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Personal health records, electronic health records, and health information exchanges could all play key roles in response and recovery efforts during and after a natural disaster, such as a hurricane or a tornado, according to a new report from the Office of the National Coordinator of Health IT (ONC).

The report focuses on the health IT capabilities of six southern states--Alabama, Arkansas, Florida, Georgia, Louisiana, and Texas--that are often subject to these kinds of natural disasters. The Southeast Regional HIT-HIE Collaboration (SERCH), which prepared the report for ONC, included representatives of all these states.

"The consortium's goal was to develop a strategic plan for sharing health information data among the Southeast and Gulf States during and following a declared natural disaster," explained Lee Stevens, policy director of the ONC's state HIE program, writing on the office's HealthIT Buzz Blog.

The report includes an "actionable plan" for preserving access to health records and makes suggestions that can support progress in the absence of "routine, widespread health information exchange," Stevens said.

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One suggestion is to explore the potential of personal health records (PHRs), which are Web-based repositories of medical information under patients' control. Some PHRs include a subset of EHR data or claims-based medical histories from insurance companies. Such a PHR is referred to as "tethered" because it is tied to a particular provider's electronic health record (EHR) or to a particular insurer. "The ability to access a tethered PHR could be critical following a disaster because it offers an immediate pathway to patient records," the report noted.

"Untethered" PHRs, such as those provided by Microsoft Healthvault and Dossia, could also be valuable because they are Web-based, the SERCH document stated. But it cautioned that clinicians must distinguish between the clinical data and the patient-entered data in such PHRs.

EHRs of the older, client-server variety would not be of much use in a disaster, the report said. But an increasing percentage of newer EHRs are Web-based. The databases are stored remotely and "often have redundancy and business continuity capabilities far exceeding the typical clinical enterprise," the report pointed out.

Finally, health information exchanges (HIE) may be of use in a disaster as they become more sophisticated. Some HIEs, the report said, are structured to push information from one place to another, such as exchanges that deliver hospital reports and results to doctors. Other HIEs allow clinicians to query systems and pull pertinent patient records. As the latter grow and spread, the report said, "they increase the potential availability of information in a disaster."

However, in most of the SERCH states, statewide HIEs were still fairly limited and interstate health data exchange was minimal or nonexistent.

Among the report's recommendations for public and private organizations seeking to exchange electronic health information during a disaster are these:

-- Understand the state's disaster response policies and align with the state agency designed for emergency support before the disaster.

-- Develop standard procedures to share electronic health information across state lines.

-- Consider enacting a "mutual aid memorandum of understanding" to establish a waiver of liability for the release of records when an emergency is declared.

-- Assess the state's availability of public and private health information sources and the ability to electronically share the data using HIEs and other health data-sharing entities.

-- Consider a phased approach to establishing interstate electronic health information-sharing capabilities.

Taken together, these recommendations establish a roadmap for other states that want to combine health IT with disaster planning, Stevens said. "Combining these two important healthcare functions will help ensure that when a disaster strikes, patients and providers will have better access to information and providers will be better able to provide appropriate care."