General Information and Policy
1. Blumenthal D. Launching HITECH. New England Journal of Medicine. 2010; 362(5):382-5.
This article provides an overview of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was passed in 2009 as part of the stimulus bill. The HITECH act supports national, interoperable, private, and secure electronic health information systems, with the ultimate goal of providing better healthcare to Americans. The act emphasizes meaningful use of electronic health records (EHR), which means that the use of EHRs improve quality, efficiency, and safety of healthcare, and promote public health in such a manner that also ensures privacy and security of the data. Link to article.
2. Stevens L, Rancourt J. Health Information Technology Can Make Disasters Seem Like Business as Usual.Annals of Emergency Medicine. 2014; 63(4): 425-427.
This article encapsulates the mission of the Office of the National Coordinator for Health Information in regards to Health Information Technology (HIT) in disasters. The article goes through the history of developing HIT in the US, starting with issues surrounding Hurricane Katrina and the initial efforts to make technology that would be implemented only in a disaster. This idea was exchanged for interoperable electronic health records that would be used in day-to-day medicine. This concept was implemented in New York, was tested in Hurricane Sandy, and was a success. Link to abstract.
3. Friedman DJ, Parrish RG, Ross DA. Electronic Health Records and US Public Health: Current Realities and Future Promise. American Journal of Public Health. 2013; 103:1560-1567.
This article goes into depth on how the concept of meaningful use will be implemented in EHRs, as required by the HITECH Act. The first stage of meaningful use involves the automatic reporting of immunization data, syndromic surveillance, and lab results of reportable diseases. The second stage involves reporting diagnosis to cancer registries and other specialized registries. This article also details barriers to adoption of EHR, notably funding, standardized data and transmission methods, and information content. Link to abstract.
4. Lenert L, Sundwall DN. Public Health Surveillance and Meaningful Use Regulations: A Crisis of Opportunity. American Journal of Public Health. 2012; 102(3): e1-7.
This article delves into the challenges and opportunities facing local and state public health departments in regards to the Meaningful Use regulations of the Affordable Care Act (ACA). The authors state that most public health departments do not have the IT infrastructure to handle the data they would be required to process, and the funding is not available to revamp those infrastructures. They suggest cloud computing as a secure, economically feasible way for public health departments to increase their data-handling capacity and share data among departments, between state and local departments, and between state/local and federal health entities. Link to article.
5. Rader A, Edmunds M, Bishop J. Public Health Preparedness and Response for At-Risk Populations: Harnessing the Power of Health Information Technologies. Booz Allen Hamilton Publications. 2010.
This report contains the aspect of health IT in disasters in two unique respects; through the lens of at-risk populations, and with the American Recovery and Reinvestment Act (ARRA) of 2009 as policy to consider. ARRA is relevant in this context due to its funding to increase the reach of wireless and broadband technology around the country. The report provides a thorough and broad look at at-risk populations, delves into those populations that would not immediately be considered so, and discusses various federal policy that impacts disadvantaged populations. Link to report.
6. Healthcare and Public Health Sector Coordination Councils. Working Without Technology: How Hospitals and Healthcare Organizations Can Manage Communication Failure.
This document contains recommendations to assist healthcare organizations and facilities in planning for communications and technology failures. These recommendations include multi-tiered approaches to information sharing, providing emergency communication devices to staff, planning ahead, knowing your local partners, and empowering staff at all levels to make decisions. Link to report.
Information and Toolkits for Primary Care Providers
7. American Academy of Pediatrics, Preparedness Checklist for Pediatric Practices, 2013.
This checklist provides a framework for disaster preparedness planning for pediatric practices. This list encompasses a wide variety of considerations when planning for disaster, from specific needs of patients and medications that a practice would need on hand, to protecting patient records and obtaining appropriate insurance coverage. Link to checklist.
8. Morehouse School of Medicine, Emergency Preparedness Toolkit for Primary Care Providers.
This toolkit for primary care physicians provides trainings, fact sheets, and templates for a wide variety of disaster scenarios, including but not limited to blackouts, terrorism, earthquakes, chemical attacks, winter storms, and earthquakes. Link is a Google document and will launch an immediate download.
9. Freedy JR, Simpson WM. Disaster-Related Physical and Mental Health: A Role for the Family Physician. American Academy of Family Physicians. 2007; 75(6):841-846.
This paper discusses how family practice physicians can be aware of and respond to the mental health outcomes of disasters. It discusses mental health risk factors and common post-disaster health problems, both physical and mental in nature. Link to article.
