- Providers utilized the health center’s connection to Surescripts to access prescription histories and medication lists for patients that didn’t normally receive treatment at Petaluma.
- We didn’t need to call the pharmacy because for most patients we were able to hit external RX history in the EHR and see what their medications were, verify that information with the patient, and get those medications prepared. That was really helpful.
Petaluma Health Center relied on advanced EHR use to streamline care delivery following the wildfires in northern California.
Last year, providers at hospitals and health systems across the country faced major care challenges when dealing with the aftermath of natural disasters including Hurricane Harvey, Hurricane Irma, and the northern California wildfires.
The latter charred more than 200,000 acres of land across 10 counties and was declared a public health emergency by HHS Acting Secretary Eric Hargan. Natural disasters of this magnitude can have a significant impact on patient access to care, health data access, and clinician workflows. Patients fleeing natural disasters often seek care at medical facilities they have not visited previously, which requires providers to find ways to access necessary patient health information for well-informed clinical decision-making.
Petaluma Health Center CMIO Danielle Oryn saw firsthand how natural disasters can prompt a sudden and pressing need to quickly access patient EHRs for efficient care delivery.
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“The night of the wildfires was a Sunday night,” she told EHRIntelligence.com. “Actually, it was the day after the eClinicalWorks national user conference in Texas. Many of us were driving back on the highway and we could see the glow of the fire on the mountains.”
Oryn and others at the Sonoma County-based Federally Qualified Health Center were notified by phone of a serious wildfire affecting Santa Rosa residents around 3 AM local time.
“Seeing fire in this area at that time of year is not incredibly unusual we’ve just never had it in Santa Rosa this close in,” she said.
Oryn and her colleagues soon learned a few hospitals in Santa Rosa were in danger because of their proximity to the wildfires. The hospitals were evacuated and forced to close. Meanwhile, Petaluma Health Center was not at risk of being directly affected by the fire.
Word that some hospitals had closed meant the health center would see a significant increase in patient volume. Petaluma officials activated the health center’s incident command and emergency system and began seeing patients at around five o’clock in the morning.
“We knew there was going to be a mass number of people coming south getting away from the fire and that there weren’t going to be placed to access healthcare in Santa Rosa,” said Oryn. “Even though it was smoky, we decided we would open because we could. We wanted to try to help take the pressure off the emergency room here in Petaluma.”
With expectations to treat higher-than-normal patient volumes, health center officials immediately made efforts to leverage all communication, analytics, and health data exchange tools available through Petaluma’s eClinicalWorks EHR system to meet the needs of all affected patients in the area.
Leveraging Ehr-Integrated Tools To Treat New Patients
Immediately after wildfires ravaged northern California, Petaluma Health Center opened its doors to all patients in the community who needed to refill medications, receive treatment for respiratory problems resulting from smoke exposure, or replace medications that had been left behind during home evacuations.
To ensure all patients in need of treatment knew where to find access to care, health center officials used the eClinicalWorks EHR to issue notifications that the facility was open. Petaluma’s EHR system includes patient EHRs on all visitors that have come into the health center over the past several years.
“Even though we only have 32,000 active participants, we have about 60,000 patients in our database,” Oryn said. “I want to say we sent somewhere around 50,000 messages between automated voice messages and text messages to really let the community know we were open.”
“We knew pretty quickly that was effective because we started seeing posts on social media saying, ‘I just got a message from Petaluma. If anyone needs care, they’re open.’ It had a ripple effect, which was really effective,” Oryn continued.
After issuing notifications, Petaluma providers prepared to treat an influx of new and visiting patients.
“We were seeing more and more people come in,” said Oryn. “People who left their homes — they didn’t have their medications with them. Others were just passing through and they also didn’t have their needed meds.”
Providers utilized the health center’s connection to Surescripts to access prescription histories and medication lists for patients that didn’t normally receive treatment at Petaluma.
“Someone would come in and say ‘I’m on three medicines for my blood pressure and I don’t remember their names,’” explained Oryn. “We didn’t need to call the pharmacy because for most patients we were able to hit external RX history in the EHR and see what their medications were, verify that information with the patient, and get those medications prepared. That was really helpful.”
Petaluma also leveraged its connection to a private health information exchange to obtain health data on patients that didn’t ordinarily frequent the facility.
“We’re part of a health information exchange with the other community health centers in our region,” clarified Oryn. “We have that set up through eClinicalWorks. Many of the health centers around this region use eClinicalWorks. So we are able to see some continuity of care information which includes medication lists, problem lists, and allergies.”
“We’re part of a health information exchange with the other community health centers in our region.”
Currently, there is no regional health information organization or statewide HIE in Petaluma’s area.
Petaluma and other community health centers in the region engage in health data exchange through a connection to the Redwood Community Health Coalition. Established in 1994, RCHC includes 17 community health centers across Sonoma, Napa, Marin, and Yolo counties. As a health center controlled network, RCHC is intended to help community health centers complete EHR implementations.
“Through the coalition, many of the health centers in the region implemented eClinicalWorks together,” said Oryn. “We implemented eClinicalWork’s HIE product, and we’ve had that going for some time now. So there’s a good number of records to access there.”
“The vision was always that we’d use health data exchange and other analytics tools to connect us back together as a coalition in the end,” continued Oryn.
By having the health IT infrastructure in place to securely access patient EHRs and prescription histories on new and visiting patients, Petaluma providers were able to treat all northern California residents in need of medical services without significant delays in care delivery.
Furthermore, Petaluma was able to launch outreach efforts centered on treating individuals in need of care who were unable to make it to the health center.
Enabling Outreach Efforts Through HIE Use
In addition to treating new patients at the health center, providers were also able to leverage Petaluma’s HIE connection and EHR capabilities to offer medical services to individuals unable to travel to the facility. Specifically, Petaluma sent personnel and supplies to assist in treating individuals recovering from the natural disaster in nearby shelters.
“There were a number of large shelters and we sent clinicians, nurses, medical assistants, and supplies out to those shelters to get them started,” said Oryn. “As the situation continued and there were a lot of medically-fragile people who were being transferred out, we were able to use the provider portal to access medical records through the HIE.”
Using the web-based portal, Petaluma providers and volunteer clinicians treating patients in shelters were able to view complete patient EHRs and deliver accurate care.
“That piece is not something we ever anticipated happening, but it’s definitely going to be a larger part of our emergency planning in the future,” Oryn emphasized. “Making sure we can at least provide web portal access to records for patients. It was late when we realized the benefit of that, and it’s something we might keep in mind to do sooner in the future.”
Having the ability to access patient information from outside the health center through a web-based portal helped clinicians to avoid medical errors, eliminate unnecessary procedures, and reduce confusion.
“It underscored the importance of it for us,” said Oryn. “It really helped us to realize how important having patient information is. We felt extremely lucky to have it in place to use during this kind of crisis.”
Ultimately, Oryn emphasized that keeping the lines of communication open between providers by encouraging effective EHR use is a top priority during any kind of health emergency.
“The lessons we took away were definitely about the importance of maximizing the communication systems within our EHR,” said Oryn. “Being able to really leverage all that information to help people know what to do. That was a key piece.”
Date: Mar 27, 2018