Improved routine access to health data ensures disaster preparedness

State health information exchanges can best prepare for emergencies by ensuring that health information is readily accessible during routine care, concludes a report (.pdf) from the Southeast Regional HIT-HIE Collaboration published in July. But the report finds day-to-day health information sharing is a challenge, as individual state's efforts and HIE implementation timelines vary considerably.

The consortium behind the report--formed by the Health and Human Services Departments' office of the national coordinator for health information technology in November 2010--was tasked with developing a strategic plan for sharing health data among Southeast and Gulf States in the event of a natural disaster.

Some of the primary challenges to health information exchange during a disaster are not unique to emergency situations, say report authors. For example, the report cites the inability to communicate, share and transmit health information; the credentialing of healthcare providers; and the destruction of medical records as obstacles to cooperation across jurisdictions.

Health information sharing success in disaster response corresponds with sharing success during non-emergencies. The Veterans Affairs Department fared exceptionally well during Hurricane Katrina because its use of the Veterans Health Information Systems and Technology Architecture, or VistA, ensured a mature health record system was already in place, say report authors.

Legal issues, some of which are unique to emergency situations, are one barrier to cooperation, finds the report. Consortium states are considering concrete steps for avoiding the legal pitfalls of health information exchange, it adds.

They are considering how a state will identify and authenticate authorized users in disaster transmissions, crafting policies that facilitate direct secure messaging and making changes to state HIE and participant agreements to address disaster situations. Report authors also say states are addressing emergency "break the glass" scenarios in policies, and with HIE vendors, considering disaster recovery plans and disaster contingency policies.

Beyond legal hurdles, report authors uncovered technical issues that challenge cross-state exchange. The report recommends states use federal standards to ensure their HIE implementations are consistent and compatible for cross-state deployments. States should take inventory of and enable access to health data sets, even from personal health records and claims data where possible, say report authors.

The report says states should focus initially on five legal, technical and governance recommendations to improve exchange. The report recommends states:

1. Understand the state disaster response policies and ensure they align with public health and medical services;
2. develop standard procedures for electronic health information sharing across state lines;
3. consider enacting a mutual aid memorandum of understanding to establish a waiver of liability for the release of records when an emergency is declared and default state privacy and security laws to existing HIPAA rules in a disaster;
4. assess public and private health information sources to enhance electronic data; and
5. consider a phased approach to establishing interstate electronic health information-sharing capabilities.

"These recommendations offer a path forward for other states that wish to integrate disaster planning and health information exchange efforts," wrote Lee Stevens, policy director of HHS's state health information exchange program, in a Sept. 24 blog post

For more:
- download the report, "Southeast Regional HIT-HIE Collaboration (SERCH): Final Report – ONC State Health Policy Consortium Project: Health Information Exchange in Disaster Preparedness and Response," (.pdf)
- read Stevens' blog post

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