10. Runkle JD, Brock-Martin A, Karmaus W, Svendsen ER, Secondary Surge Capacity: A Framework for Understanding Long-term Access to Primary Care for Medically Vulnerable Populations in Disaster Recovery. American Journal of Public Health. 2012;102(12):e24-e32.
This paper discusses the need for identifying vulnerable populations pre-disaster, in order to anticipate and plan for a surge in their primary care needs in the aftermath of a disaster. Link to toolkit.
11. Pomaski J, Ying J, National Center for Disaster Medicine and Public Health. Health IT and Disaster Preparedness. Published September 30, 2014. Accessed December 1, 2014.
This webinar (audio available) discusses health IT preparedness and recovery lessons learned from New York City. The first half focuses on Health IT preparedness from the technical standpoint while the second half presents the experience of one Federally Qualified Health Center as they prepared, weathered, and recovered after Superstorm Sandy. Direct Link to Audio Recording.
12. Davidson D, Missouri HIT Assistance Center. Disaster Recovery & HIT: A Lesson from Joplin. Published August 9, 2013. Accessed May 2, 2014.
This webinar (slides and audio available) details the impact that the 2011 tornado had on the Joplin community, including the large impact on its healthcare system. It specifically focuses on the preparedness planning, response, and recovery efforts of the ACCESS Family Care clinic, a Federally Qualified Health Center with five branches in the Joplin area. Much of the planning for HIT-specific preparedness is broadly applicable to other types of practices.
Link to slides.
Link to audio and other webinars provided by the MO HIT Assistance Center.
13. Health Resources and Services Administration (HRSA). Continuity and Resiliency for Health IT Systems: Preparing for Unforeseen Events. Published May 17, 2012. Accessed Dec 3, 2014.
This recorded webinar (1:18:38) provides advice on the use of IT in disasters. It is specifically geared towards rural primary care and inpatient settings.Link to video clip.
14. Health Resources and Services Administration (HRSA). Disaster Recovery Plans for HIT - Why is it Important. Published Nov 1, 2010. Accessed Dec 3, 2014.
This recorded webinar (1:20:50) goes over HIT disaster recovery plans. Continuity of critical operations is emphasized, and steps and strategies are discussed for recovery planning. Examples are given from Hurricane Katrina. Link to video clip.
Electronic Health Records (EHRs)
15. Horahan K, Morchel H, Raheem M, Stevens L. Electronic Health Records Access During a Disaster. Online Journal of Public Health Informatics. 2014; 5(3):e232.
This paper discusses the successful access of EHRs by a New York medical center following Superstorm Sandy. This facility had the data backed up to a remote location that was unaffected by the floodwaters, and when the fiber optic cables were destroyed they accessed their data via a microwave link system they had tested previously. The paper also discusses the State of New York's efforts to facilitate the availability of electronic medical information after disasters, as well as how New Jersey implemented just-in-time measures to backup electronic health data. Link to article.
16. Abir M, Mostashari F, Atwal P, Lurie N. Electronic Health Records Critical in the Aftermath of Disasters. Prehospital and Disaster Medicine. 2012; 27(6): 620-2.
This article covers EHR after Hurricane Katrina and in Joplin, MO, and specifically focuses on aspects outside of continuity of care. For example, EHRs in Joplin were able to allow an Opioid Treatment Program to continue, as well as providing dental records for fatality identification. The utilization of EHRs by US physicians responding to the Haiti earthquake ensured that appropriate specialists were deployed. The article overall emphasized the usefulness of "robust IT strategy, including standardization, consolidation, virtualization, and discipline." Link to abstract.
17. Shin P, Jacobs F. An HIT Solution for Clinical Care and Disaster Planning: How One Health Center in Joplin, MO Survived a Tornado and Avoided a Health Information Disaster. Journal of Public Health Informatics. 2012; 4(1):e7.
This article details the steps that a Community Health Center (CHC) took to transition to Electronic Medical Records, and then outlines how these steps proved invaluable when a large tornado struck the area. Due to electronic records and a resilient system, the CHC was able to resume operations within 12 hours and provide critical services to the community. Link to article.
18. Russell M. Permanent Record: Electronic Records Aid in the Aftermath of Joplin Tornado. Journal of AHIMA. 2011; 82;34-7.
This article details how another healthcare provider in Joplin, St. John's Regional Medical Center, was able to provide care to the community due to electronic medical records. The building itself was completely destroyed, but the hospital had transitioned to electronic health records, housed in a tornado-proof, off-site location, 21 days prior to the storm. Access to these records allowed for St. John's to set up a satellite location to provide healthcare services to the community. Private physicians associated with the hospital were also able to access their records and continue to provide care even if their offices were destroyed. St. John's also provided information to the surrounding community on how to return or destroy medical records that had been blown away, and due to the EHR system the field hospital was nearly paperless. In contrast, Freeman Health System's EHR was shut down after the storm to conserve power, and as a result patient lists and documentation were not reliable. Link to abstract.
