In the year since Hurricane Katrina devastated the Gulf Coast, health IT has emerged as a key element in ambitious plans to rebuild and improve Louisiana's healthcare infrastructure.
Although "we were hoping for Santa to give us an electronic health record, we looked under the tree and it wasn't there," quips Dr. Allan Miller, a physician stakeholder in the Louisiana Healthcare Redesign Collaborative, a 40-member state-appointed board. Health IT is a crucial component of a proposal drafted by the Collaborative that seeks to redesign healthcare delivery and financing in Katrina-affected parishes as well as the entire state.
The proposal, awaiting approval from the U.S. Health and Human Services, recommends the use of IT to link "medical homes" (primary care physicians affiliated with a network of hospitals, specialists and other providers), using community-wide electronic medical records (EMRs) as "the backbone" for patient-centered healthcare.
"The storm offered us an opportunity to take a leap forward in the health IT work we were already doing," says Dr. Roxane (cq) Townsend, deputy secretary of the Louisiana Department of Health and Hospitals. "It encouraged collaboration among partners who never sat down together in the past."
Information technology has already played an important role helping officials care for residents post Katrina. In the chaotic days directly following Katrina, a secure online website, katrinahealth.org, was developed to house a database of residents' medication histories; in addition, a state immunization registry and a state electronic disease surveillance registry were established.
The data fallout after the devastation— many paper records as well electronic records without redundancy and remote backup were wiped out—showing that electronic medical records "were the fundamental thing we need to get done," says Stuart Capper, health informatics professor at Tulane University.
Now, post-storm, "the Katrina Pedal" is propelling the state at an accelerated pace toward adoption of electronic medical records, says Dr. Tony Sun, chief medical director at the Louisiana Health Care Review.
The Louisiana Health Information Exchange, for example, a regional health information organization (RHIO) prototype funded by a $3.7 million federal contract, brought together collaborators who accomplished in a short nine months "what would have normally taken two to five years," says Townsend. Another initiative, the Health Information Security and Privacy Collaborative, is reviewing state and federal laws currently in place that would impede in the creation of a national electronic health information-sharing network. "We have renewed motivation and interest," says Dr. Karen Desalvo, chief of general internal medicine at Tulane University.
Still, one year after Katrina, only 50 percent of an estimated 6,000 to 8,000 physicians are practicing in New Orleans, according to a HealthLeaders/InterStudy report. Plus, physicians who have returned are struggling with staffing shortages, reduced patient populations, and uncertain economic conditions. But "we have a chance to make a fresh start; an opportunity to put in new systems and look at processes in a new way," says Clayton Williams, director of the Louisiana Public Health Institute.
Across the city, numerous smaller community initiatives to develop RHIOs as well as encourage providers to adopt electronic medical records are in place. And a Medicaid transformation grant to bring EMRs into Louisiana Medicaid provider practices has been submitted to the Centers for Medicare and Medicaid Services, because, as Sun says, "physicians are choosing between brick and mortar vs. medical records."
Jeannine Hinton of Healthworks Louisiana, a management services firm, and a Collaborative member says, "There is an incredible amount of work to be done."
"What a lot of people don't understand is New Orleans is not back on its feet," agrees Townsend. "Every day we still have doctors in emergency rooms who are still trying to figure out patients' history because there is no record of what went on before the storm. It's a lesson for the rest of the nation about the need for EMRs."