Commentary

The main point of this New England Journal of Medicine commentary (free, full text) is that homeland security and health care reform are inter-dependent.

What if, instead of a hurricane, Katrina had been a terrorist attack? As hard as this is to believe, it would have been even worse because there would have been more damaging chemicals involved or other medical hazards, depending on the type of weapons used.

One of the important building blocks of health care in the future—whatever model ends up being the one chosen—rests on readily accessible electronic medical records. As we have reported before, some experts have warned an electronic system is not magic. It will be as good as the people designing it are. However, in the case of Hurricane Katrina, as Dr. Lurie notes, the victims whose medical records could be accessed were veterans. The VA has the very system being proposed and, in general, it works well.

This commentary came from RAND Health, Arlington, VA, and was written by Nicole Lurie, M.D., M.P.H.

After writing this article, Dr. Lurie was named Assistant Secretary for Preparedness and Response, Department of Health and Human Services.

New England Journal of Medicine

…”Investments in interoperable health information technology (HIT) form one of the cornerstones of health care reform. After Hurricane Katrina, the lack of access to medical records was a major impediment to caring for most displaced, chronically ill persons; the records of those who received care through the Department of Veterans Affairs, however, were accessible anywhere in the country. Portable, interoperable HIT will be essential for efficiently and safely caring for displaced populations during a health emergency. (Emphasis added)

“With appropriate planning and standards, HIT can also play a key role in detecting and monitoring disease outbreaks. Routine, automated reporting of diagnoses to health departments by primary care practices, emergency departments, and laboratories can provide early evidence of an impending epidemic. Such monitoring has proved useful in determining whether a report of a single case might be accompanied by spikes in the use of health care services, signaling that many people are ill. Such a system was used recently by the New York City health department and others to determine whether large numbers of people were ill when a cluster of cases of H1N1 influenza was identified in a school and to monitor the epidemic.

“A key challenge facing public health officials who are planning responses to a potentially more severe H1N1 influenza epidemic this fall is finding a way to quickly link information regarding who is vaccinated to information about the subsequent use of health care services by these people. Such linking will be essential for detecting and interpreting reports of adverse events after vaccination and determining the effectiveness of vaccines in preventing illness. Whereas some countries with universal health care systems can readily gather and use such information, the fact that not all Americans are accounted for in our system and the lack of HIT make it impossible to do so in most of the United States.” (Emphasis added)

Source: New England Journal of Medicine, Posted online, August 26, 2009