As Hurricane Irma was raking Florida, fever began spiking in a 20-month-old child who had been battling a cold for a couple of weeks. The mother called CareConnect, the telemedicine service from Orlando-based Nemours Children’s Hospital.
Doctor’s offices and urgent care clinics were closed, as were retail pharmacies.
“We spent a good amount of time discussing what her options were,” says Patricia Josephson, who works in a Nemours’ urgent care department in Jacksonville, Fla. “With the storm looming, the child worsening and not having many options, I think we were able to alleviate her concern.”
With the help of a Nemours clinician, the parents chose to drive to a hospital pharmacy an hour away for medicine. It was the only one open in central Florida, Josephson says.
Telemedicine Brings Care to Those in the Heart of the Storm
Launched in 2015, the CareConnect app allows parents to consult Nemours pediatricians through a smartphone, tablet or laptop. To continue to reach those in areas affected by the storms, Nemours made consults free during Hurricane Irma and extended the service to Texas in the aftermath of Hurricane Harvey.
Josephson says the 270 calls received Saturday through Tuesday, as Irma hit Florida, were typical pediatric illnesses: colds, fever and vomiting. Many parents just wanted reassurance and advice.
The service remained online throughout the storm, although lack of internet access and power did present a problem. Josephson lost power and connectivity for 24 hours, but because Nemours has another hospital in Delaware, she was able to hand off calls to physicians there who were also licensed in Florida.
Consoles in affiliate hospitals throughout central Florida allow care teams to consult with Nemours’ pediatric specialists, should it be impossible to transfer a child. The hospital also set up consoles at local shelters.
Lessons Learned Keep Health Info Available During the Storm
Nemours closed outpatient facilities during the storm, but it never lost power.
With so many cloud-based healthcare applications (as well as telemedicine access), however, providing care is not just about maintaining power, but also sustaining internet connectivity, says Karen DeSalvo, former acting assistant secretary for health in the Department of Health and Human Services (HHS) and former national coordinator for health IT.
“The [overall] lack of system failure is really the great story, the happy story,” DeSalvo says. “Every time we have a storm, everybody does a little bit better.”
Much has been learned since Hurricane Katrina in 2005, when healthcare workers were trying to piece together the medical histories of people in shelters. Often people are evacuated without their medications, and trying to replace them is very difficult during storms, she explains.
The federal government’s push for electronic medical records (EHRs) “was designed for improving access to health information, not only every day, but during disasters, so there’s more that can and will be done. But I think what we saw in the last couple of rounds of storms, there’s been significant progress,” DeSalvo says.
During Harvey, the Houston and San Antonio health information exchanges (HIEs) sent staff to shelters, where they could help locate the patient records of those housed there using laptops and Wi-Fi. There were long lines.
The state’s HIEs have been connected since 2015. With a backup in Salt Lake City, records would be available even if a particular hospital’s system went down. Reportedly, though, that wasn’t a problem.
Further, claims data helped HHS map and provide appropriate medical care during the storm. HHS set up a medical shelter at the convention center and called on its emPOWER tool, which uses Medicare information to map the location of those dependent upon medical equipment that requires electricity, such as dialysis, oxygen and power wheelchairs, in order to locate and assist vulnerable people during power outages.
Strategy, Staff Keeps MD Anderson Cancer Center Up and Running
The Houston-based MD Anderson Cancer Center became an island during Harvey. While the surrounding streets turned to rivers, the center was prepared.
After Hurricane Allison swamped the Houston area in 2001, FEMA funding helped MD Anderson build flood walls, so the center was able to close everything down except for its main entrance. And while water did find its way into a basement switch room, equipment was protected.
“[Preparedness] is something we work diligently on every year,” says Craig Owen, the center’s executive director of EHRs and interim CIO.
And the center certainly did prepare. As Hurricane Harvey approached, daily meetings among leaders increased to two a day, with each department planning for its “ride-out teams” to weather the storm. Seven IT staff members were on site as the storm unleashed nearly 50 inches of rain on the city.
Overall, a staff of nearly 1,000 stayed to care for about 500 inpatients and 300 family members.
There were no significant network or data center outages. The data center on the main campus resides on the fourth floor, with the EHR and other primary applications spread between it and a second data center across the bayou. There was no need to engage its third site, 40 miles to the northeast. Its systems can run about 80 days on diesel generators, Owen says.
Moreover, to ensure redundancy, the hospital maintains two outside connectivity points with two internet service providers.
The hospital had to suspend outpatient services, but its analytics and reporting capabilities allowed teams to identify patients in outlying areas who could get treatment at one of its satellite facilities.
IT Gets Healthcare Staff to Work
Despite preparation, staffing became the primary problem for the main campus. Owen estimates that at least 35 percent of MD Anderson’s 20,000-person workforce had to evacuate or experienced damage to their homes or vehicles during the storm.
“We quickly realized we had a major problem with the flooding all around,” Owen says. “With the number of patients we had in-house — and we have very complex patients — making sure we had the right number of physicians, midlevel providers and nurses on the ground was absolutely critical for us.”
Ultimately, a development team built a geocode application within 48 hours that mapped the location of all employees.
“We could see: Where are all my infusion nurses? Where are all my surgery techs?” he says. That information was overlaid with a map of the flood plain to understand where staff members may have been evacuated, or where conditions were mild enough that staffers could make it in to work, Owen says, recommending that every organization build a similar map.
Employees who had not previously worked from home, such as nurses and pharmacists, found they were able to provide many of the same duties remotely. The IT staff sent out a virtual private network link to get staff securely into the systems.
MD Anderson also used event management software to send status updates and bidirectional messages to poll employees about availability in real time.
The facility also got help from other institutions, which meant learning how to rapidly onboard people into the system and provide security and EHR training. In just a two-week period, MD Anderson Cancer Center added about 150 people from other healthcare organizations across Texas.
While the center faired the storm well thanks to strategic use of health IT, Owen says it also learned some valuable lessons.
“We’re definitely better prepared for the next storm that comes,” he says.
Learn more about implementing successful IT disaster backup and recovery at your healthcare organization.