A Health Information Exchange for Disasters

The evacuee was down to his last dose of insulin. The Camp fire, which destroyed his home of Paradise, Calif., had taken with it his physician’s office and pharmacy, and other CVS branches couldn’t access his information to authorize more.

Disaster responders using the state’s new PULSE health IT disaster response platform could, though, and came through for the victim just in time. And he wasn’t the only one. “I can’t tell you how lucky we are in California to have this,” Leslie Witten-Rood, a program manager with the state’s Emergency Medical Services Authority (EMSA), told attendees at HIMSS Tuesday in Orlando.

PULSE stands for Patient Unified Lookup System for Emergencies, and it grew out of a failure identified after Hurricane Katrina: Some 10,000 people needed immediate care across states and jurisdictions then, but their health information wasn’t digitized and accessible. Fourteen years later it largely is, for them and many other Americans, and PULSE, initially funded by a 2015 grant from the Office of the National Coordinator for Health IT, makes it available to disaster responders when other systems may be disrupted.

That information can be essential to the care of volunteers and other responders in places like shelters and field hospitals who can’t otherwise access patients’ EHRs, or for any patient with a medical need in a time of duress. Once activated by EMSA in an emergency, PULSE gives access to six types of providers—physicians, RNs, LPNs, physician assistants, pharmacists, and EMTs and paramedics, authenticated through California’s Disaster Healthcare Volunteers database—and can alert them to everything from patients’ histories and allergies to prescriptions. Patient information comes from a range of connected providers, networks, and exchanges. “We don’t have to build new networks for disasters every time,” said Mariann Yeager, CEO of the Sequoia Project, a nonprofit collaborative that supports health IT interoperability initiatives.

Wildfires over the last few years have helped test and extend PULSE’s reach. Last year in Butte County, a three-member EMSA team scrambled to conduct training and had the system up and running in 10 minutes, said Witten-Rood. Ultimately 132 medical staff got just-in-time training, including Medical Reserve Corps volunteers and members of the National Guard. The Camp fire killed at least 85 and injured 17, including five firefighters.

For fires the year before, PULSE tied in to the eHealth Exchange, the country’s largest health data-sharing network, which connects nearly half of all U.S. hospitals and medical groups that care for some 100 million patients, dramatically increasing its geographical coverage. Funding from CMS will allow further expansion. The project is also connected to Carequality, a multi-stakeholder initiative that enables health data-sharing networks to interconnect, and the RSNA Image Share Validation Program, an interoperability testing program to enable sharing medical images.

For more on PULSE system requirements, design, and a drill report, see https://www.ca-hie.org/initiatives/pulse/. For a demonstration see https://sequoiaproject.org/pulse/.