Mike Miliard, Managing Editor
Mike Miliard is Managing Editor at Healthcare IT News. Mike covers topics such as health information exchange, privacy and security, analytics and ICD-10. Follow Mike on Twitter @MikeMiliardHITN.
In disasters such as Sandy, HIE is 'as critical as having roads, as having fire hydrants'
David Whitlinger
NEW YORK | October 31, 2012
The Statewide Health Information Network of New York (SHIN-NY) sees itself as a "public utility" as much as an HIE. In the wake of Hurricane Sandy, as patients bounce between hospitals (and as other public utilities, such as electricity and transportation, are compromised), it has enabled critical continuity of care.
The images of dozens of red-flashing ambulances, evacuating as many as 200 patients – some of them in critical condition, some of them infants – from NYU Langone Medical Center, whose backup generator had failed, to hospitals such as Sloan-Kettering and NewYork-Presbyterian, will be some of the most enduring images from the super storm.
The harrowing process was made much smoother by the fact that those patients' electronic health records were secure and readily accessible at the hospitals to which they were transported, thanks to New York's statewide HIE.
Healthcare IT News spoke with David Whitlinger, executive director of New York eHealth Collaborative (NYeC), which oversees SHIN-NY, about what's happening in New York City, about the critical roles for health information exchange in crisis situations, and about his hopes that this can be a teachable moment for those care providers that have yet to link up with an HIE.
Describe what's happening in New York City right now.
All the services – electricity, Internet – all those things are really struggling right now in Manhattan and in some surrounding counties. Everybody's trying to make do, from a living perspective.
All the healthcare services have backup generators and backup systems, so they're not in duress. But the communities at large are just trying to learn how to live without at this point.
It's looking like some of the power outages might last a week or more in the outer counties, and then in the upstate region we're supposed to get several feet of snow, and so forth. So that'll be another wave of natural effects that could have impact.
For the most part, the data centers and all of our connectivity weathered through the storm well. It's a matter of people utilizing the services – where they might not have had access to information, they now do, as long as they can get an Internet connection.
What is NYeC doing to respond? Are your doing outreach to hospitals?
The hospitals that are receiving patients now, from some of the other hospitals that are having to move patients around, they have continuity because they are able to access the records through the HIE.
We're not having to do anything boots-on-the-street explicit. That's the power of the virtual network. For the most part this just happens naturally. It happens as part of the course of the network that's in place.
Showing 2 Comments
pjcasey75 say: If it looks like a road or public utility, maybe we should...
October 31, 2012 | 15:07 PM GMT
There is no comparison between the state of health records security and transportability post-Sandy New York versus post-Katrina New Orleans. We've made huge progress. This is an excellent case study demonstrating just some of the advantages now enjoyed after multi-million dollar investments in EHR and HIE infrastructure, advantages which some politicians were, just a few weeks ago, unwilling to acknowledge. I refer to the letter written by several congressmen to HHS.
Other major cities, all the States, as well as the Federal Government do well to pay attention to this New York example, especially as the responsibility for disaster avoidance and recovery usually fall squarely upon the shoulders of public institutions. The HIE in this case mitigated consequences of Sandy which lightened the load for a slew of state agencies.
However, this article, while rightly comparing the critical nature of HIEs to that of public utilities, such as electric companies, and to public infrastructure such as roads, may allow us to wrongly assume that HIEs are all, like roads or public utilities, fully funded or partially supplemented by state or federal resources, or at least regulated in a way that allows them to defray their costs through appropriate rate adjustments. In my state, many HIEs competed for regional grants which barely cover, in most cases, their considerable startup costs. Their long term economic viability is entirely dependent on their being able to make a living based on fee for service. Precious few of our roads are funded as toll roads, yet most of our HIEs charge a fee directly to providers. I confess that I do not know how the New York statewide HIE is funded. I suspect that they enjoyed a substantial amount of government funding through one avenue or another.
If, as it appears in this case, the benefit of a utility or other public infrastructure investment accrues to the public at large, it does not make economic sense to send the entire bill for that service to hospitals and other healthcare providers when they cannot legally or practically raise their own rates (as Medicare/Medicaid set rates and private payers follow suit) to cover these additional costs. The provider doesn't realize the whole benefit of an HIE, yet in most cases they must bear (through HIE service fees), the whole cost, which cost they cannot (as in normal circumstances of a free-er market) pass on to the others (i.e., patients, insurance companies and public health agencies, all of whom benefit from HIE services). For example, a physician who, for all the right reasons connects to an HIE (which then charges him for the service), can't just raise his rates on claims to Medicare, Medicaid or, for example, Blue Cross/Blue Shield. It just doesn't work like that.
It isn't right, it isn't good economics, and it means that inadequately funded HIEs (unlike the one in New York?) will suffer yet another round of start-up, then fail, instead of moving the whole country smoothly forward towards this New York model as quickly as possible.
If it looks like a public utility, acts like a public utility, smells like a public utility, maybe we should fund it and/or regulate it like one.
preston pennington say: HIE's and secure messaging
You have brought up some very good points, HIE’s and secure messaging help in making people share information about patients quickly. With secure text messaging apps like qliqsoft, a doctor has the ability to text and communicate with hospitals and nurses without even having to be there. This could help in natural disasters such as Sandy greatly. A physician not at the hospital would have the chance to text nurses and other physicians through secure messaging using a tablet,desktop,laptop, or smartphone. This would rapidly speed up patient care where needed in these type of situations. It would be real time messaging that encrypts and secures every message and it would allow for patient files and information to be shared easily to different hospitals and medical practices. This will also allow healthcare professionals to multi task instead of being stuck on a phone call not being able to help patients. Overall this is something that needs to be used for doctors and nurses alike to text and share information to multiple healthcare professionals.