Best practices under pressure

As Hurricane Katrina evacuees poured into Tarrant County, Texas, by the thousands, medical personnel at Fort Worth's JPS Health Network, which includes a 459-bed hospital and 28 clinics, tried to keep to their best practices, only on a much larger scale.

"Nothing can prepare you for Katrina and, today, Rita," said Adonna Lowe, JPS' chief nursing officer. "We were fortunate because our mainframe system was large enough. We just took the clinic approach and doubled and tripled it, and we never had any downtime."

JPS saw about half of the 4,000 to 4,500 Gulf Coast residents evacuated to Tarrant County. As evacuees stepped off buses into clinics, each person's information was entered into the center's mainframe-based intake system.

JPS admitted 48 people to the hospital, sent 259 to the emergency room and treated 760 people as outpatients. "We were able to process this level of service to them in a quick way," Lowe said. "We were already set up to do that."

JPS' speed in processing the evacuees was due in part to its large population of resident physicians -- 166 total -- which enabled every evacuee to be seen by a doctor. Although most of them arrived without any paper medical records and only some with prescription bottles, each received a medical exam, which produced a new medical record.

At the height of the Katrina intake, there was no federal coordination in the area of health technology, Lowe said. Instead, federal officials were focused on providing shelter, food and safety for evacuees, leaving state and local officials to coordinate the health response.

Even so, federal support in the area of health IT would likely have helped little, Lowe said. JPS officials found the National Disaster Medical System inadequate, while the speed at which health care facilities were reacting to Katrina led to some data mix-ups.

She said a virtual regional health information organization, which Dr. David Brailer, national health information technology coordinator at the Department of Health and Human Services, has proposed would be helpful, she said, although deciding what information to share might be tricky.

Sharing demographic information and data such as beds available might not be enough, and there is always concern about collecting and sharing too much, Lowe said. "What kind of virtual information needs to be studied more," she added.

-- Sara Michael