Care of the Critically ill and Injured During Pandemics and Disasters: Portable Mobile Support Information Networks
We suggest hospitals have the ability to effectively and quickly download all patient-related information into a mobile package (eg, a flash drive or disk) that can be easily read by other information systems, and can be rapidly prepared for transport with the patient. This should obey the clinical document architecture/continuity of care document documents currently specified under meaningful use proposals, making them both human and digitally readable.
We suggest hospitals have real-time connection to databases for uploading and downloading clinical information.
We suggest hospitals have the necessary IT functionality to store health information when hospital systems are not available, and be able to rapidly upload and download clinical information once connections are re-established.
We suggest hospitals have the means to ensure confidentiality of all patient protected information.
We suggest patient information may be uploaded and stored in central, off site databases, similar to that used by the Veterans Administration system in the United States, and consistent with local healthcare laws and regulation pertaining to patient privacy and protections.
Hospitals IT systems can be affected to varying degrees, from being physically intact but surging to accept large numbers of patients, to partial infrastructure damage but functioning, and, finally, to (near) complete loss of infrastructure (Table 5). In disasters requiring significant hospital surge where infrastructure and IT systems are intact, all that may be required is an extension of existing network capability and power to clinically unused or austere areas of an hospital (eg, parking lots) using available networking equipment, portable hardware, and software. Patient care and billing functions are top information priorities for all hospitals and health systems, and when hospital infrastructures are damaged or otherwise unavailable, we suggest planning and preparing for a portable mobile-support information network. The investment of resources and time for this level of preparedness may best be accomplished at the health-care coalition/regional health authority level (see “System Level Planning, Coordination, and Communication” article by Dichter et al in this consensus statement).
Table 5 – Technology Required to Maintain Information Systems Under Different Levels of Disasters
Level of Disaster | Likely Level of Technology | Suggestions |
External to health care: such as 9/11 or Boston Marathon bombing | Although the hospital may experience a surge of patients, hospital operations are fully operational | Ability to flow hospital functions to overflow, possibly austere areas (parking lots, lobbies, and so forth). These areas essentially form an operational ward of the hospital, requiring networking and power (long extension cords) and potentially capable of full system functionality, and may need to be EHR defined in advance. |
Power is often more of a problem than networking, as wireless networks can cover large areas, and power is often scarce. | ||
May be simulated by placing systems in these areas and load testing them. | ||
Hospital affected directly: such as Hurricane Sandy | Hospital systems affected, and hospital will be working without all usual systems | Patients likely need to be evacuated to distant sites, and records must be transferred. |
Computerized record transfer preferable; paper records may be required. | ||
While transfer in process, contingency systems must be able to sustain the limited operations possible. | ||
Massive regional disaster: Hurricane Katrina, Haiti earthquake | Hospital operations completely offline, and care is being delivered in (field) hospitals under possible “battlefield” conditions | Portable, self-powered solutions may provide basic support for registration, tracking, and simple documentation. |