19. Hoffman S, Podgurski A. Big Bad Data: Law, Public Health, and Biomedical Databases. Journal of Law, Medicine and Ethics. 2012; 41(s1):56-50.
This article focuses on the implications inconsistent data quality in EHRs would have on the public health benefits of these data. The article touches on the many ways EHRs could benefit public health, including in disaster situations, but states that there are many flaws. Entry error, upcoding, interoperability issues, and fragmented patient records are all discussed, as well as the fact that the infrastructure to process such massive amounts of data is not available. Suggestions on how to fix these issues include incentivizing or compelling interoperability in EHR software and the development of software that can pull relevant data out of EHRs automatically. The authors suggest formulating error rates and uncertainty characterization will assist in the analysis of these data. Link to article.
20. Bala H, Venkatesh V, Venkatraman S, Bates J, Brown SH. Disaster response in health care: A design extension for enterprise data warehouse. Communications of the ACM. 2009; 52: 136-140.
This article discusses the use of Enterprise Data Warehouses (EDW) in disasters, specifically modifying the architecture of data warehouses in order to make data available during disasters. They modeled their modification after the Veterans Health Administration IT systems response during Hurricane Katrina. It is available for free online. Link to article.
21. DeGaspari J. States Prepare for Seamless Exchange of Health Records After Disasters. Healthcare informatics (website). 2013.
This news article details a new multi-state effort to facilitate the exchange of health records in a disaster through Health Information Exchange programs. These states are working with the Office of the National Coordinator for Health IT (ONC) in order to accomplish this. Multiple recent disasters are cited as examples of the importance of protecting patient health records through electronic tools. Link to article.
22. Rutkow L, Vernick JS, Wissow LS, Kaufmann CN, Hodge JG. Prescribing Authority During Emergencies Challenges for Mental Health Providers. Journal of Legal Medicine. 2011; 32(3):249-260.
This paper discusses general concerns and barriers to providing mental health prescriptions in a disaster setting. It focuses in on electronic prescriptions as a solution to some of these barriers. E-prescriptions are seen as a solution since it would not be necessary to find a healthcare worker with prescribing authority to continue treatment; however some states still have laws prohibiting the use of e-prescriptions for some controlled substances. In regards to how e-prescriptions can facilitate mental and behavioral health treatment in a disaster, the paper recommends that states update their laws to match the federal law allowing the e-prescription of controlled substances. It also recommends the use of national databases of prescription history in order to address concerns related to displacement. Link to article.
23. Ducker M, Sanchez C, Taylor SR. Pros and Cons of E-Prescribing in Community Pharmacies, U.S. Pharmacist, 2013; 8(38)(P&T Suppl):4-7.
This paper discusses general policy as well as the pros and cons surrounding e-prescriptions. The pros are outlined as increased patient safety, cost benefits, access to records, and improved workflow. In the section detailing access to records, the paper addresses the success of utilizing e-prescription data to access the medication needs of Katrina evacuees. The cons listed were clarifying inaccuracies, software design issues, and cost. Link to article.
24. Piza F, Steinman M, Baldisserotto S, Morbeck RA, Silva E. Is there a role for telemedicine in disaster medicine? Critical Care. 2014; 18:646.
a. This letter discusses the positive outcomes resulting from the use of telemedicine after a large fire in Brazil. The hospitals that received the patients were able to discuss challenges with specialists around the world. This assisted in the diagnosis and management of the patients. While the authors are fully in support of telemedicine, they acknowledge a significant limitation; in the event of a natural disaster, internet connectivity may be disrupted, removing telehealth as an option. Link to article.
25. Xiong W, Bair A, Sandrock C, Wang S, Siddiqui J, Hupert N. Implementing Telemedicine in Medical Emergency Response: Concept of Operation for a Regional Telemedicine Hub. Journal of Medical Systems. 2012; 36:1651-1660.
This paper investigates a telemedicine hub as a potential resource in a disaster response scenario, discusses what the operational characteristics of such a hub would be, and discusses the potential benefit of remote clinical consultation. Probalistic models were utilized to develop scenarios (major, medium, and minor scale) with earthquake victims that took into account wait time for treatment and mortality due to delay of treatment. Setting up a designated receiving center with telemedicine capability was shown to greatly decrease mortality to due to delay of treatment. Link to article.
26. Latifi R, Tilley EH. Telemedicine for Disaster Management: Can it transform chaos into an organized, structured care from the distance?. American Journal of Disaster Medicine. 2014; 9(1):25-35.
