Satellite image of Isaac
on Aug. 28 (Credit: NASA)

Weathering Hurricane Isaac: health care lessons learned from Katrina

September 11, 2012
by Brendon Nafziger, DOTmed News Associate Editor
When Hurricane Isaac made landfall two weeks ago in New Orleans nearly seven years to the day since Katrina struck, the Category 1 storm brought much devastation: possibly more than $1 billion in damages, at least nine U.S. deaths, power outages affecting hundreds of thousands, and flooding that drove thousands from their homes.

But the $14.5 billion-dollar levee system protecting New Orleans, rebuilt in the aftermath of Katrina, withstood the rains. And hospitals and health systems were better prepared than they were in 2005, when the costliest natural disaster in U.S. history damaged local hospitals and wiped out nearly 1 billion medical records, according to the American Health Information Management Association, a society for health IT professionals.

"There have been a lot of lessons learned since Katrina," said Julie Dooling, director of HIM solutions with AHIMA.

Restoring power

For one, many regional hospitals are better equipped to handle the widespread power losses that inevitably follow major disasters.

When Isaac slammed into southeastern Louisiana in the early evening on Aug. 29, after gathering strength along the Gulf, it unleashed storm surges that drenched the land and pummeled communities with 80 mile-per-hour sustained winds. As a result, the hurricane knocked out power in many towns -- and at all of the Ochsner Health System's facilities, according to Norris Yarbrough, assistant vice president of emergency preparedness at the New Orleans-based chain of hospitals and clinics.

However, Ochsner was able to power up all affected sites thanks to emergency generators, which are operated differently because of some post-Katrina innovations, Yarbrough said.

"We purchased several additional large KW generators, which we installed on flatbed trailers rather than going the more traditional route of permanently installing them on concrete pads," he told DOTmed News by e-mail. "This allowed us to shift the emergency power supply from campus to campus, depending on need."

He said in preparation for the storm, while hospitals and ERs remained open, clinics and health centers were shuttered early. All have since re-opened, he said, and were offering extended hours to help their communities recover.

Fuel and drills

Other preparedness strategies have also been put in place at Ochsner since 2005, Yarbrough said.

One is guaranteed fuel delivery. Yarbrough said the health system now has contracts that require suppliers to pre-position fuel trucks and drivers in locations where they would be able to refuel the centers and hospitals, if need be.

Community planning and drilling have also become an "integral part" of its emergency preparedness program. Yarbrough said the health system drills several times a year, and also shares emergency equipment inventory counts with local partners so the region is appropriately stocked.


Document recovery

But one less well-known casualty of natural disasters is often patients' private health information. Sometimes personal health records can be destroyed, or patients' privacy compromised in rather dramatic ways. When a deadly tornado struck the town of Joplin, Mo., in May 2011, for instance, it badly damaged a local hospital, which resulted in the scattering of protected health information. Winds carried patients' X-rays some 70 miles away, where they were found by residents in a neighboring county.

Under Isaac, Ochsner didn't lose any records. But it didn't lose any in Katrina, either, or any other hurricane, Yarbrough said. That's because Ochsner has been using an electronic medical records system for the past decade. The hospital also said it has backups kept out of state to be preserved in a worst-case scenario, an often recommended "business continuity" protection measure.

Storing digital backups of records off site will become increasingly common, especially as more hospitals embrace EMRs. This adoption will be partly driven by, for instance, the Centers for Medicare and Medicaid Services' recently released stage 2 meaningful use rules that require eligible hospitals to provide at least 5 percent of patients with electronic access to their health records. "It's a step in the right direction," Dooling said.

But Dooling said many hospitals are still in what she called a "hybrid stage" of record-keeping, using both paper and electronic health records, or are scanning backlogs of paper and uploading them to document management systems that then integrate them with the EHR.

For them, she said, it's important to have certain measures in place before a storm hits, such as developing the right vendor relationships. For example, hospitals with extensive paper records might want to have a cleaning company, which specializes in record retrieval, mold elimination and freeze drying, on hand to help with recovery efforts.

"If they haven't formed those vendor relationships, they should do it now," she said.

This advice doesn't only apply to hospitals and clinics operating in the hurricane-prone Gulf, or in the tornado-stricken Midwest. She said that document loss isn't always caused by headline-grabbing natural disasters. Instead, it's often brought about by "internal disasters," such as flooding in a hospital building or other mishap.

Patient responsibility

Patients also have a role to play, Dooling said. They should consider creating a personal health record -- first by contacting their different providers to request health information, gathering it together, and then using what they have to develop a PHR. They can then use one of several vendors to create a PHR account accessible online. (More information can be found here: http://www.myphr.com/.)

However, people should probably still carry something more low-tech on their person, in the event of an emergency -- such as a list of medications, allergies or other pertinent info on a card in their wallets, Dooling suggested.

"Most likely you'll have your wallet with you if you have to evacuate," she said.

Read DOTmed News' August report on how to get your health care facility prepped for a disaster.