- Without access to health data exchange, clinicians risk missing out on key patient information and running into problems with adverse drug reactions, duplicative testing, and medication errors during care delivery. Providers at hospitals and health systems nationwide face unexpected challenges that necessitate immediate health data access for quick clinical decision-making.
Natural disasters and other emergencies can heighten problems with health data access. In times of crisis, patients often must migrate to medical centers or care sites different from where they regularly receive services. In these instances, health data exchange is especially necessary for enabling clinicians to deliver accurate patient care.
In response to the health data access challenges inherent to natural disasters, the Sequoia Project assisted federal stakeholders in deploying the Patient Unified Lookup System for Emergencies (PULSE) health IT platform. Along with ONC, CMS, and the Assistant Secretary for Preparedness and Readiness (ASPR), the Sequoia Project launched the health IT platform in California to allow disaster healthcare volunteer providers to query and view patient documents from connected healthcare organizations.
Sequoia Project CEO Marianne Yeager told EHRIntelligence.com that immediate health data access is particularly helpful for clinicians treating displaced or evacuated individuals at field sites.
“These individuals are typically are hurriedly evacuated from their homes due to flooding or fire,” Yeager explained. “They may not remember the medications they take or the specific dosages — and if someone has cognitive impairments, they may not remember what their medical conditions or allergies are.”
Field sites are generally set up in parking lots, churches, schools, or tents. In cases of emergency, only credentialed authorized disaster volunteers are able to treat displaced individuals. States maintain databases of credentialed volunteers.
Volunteers often treat evacuated individuals without access to their own health data who may have chronic conditions, allergies, or medication prescriptions that clinicians may not know about.
“The lack of underlying medical information really limits the ability of those treating and triaging them in the field,” said Yeager.
PULSE provides a way for volunteers to access these patient health records through existing national networks – such as Sequoia Project’s eHealth Exchange — for better-informed patient care delivery. PULSE was first implemented and utilized in California during the 2017 wildfires that swept through the northern part of the state.
“Certain communities had to be evacuated quite suddenly,” said Yeager. “With fires, there’s very little advanced warning. Unlike hurricanes — you have days to plan and evacuate. With the wildfires it occurred so quickly. They had to evacuate at least two inpatient acute care hospitals, and that really created a demand for those individuals.”
PULSE allowed volunteers to quickly access patient health information to support what Yeager called a “state of instantaneous readiness.”
After the successful launch of PULSE in California, the Sequoia Project and its federal partners began efforts to expand the disaster recovery health IT platform nationwide.
“PULSE has this almost instantaneous ability to scale because it’s leveraging an existing backbone of interoperability by tapping into and using existing health information exchange networks,” explained Yeager. “You don’t have to build something new. You just need to have a way to connect this technology to the state’s database so that they’re able to request the records.”
“That’s what we saw in terms of the public good and the opportunities this provides,” she added.
Each state interested in launching PULSE will develop its own disaster preparedness plan. The Sequoia Project and its federal partners will then work with states to assess their levels of connectivity and ability to engage in effective health data exchange.
“We’ve been working with ONC, HHS, CMS, and ASPR to identify the states and regions which are most likely at risk for having an event,” said Yeager. “We know the East Coast, the Pacific Northwest for sure, and the Gulf Coast.”
The Sequoia Project will work collaboratively with identified regions to help providers adapt PULSE to their disaster preparedness plans.
“We’ve done analyses on our end comparing the connectivity and density and availability based on the overlay between eHealth Exchange and Carequality,” said Yeager. “We have a really good idea about where there’s a good fit.”
The nationwide PULSE launch will ultimately be a phased deployment. The Sequoia Project will work with emergency management services and public health agencies within each state to coordinate the health IT platform launches.
“So far, the groups we’ve been working with are so receptive,” said Yeager.
Many healthcare organization leaders, providers, and industry stakeholders are generally dissatisfied with the current state of interoperability and health data exchange. Several initiatives launched this year — including the Trump Administration’s MyHealthEData initiative — aim to improve the flow of health data, reduce information blocking, and ensure patients have control over their own health information.
However, during times of crisis, clinicians expect to have access to little or no information on evacuated or displaced patients.
“In this case, if there’s any information available, it’s so much better than having nothing,” said Yeager. “We haven’t reached ubiquity in interoperability. We haven’t. It’s attainable in the next few years. But in this community, if you save one life, that’s one life.”
“It’s a very different philosophy and it’s really exciting to have an opportunity to support them,” she added.
While interoperability is not yet ubiquitous, Yeager is confident the industry is steadfastly headed toward achieving seamless health data exchange between organizations nationwide in the near future. She noted that information blocking by healthcare organizations has little to do with the slow rate of progress in advancing interoperability.
“We have not seen reticence from the provider community in sharing information,” she maintained. “It just takes incremental progress and time. I do think we’re reaching the tipping point where this is becoming the standard expectation.”
“We believe we’ll have that more universal coverage in a short period of time,” she continued. “A few years if that.”
In addition to significantly improving disaster preparedness, health data exchange can also improve care delivery for patients with complex health conditions.
“In Virginia, there was a veteran who had an organ transplant and apparently was not compliant with her medication,” said Yeager. “After being discharged, she ended up in a different hospital in the private sector. The private sector had a person in the emergency department who had to assess what was going on, didn’t know she had an organ transplant.”
The emergency department physician requested a copy of the patient’s medical record from the VA. By consulting the available information, the physician learned of the patient’s organ transplant, as well as her medication history.
“They avoided all these unnecessary tests,” said Yeager. “And they were able to prescribe the medication and avoid an unnecessary hospital admittance.”
Reducing duplicative testing and hospital admission rates can save healthcare organizations thousands of dollars per patient in unnecessary spending. Cutting unnecessary procedures can also boost levels of patient satisfaction and allow for faster, more effective treatment. Most importantly, accurate health data access can improve patient health outcomes by avoiding medication errors.
“You can’t quantify the business incentive or value of that,” said Yeager. “That’s just good will and good patient care.”
Looking ahead, the Sequoia Project hopes to further improve health data exchange by working collaboratively with other stakeholders to advance image exchange. This kind of collaboration epitomizes the blueprint for health IT innovation that stakeholders such as CMS, ONC, and Pew Charitable Trusts strongly support.
“We enjoy working with other groups who have started incubating ideas and then we can work collaboratively with them to take it forward,” said Yeager. “So it’s not even that we have to develop everything within Sequoia. There’s so much good work going already.”
Currently, the Sequoia Project is working with the Radiological Society of North America (RSNA) on an image exchange testing program.
“We’re testing and verifying that the systems that generate those images and read those images can interoperate using a standard,” explained Yeager. “That lays the groundwork for then promoting image exchange.”
The Sequoia Project plans to continue to promote improvements with RSNA and pursue other opportunities to collaborate for interoperability advancements in the future.
“We’ve done great work with RSNA to date and there are plenty of opportunities ahead,” Yeager concluded.