States Seek Direct Messages For Health Data During Disasters

6 HIE Vendors: How They Measure Up

The growth of access to Direct secure messaging will help guarantee the availability of health information in the 10 states that recently entered a compact to exchange patient data in case of a natural or a man-made disaster. But, as a July 2012 report by the Southeast Regional HIT-HIE Collaboration (SERCH) makes clear, neither Direct messaging nor regional health information exchanges that would serve as the hub for such point-to-point messaging in an emergency are universally available.

Working with the Office of the National Coordinator for Health IT (ONC), state health information exchange (HIE) programs in Alabama, Georgia, Louisiana, Florida, South Carolina, North Carolina, Virginia, Michigan, Wisconsin and West Virginia last week announced a partnership to allow for the exchange of health data among providers caring for patients who are displaced from their homes after disasters. The plan is to use Direct, a national standard protocol for secure e-mail that has now been embraced by most statewide HIEs.

All of the state HIE programs participating in the initiative already have established at least one interstate connection and are working with other states, including Arkansas and Mississippi, according to a press release from the Department of Health and Human Services (HHS). Both of the latter states are part of SERCH, an ONC-funded research project that is leading the new collaborative effort.

[ Health information exchanges might not be cost effective across the board. Read HIE Participation Doesn't Create Test Savings, Study Says. ]

Formed in 2010, SERCH grew out of the national concern over the destruction of much of the Louisiana healthcare system in the wake of Hurricanes Katrina and Rita in 2005. Although some people, especially patients of the VA system, were able to get their health records online after they fled to other states, many others couldn't.

The goal of SERCH was "to develop a strategic plan for sharing health information data among the Southeast and Gulf states during and following a declared natural disaster," said a blog post by Lee Stevens, policy director for ONC's state HIE program. The states involved in SERCH included Alabama, Arkansas, Florida, Georgia, Louisiana and Texas.

In its 2012 report, SERCH made a number of recommendations about how the participating states could prepare to recover health records after the next disaster. What the SERCH team found was that "a mix of HIE models are being deployed [in the participating states] and that little or no cross-state exchange of electronic health information is currently taking place." Because of the limited amount of data exchange going on within states, SERCH proposed a "phased approach" to information sharing that includes making available data from health insurers and state agencies.

Direct messaging requires the use of a health information service provider (HISP). HISPs are not available everywhere and have had difficulty in communicating with one another, partly because there has been no national governance structure to create conditions of trust. But many health information exchanges have adopted Direct as a shortcut to interoperability, and some statewide HIEs have used it to communicate across state lines. In the event of a disaster, a cloud-based HIE or EHR could theoretically be used to transmit key health information via Direct to patients and providers in other states.

"Through disasters like Hurricane Katrina and Hurricane Sandy and large tornadoes in Alabama and Joplin, Missouri, in 2011 and more recently in Moore, Oklahoma, we have learned the importance of protecting patients' health records through electronic tools like health information exchanges," said Farzad Mostashari, M.D., national coordinator for health IT, in the news release. "Patients are better off when states and health information exchange organizations work together to ensure that health information can follow patients when they need it the most."

ONC statistics show how rapidly the number of organizations using Direct has grown. Between the second quarter of 2012 and the first quarter of 2013, the number of organizations across the U.S. that were enabled for "directed exchange" through state HIE grantees grew from 7,902 to 19,586. The number of clinical and administrative staff enabled for directed exchange jumped from 44,061 to 112,111.

Notably, however, the Gulf states in the new compact had far fewer Direct-enabled clinical and administrative staff than some other states did. For example, Louisiana had 713 and Alabama, 484, while Michigan had 17,352 and North Carolina, 1,105.