In Katrina's wake, a chance to prove health IT's value

Floodwaters destroyed the medical records of thousands of evacuees from New Orleans, washing away orders for cancer and diabetes treatment and medication information stored in physician offices and clinics.

The Health and Human Services Department is trying to recreate some of that medical data electronically, in what is proving to be a test case for the government's efforts to develop health IT systems.

'The health IT community can be one small thread of the recovery and response,' said David Brailer, HHS's national coordinator for health IT.

If Louisiana chooses to rebuild its health care system with a digital infrastructure, it could speed the creation of health IT systems around the country, federal and state officials say.

HHS is leading nine federal agencies, along with physicians and hospitals, retail pharmacists, insurers and the health departments of the affected states, in efforts to recover medical data and store it in one place so physicians can access it.

'We want to have some form of a medical data record or collection available in the shelters,' Brailer said.

The federal agencies include HHS' Centers for Medicare and Medicaid Services, Agency for Healthcare Research and Quality, and Centers for Disease Control and Prevention; the Defense and Veterans Affairs departments; and the Homeland Security Department, including the Federal Emergency Management Agency.

'If ever there was a case for health IT, this is it. This disaster underscores the need,' said HHS secretary Mike Leavitt at the recent Health IT Summit in Washington.

With standards for interoperability, systems also could let public health officials quickly identify an emerging pandemic from symptoms found in emergency rooms.

With one million people displaced and many of those without health records, the task of rebuilding records is huge, and the process to extract the data can be complex.

'First, we need to identify patients and reconstruct medical records on people in shelters,' said Frederick Cerise, secretary of the Louisiana Department of Health and Hospitals.

He told the audience at the Health IT Summit via teleconference that the biggest issue now is providing care without a health care system for persons suffering from chronic diseases.

States and their Medicaid contractors and insurers have a large amount of prescription information contained in electronic claims data, in addition to data potentially available from labs that file claims. About 25 percent of Louisiana's population receive their health care through Medicaid, Cerise said. CMS has similar data available through contractors that process insurers' Medicare claims.

HHS and its loose public/private affiliation of organizations are trying to collect medical data where it resides with contractors and pharmacy databases and determine how to make it accessible to physicians, Brailer said.

Officials said they had been able to compile data from pharmacies and other providers into databases available via the Internet to physicians working in eight shelters. The data covers people in the ZIP codes devastated by the hurricane. HHS plans to add Medicaid data from Louisiana, Mississippi and VA hospitals and clinics, and results from labs.

Virtual access

'We want to see a kind of virtual [regional health information organization] formed for people who want to be involved, so that we can start organizing their data as they go through their journey of care and eventually deliver [it] to wherever they are going to end up,' Brailer said. 'We can put controls and protections on the data so we can be sure it's only for people who are in shelters and only accessible to the doctors there.'

Many evacuees will return to New Orleans at some point, so their medical records will then have to be integrated with the system of care there. 'We're trying to accelerate this, bring national expertise to bear on it, and get all the other players involved at the table,' he added. 'If we had had interoperability, or some portable asset, it would have made the first or second response more effective.'

How Louisiana rebuilds its health care system could be a model for other states, said Sen. Tom Carper (D-Del.). Carper, a former governor, also is a sponsor of the health IT legislation, the Wired for Health Care Quality Act.

'It could expedite the introduction to and harness IT among health providers not only in Louisiana but across the country,' he said.

To broaden access to medical care, HHS has relaxed and streamlined access to Medicaid and other federal benefits for Katrina victims, CMS administrator Mark McClellan said.

Medicaid systems are up and running in Louisiana and Mississippi, so their eligibility and enrollment files are being used at shelters in Texas, Alabama and Georgia to do a quick determination of eligibility for services, he said.

CMS also supports health care at the shelters, for example in Houston and Dallas, where local providers have organized clinics.

'We are supporting that effort through modifications in our payment system by not following the usual and standard Medicare and Medicaid rules,' McClellan said.

CMS is working with states to create a new category of Medicaid eligibility for evacuees until they get back on their feet.

'There's a lot of interest in Louisiana and Mississippi to rebuild not just the health care system they had, but one that better reflects the most effective modern medical practice that includes electronic records, community-based care and better integrated care, in which health IT would play a big part,' McClellan said after his presentation at the conference.

Cerise, the senior Louisiana health care official, said a digital health care infrastructure would prevent the governments from ever having to recreate records again.