Medicaid records speed response

For Dr. Roxanne Townsend, Medicaid medical director at the Louisiana Department of Health and Hospitals (DHH), drenched medical bottles symbolized the health information shortage. After spending four days tending patients in the New Orleans Superdome, Townsend saw critical health information literally washing away.

"When the water came in, the labels peeled right off the bottles, and the contents were reduced to slush," Townsend said. "This posed a tremendous problem, especially for those patients who didn't remember what drugs they were taking."

DHH does not keep detailed drug and medical histories on state Medicaid recipients, but it does keep a database of payments the state has made on behalf of individual Medicaid claimants. After the storm hit, department officials used the information to help piece together partial medical records for doctors and nurses tending to Medicaid patients in the Superdome and throughout New Orleans.

In some cases, DHH employees provided temporary user names and passwords to pharmacies rushing to fill prescriptions. "We put all of our people to work on a phone bank, so providers could call and we could verify that an individual was indeed a Medicaid patient and then provide access to the medicine and treatment this patient was taking," Townsend said.

The information proved critical to maintaining continuous care of people with long-term diseases -- the paramount challenge for medical workers. "During the hurricane and subsequent flooding, there was not mass casualty or even many broken or severed arms," she said. "The thing we had to think about in this disaster from a public health perspective were the needs around chronic illnesses."

Naturally, health care providers focused first on those patients with the most life-threatening illnesses. "The HIV population is one that you don't want off medications or out of care for very long," she said. Some health care workers were able to use Labtracker, an electronic medical record system maintained by Louisiana State University (LSU) to care for HIV patients.

LSU's CLinical InQuiry (CLIQ) system, which contains almost 30 million individual records on more than 350,000 patients, was also put to work after Katrina. The system went down during the disaster, but CLIQ helped emergency workers and others gain access to patient data housed in area health care facilities such as New Orleans' hard-hit Charity Hospital.

Using a patchwork of databases to disseminate information on patients displaced by Katrina has made officials acutely aware of the need for integrated medical records. As a result, DHH leaders are meeting with federal Department of Health and Human Services officials to negotiate a role for the state in developing a national medical records database.

"We've recognized the need to do this regardless of whether we are awarded a contract or not," Townsend said. "Before Katrina hit, there was not a comprehensive, overall push for information. Instead, we hoped and prayed this would never happen. Now that it has, we realize that our lives are very different here in Louisiana."