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Katrina Shows Need for Electronic Health Records

After Hurricane Katrina pounded the Gulf Coast nearly a month ago, most of the 1 million people displaced by the storm were left with no medical records -- making it difficult, if not impossible, for doctors working in disaster medical centers and community hospitals to treat them.

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

After the storm, Baum temporarily relocated to Austin, Texas, to treat his own, now displaced, patients. “I had access to some of my patients’ records over 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 made coordinating care in the patients’ new cities much easier,” he says.

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

“I am convinced now more than ever that patients should have portable access to medical records,” he says. There are many ways that this can be accomplished, he says, including on a chip, a CD ROM, paper format, or over the Internet.

“If the displaced patients left with their records in an electronic format, there would have been better continuity of care and fewer mistakes would be made,” he says.

Lawmakers Propose High-Tech Medical Records

Do-It-Yourself Medical Records on the Go

But no one has to wait for a “universal” system to be developed and approved. A little low-tech preparation today can stave off medical mistakes and ensure that you get the best care possible if, like the Hurricane Katrina victims, you have to go to a shelter, a hotel, or stay with a friend for a long period of time.

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

Implantable Chip Approved for Medical Records

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

Along with a valid insurance card, “the most important, nonnegotiable thing that everyone should have with them at all times is a list of the medications that they take,” Savard tells WebMD. “This tells a doctor more about your health and health conditions than anything,” she says. In your wallet, keep a complete up-to-date list of the doses and directions of all medications that you currently take including vitamins, herbs, and over-the-counter medications. “Everything counts,” Savard stresses. “This list will avoid duplication of drugs and side effect issues in an emergency situation.”

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

Electronic Records, Private Lives

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 are helpful in certain emergency situations, a go-file of your more extensive medical records -- kept somewhere easily accessible -- can also save lives, she says.

“Take your health care record and folder with you if you have time before you are asked to evacuate, or keep it in kitchen or in a kitchen counter in 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 a self-addressed stamped envelope after each office visit so he or she can send you your latest reports,” she advises. ”Keep it in an accordion folder or a three-ring binder where you can easily drop in new test results and reports.”

Taking Charge of Your Hospital Stay

Go Digital

In case of emergency, a close relative should also have a copy of these important medical records. “More and more people are scanning their records and emailing the file to close relatives,” she says. As far as concerns about privacy, Savard says “I would be more worried about it being lost if I 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 tapped 16 commissioners to serve on the American Health Information Community. The federal commission is charged with advising Leavitt on how to make health information digital and interoperable. The federal government’s goal is to provide 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 Santa Monica, Calif.

Yet problems exist with these existing systems, namely they are hospital- or doctor-specific, not easily transferred and read by other health care providers.

In a news release announcing the new commission, Leavitt stated that “from nearly anywhere in the world, we can withdraw money from our bank accounts, pay bills, apply for a mortgage, book airline tickets, and even order groceries 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 street corners.”

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

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

“There has been need before, but in America it takes a disaster to help pinpoint home what people have been talking about previously,” says James W. Scheurich, MD, deputy chief of staff at Michael E. Debakey Medical Center in Houston, 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 to patient files, the more than 38,000 veterans and the doctors throughout southeast Louisiana, Mississippi, and the Florida panhandle did not. That’s because the Veterans Affairs (VA) progressive Computerized Patient Record System enabled all patient records, prescriptions, and laboratory and radiology results from all New Orleans VA patients to be accessed by any VA physician nationwide.

Within about 100 hours, the VA system had all electronic health records for all 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 patients a day who were displaced from New Orleans, and we hospitalized 127 patients that 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 up a “universal standard approach,” he tells WebMD.

But universal access has some thorns namely privacy issues.

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

Others in the field resist the technology because of the perceived start-up cost, but that might be short sighted. Using a statistical model, RAND researchers recently tabulated that America's health care system could save a whopping $81 billion annually and improve the quality of care if it was to broadly adopt computerized medical records. The cost savings come from reducing redundant care, speeding patient treatment, improving safety, and keeping patients healthier.

“Hopefully we can breakthrough some of the resistance within the health care industry and outside of the health care industry towards integrating technology into the health care system,” says Jennifer Greeson, a spokeswoman for Intel in Santa Clara, Calif. Intel is involved in the new federal commission. “We hope to expand upon good examples like the VA system and make them more common and more consistent,” she says.

By Denise Mann, MS, reviewed by Brunilda Nazario, MD

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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