Katrina Shows Need for Electronic Health Records

Doctors on front lines of Hurricane Katrina disaster relief call for universal medical records.

Sept. 21, 2005 -- After Hurricane Katrina pounded the Gulf Coast nearly amonth ago, most of the 1 million people displaced by the storm were left withno medical records -- making it difficult, if not impossible, for doctorsworking in disaster medical centers and community hospitals to treat them.

Urologist Neil Baum, MD, an assistant clinical professor at TulaneUniversity School of Medical in New Orleans, is one of the lucky ones and evenmore to the point, so are his patients.

After the storm, Baum temporarily relocated to Austin, Texas, to treat hisown, now displaced, patients. "I had access to some of my patients' recordsover the Internet and that made communicating much easier," he tells WebMD."I was able to get lab reports, X-rays and pathology reports and it madecoordinating care in the patients' new cities much easier," he says.

Unlike other physicians, Baum didn't have to go from memory or contact labsby phone, which can be arduous and difficult. "I saw other doctors andpatients struggling and getting very frustrated," he recalls.

"I am convinced now more than ever that patients should have portableaccess to medical records," he says. There are many ways that this can beaccomplished, he says, including on a chip, a CD ROM, paper format, or overthe Internet.

"If the displaced patients left with their records in an electronicformat, there would have been better continuity of care and fewer mistakeswould be made," he says.

Do-It-Yourself Medical Records on the Go

But no one has to wait for a "universal" system to be developed andapproved. A little low-tech preparation today can stave off medical mistakesand ensure that you get the best care possible if, like the Hurricane Katrinavictims, you have to go to a shelter, a hotel, or stay with a friend for a longperiod of time.

"People need to be cognizant that their personal health information isthe most important information and they need to take responsibility for theirhealth because these records may not be available to them when they need itmost," stresses Marie Savard, MD, a clinical associate professor ofinternal medicine at the University of Pennsylvania in Philadelphia, and authorof How to Save Your Own Life.

Pocket-Sized, Up-to-date Medication List Is Key

Along with a valid insurance card, "the most important, nonnegotiablething that everyone should have with them at all times is a list of themedications that they take," Savard tells WebMD. "This tells a doctormore about your health and health conditions than anything," she says. Inyour wallet, keep a complete up-to-date list of the doses and directions of allmedications that you currently take including vitamins, herbs, andover-the-counter medications. "Everything counts," Savard stresses."This list will avoid duplication of drugs and side effect issues in anemergency situation."

But that's not all you should keep in your wallet. "Information aboutyour allergies is also critical," she says. "If you are not allergic toanything, write that down, too." This can be clearly written on the samepaper where you list medications. Also "list the name and information aboutwho to contact during an emergency on this piece of paper," she says.Immunization records for flu, pneumonia, and tetanus should also be noted asthese can be key in emergencies -- especially for seniors. "If you have hadan abnormal electrocardiogram (ECG/EKG), keep a folded-up copy of the report inyour wallet as well."

Make a 'Go File'

You have probably seen public service announcements about packing a go-bag-- an emergency collection of items you may need in the event of an evacuation;a go-file of medical history is also important. While pocket-size records arehelpful in certain emergency situations, a go-file of your more extensivemedical records -- kept somewhere easily accessible -- can also save lives, shesays.

"Take your health care record and folder with you if you have timebefore you are asked to evacuate, or keep it in kitchen or in a kitchen counterin case of emergency so that the medical technicians can easily access it,"she says. To make sure that these records are up to date, hand your doctor aself-addressed stamped envelope after each office visit so he or she can sendyou your latest reports," she advises. "Keep it in an accordion folderor a three-ring binder where you can easily drop in new test results andreports."

Go Digital

In case of emergency, a close relative should also have a copy of theseimportant medical records. "More and more people are scanning their recordsand emailing the file to close relatives," she says. As far as concernsabout privacy, Savard says "I would be more worried about it being lost ifI sent it by snail mail."

Movement to Digitalize Health Records Grows

One day all this may be done automatically for all Americans. U.S.Department of Health and Human Services Secretary Mike Leavitt recently tapped16 commissioners to serve on the American Health Information Community. Thefederal commission is charged with advising Leavitt on how to make healthinformation digital and interoperable. The federal government's goal is toprovide most Americans with computerized medical records within 10 years.

A lofty goal considering that as it stands no more than a quarter of U.S.hospitals and 20% of physician offices have adopted electronic medical records,according to research by the RAND Corp., a nonprofit research tank in SantaMonica, Calif.

Yet problems exist with these existing systems, namely they are hospital- ordoctor-specific, not easily transferred and read by other health careproviders.

In a news release announcing the new commission, Leavitt stated that"from nearly anywhere in the world, we can withdraw money from our bankaccounts, pay bills, apply for a mortgage, book airline tickets, and even ordergroceries online, but, more often than not, we can't share an X-ray digitally,from one hospital to another, even if they are on opposing streetcorners."

"Even worse, if a loved one is involved in a life-threatening accident,paramedics and emergency room doctors cannot quickly check their medicalhistories for even the most basic things -- like blood type or allergies. We can andmust do better than this."

The national strategy calls for federal agencies to work with private payersin developing and adopting a universal medical record system.

"There has been need before, but in America it takes a disaster to helppinpoint home what people have been talking about previously," says JamesW. Scheurich, MD, deputy chief of staff at Michael E. Debakey Medical Center inHouston, a command center for patients displaced by the hurricane.

VA System May Hold Answers

While many physicians and patients felt frustrated by lack of access topatient files, the more than 38,000 veterans and the doctors throughoutsoutheast Louisiana, Mississippi, and the Florida panhandle did not. That'sbecause the Veterans Affairs (VA) progressive Computerized Patient RecordSystem enabled all patient records, prescriptions, and laboratory and radiologyresults from all New Orleans VA patients to be accessed by any VA physiciannationwide.

Within about 100 hours, the VA system had all electronic health records forall patients in the South backed up, secured, and transported to the Michael E.DeBakey VA Medical Center.

Scheurich has seen the system work first hand. "We saw about 60 patientsa day who were displaced from New Orleans, and we hospitalized 127 patientsthat we got because we had access to their files," he says.

Nothing Is Perfect

To follow suit, other hospitals or health care systems would have to set upa "universal standard approach," he tells WebMD.

But universal access has some thorns namely privacyissues.

"It needs to be safeguarded so that it is not just open to anyone whowants to come in and look," he says. The VA system has bells and whistlesto prevent such unrestricted access including security codes.

Others in the field resist the technology because of the perceived start-upcost, but that might be short sighted. Using a statistical model, RANDresearchers recently tabulated that America's health care system could save awhopping $81 billion annually and improve the quality of care if it was tobroadly adopt computerized medical records. The cost savings come from reducingredundant care, speeding patient treatment, improving safety, and keepingpatients healthier.

"Hopefully we can breakthrough some of the resistance within the healthcare industry and outside of the health care industry towards integratingtechnology into the health care system," says Jennifer Greeson, aspokeswoman for Intel in Santa Clara, Calif. Intel is involved in the newfederal commission. "We hope to expand upon good examples like the VAsystem and make them more common and more consistent," she says.

Show Sources

Published Sept. 21, 2005.


SOURCES: Neil Baum, MD, urologist, assistant clinical professor, Tulane Medical School, New Orleans. James W. Scheurich, MD, deputy chief of staff, Michael E Debakey Medical Center, Houston. Marie Savard, MD, clinical associate professor of internal medicine, University of Pennsylvania in Philadelphia; author, How to Save Your Own Life. Jennifer Greeson, spokeswoman, Intel in Santa Clara, Calif.

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