This paper was a literature review of the use of telemedicine and telepresence in disasters, from 1980 to 2013. In discussing the results, the authors also describe the history and evolution of telemedicine and its use in disasters. Overall they conclude that telemedicine is a valuable tool in disaster and humanitarian aid, and should be developed specifically in disaster-prone areas. They also discuss the pros and cons of different technologies and the planning phases for the use of telehealth pre-disaster, immediately post-disaster, and the post-disaster/rebuilding phase. Link to abstract
27. Kim TJ, Arrieta MI, Eastburn SL, Icenogle ML, Slagla M, Nuriddin AH, Brantley KM, Foreman, RD, Buckner AV. Post-disaster Gulf Coast Recovery Using Telehealth. Telemedicine and e-health. 2013; 19(3):200-210.
This paper discussed the use of telehealth in the response and recovery after Hurricane Katrina. The researchers conducted interviews with key informants and national organizations involved with Gulf Coast recovery work. It was observed that funding, regulations, workflow, attitudes, personnel, technology, and evaluation were they key elements to telehealth success. It was noted that telehealth was especially helpful in meeting mental health needs in the aftermath of Katrina. Link to article.
28. Vo AH, Brooks GB, Bourdeau M, Farr R, Raimer BG. University of Texas Medical Branch Telemedicine Disaster Response and Recovery: Lessons Learned from Hurricane Ike. Telemedicine and e-health. 2010; 16(5):627-633.
After a direct hit from Hurricane Ike in 2009, the University of Texas Medical Branch was able to resume telemedicine much more quickly than physical operations. This paper discusses the technology involved in UTMB's telehealth systems, the community-level preparations that supported the telehealth center coming back online, and initial steps towards bringing remote telehealth capability back online. One of the first steps was to integrate any notes made by healthcare providers back into the patient's EMR, and it was noted that the EMR system was critical to providing care. Main lessons learned included topics relating to workforce availability, mobile technologies in telehealth, disaster planning, and systems engineering. Link to abstract.
29. Simmons SC, Murphy TA, Blanarovich A, Workman FT, Rosenthal DA. Carbone, M. Telehealth technologies for terrorism response: A report of the 2002 Coastal North Carolina domestic preparedness training exercise. Journal of the American Medical Informatics Association. 2003;10:166-176.
This article details how available health IT systems, specifically telemedicine, local and wide-area networks (LAN and WAN), and video/voice conferencing, were utilized in a joint military-civilian disaster-preparedness training exercise. Technologies performed well, but the authors noted that another drill run by actual responders would provide better results. Link to article.
Patient-Owned Personal Health Information Technology
30. Bouri N, Ravi S. Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies. Journal of Medical Internet Research mHealth and uHealth. 2014; 2(1) e8.
This paper discusses the need to overcome challenges in order to integrate Personal Health Records (PHRs) into emergency response plans. PHRs would help deliver health information even if paper and electronic systems are unavailable, allowing providers to better share data with patients, providing medical histories at the point of care, and advancing telehealth. The challenges discussed include a lack of infrastructure to manage and verify these personal health data, unclear costs to maintain PHRs, lack of standardization, and legal, regulatory, and privacy challenges. Link to article.
31. Irmiter CA, James JJ. A secure personal health information device: A tool to improve health outcomes in a disaster or public health emergency. American Medical Association. 2012.
This report details efforts to find a secure, usable, consistent technological method for communicating vital health information during a disaster. It focuses on using a Health Security Card (HSC), a credit card-sized device with a built-in chip that contains important personal health information. These cards can then be read via a handheld device. Disaster scenarios found that these cards allowed for faster triage and more effective utilization of resources. Link to abstract.
32. Irmiter CA, Subbarao I, Shah JN, Sokol P, James JJ. Personal Derived Health Information: A foundation to Preparing the United States for Disasters and Public Health Emergencies. Disaster Medicine and Public Health Preparedness. 2012; 6:303-310.
This article, which contributed to the report above (Irmiter and James, 2012), details the results of an expert panel convened to determine what critical health information would be required in an emergency. These data would then be included on a transportable device that could then be given to healthcare workers. Link to abstract.
33. Healthcare Information and Management Systems Society (HIMSS). Edited by Sarasohn-Kahn, J., Using Personal Health IT (PHIT) to Transform Healthcare. 2013. Accessed 9/19/13.
This informative website (and available pdf) details personal health information technology (PHIT), and includes detailed information about the uses of PHIT, utilizing mainstream technology for health uses, and adopting meaningful use concepts for PHIT. Link to website.