By Tom Ballard, Chief Alliance Officer, PYA
Catastrophic acts of nature, whether the wildfires that have recently decimated parts of California or this fall’s hurricanes in the Carolinas, create great disruption in the lives of individuals. Homes are damaged or destroyed. People have to evacuate, taking whatever possessions they can carry in their arms or transport in their vehicles.
Have you ever wondered what would happen if you were in one of those situations and experienced a significant health event while temporarily relocated to another state? How would the attending physician quickly access your medical records?
That was the situation that residents of the Carolinas faced this past September when massive flooding from Hurricane Florence forced many to flee to other states including Tennessee. Fortunately, a Knoxville-based organization was prepared to respond to the situation thanks to technology.
etHIN is the acronym for the East Tennessee Health Information Network. As its name implies, the organization facilitates the exchange of health information across a 20-county region that includes three major hospital systems and several of the largest physicians’ groups in the area. The counties served are Anderson, Blount, Campbell, Claiborne, Cocke, Cumberland, Grainger, Greene, Hamblen, Hancock, Jefferson, Knox, Loudon, McMinn, Monroe, Morgan, Roane, Scott, Sevier, and Union.
Officially incorporated as a non-profit in 2005, etHIN’s organizers required several years of work before the first technology stack was built in 2011 and the first data was exchanged in early 2012. Now, etHIN has 2.3 million patients in its database and a growing ability to exchange data across state lines.
“Networks like etHIN are normally either statewide in scope or regional,” Leigh Sterling, the organization’s Executive Director since 2010, explains. Interoperability with other similar organizations is not as easy as it might sound.
“We have been working on relationships with other states” to facilitate the exchange of health records,” Sterling says. They include efforts with Georgia, Kentucky, North and South Carolina, Ohio, and Indiana.
Those efforts were tested in mid-September as Hurricane Florence’s winds weakened before landfall as the dire forecasts for unbelievable amounts of rain increased.
“It’s the nature of what we do to pay attention to things that might impact our region,” Sterling says. “We had been watching the advancing hurricane, and when the local news reported that our area was already receiving an influx of evacuees from the Carolinas, I reached out to both Christie Burris, Executive Director of the North Carolina Health Information Exchange Authority, and Wyman Bowers, CEO of the South Carolina Health Information Exchange.”
Within hours, efforts were underway to establish a secure connection between etHIN and North Carolina so doctors in East Tennessee could access patient records. A connection to South Carolina could not be established before the hurricane arrived due to the evacuation of State offices and employees, which included the South Carolina HIE, but that connection is still planned for the future.
“If people who are being evacuated are sick at the time, they are still sick when they arrive in their temporary location,” Sterling said. As you might imagine, many of those individuals stopped just across the Great Smoky Mountains in Sevier County.
How important were the newly established connections for East Tennessee healthcare providers?
“Within 15 minutes of turning on the connections, we received a call to make sure they were live,” Sterling recalls, explaining that a patient from North Carolina was in a critical care unit at a local hospital, and providers at that institution needed access to the individual’s health records from his home state.
We thought that establishing these interstate connections would be fairly simple, but Sterling and Sharon Woods, etHIN Communications Manager, say that is far from the case. Both have banking backgrounds, so they drew on that experience to outline some of the obstacles.
“It took most of two decades to create an international network that allowed individuals to use ATMs and debit cards everywhere outside their local bank’s network and then to implement online banking,” Sterling said. The hurdles are both regulatory and technological in healthcare just as they were in banking, with healthcare having additional sub-layers of complexity.
One of the key issues is not just the ability to access the data, standardize it, and display it correctly for providers, but also to ensure that “you are who you say you are,” Sterling explains. “Patient matching is a huge part of the health information exchange and what we do. In many respects, the banking industry is simpler than healthcare.”
etHIN is not a household name for most of our readers, and that’s just fine for the organization’s Executive Director. “We’re more of a utility service,” Sterling says. “We promote the physician and patient relationship and stay in the background.”