hurricane Katrina and the war in Afghanistan.

Electronic Health Records (EHRs) have been shown to facilitate quality patient care as noted in our post Are Patients Benefiting from EHR? This is also true in crisis situations where healthcare providers respond in the field. If records are created in the field, they can be referenced by subsequent care providers to make informed decisions that drive favorable outcomes. To make EHRs complete, they need to be updated whenever, and wherever, patient care is provided.

A good test of a process is whether it’s followed even in crisis situations. Here are the critical success factors in enabling EHR updates in a disaster environment based on CES personnel experience in theater.

1) Ability to work in a disconnected environment: Internet connectivity can be one of the first things lost when disaster strikes. An EHR system must be able to work without access to the outside world. This way, when the internet crashes, the documentation does not go with it- it is stored and saved locally. Thus, any type of web based documentation system is not acceptable. The system must be able to work in a standalone environment- everything necessary must be accessible on the user’s own laptop or mobile device. This also means the user device must be able to support the full functions of the EHR.

2) Limited connectivity: Internet connectivity often comes back but is slow or has limited bandwidth. EHR applications must work with limited bandwidth. When documentation is complete and needs to be sent out, it cannot be a bandwidth hog. Think of old dial up modems – can the information flow through in a timely fashion?

3) Sharable information: Once connectivity has returned, sharing medical information with the outside world can be important. Are there issues, outbreaks, or specific types of medical problems that the government, FEMA or any other interested party needs to know about? Having the ability to send and share information is important in the short term. This helps with medical surveillance and allows interested parties to have the right people, right supplies and right help available to the area in need by seeing what medical issues are going on.

But long term, it is also important to share data with the patient’s personal health care providers. Printing and handing notes to patients can work, but storing them and setting up a means for remote access or obtaining the records later is more useful. Patient exposures and medical care provided during the disaster are often relevant to health events later on in life.

While this challenge is complex, it is also critical to patient care that we meet it. As the EHR revolution continues to improve patient care, we need to work collaboratively to ensure EHRs can be used both in health care facilities and in the field.