E-prescribing bounces back after hurricanes only if infrastructure does too

(Reuters Health) – The e-prescription system bounced back quickly after two out of three major 2017 hurricanes, a new U.S. study finds.

Recovery took much longer after the third, Hurricane Maria, most likely as a result of long-lasting power outages, researchers report in Health Affairs.

The cases of hurricanes Harvey and Irma demonstrate the importance of switching from paper records to electronic, said the study’s lead author, Jaime Smith, principle researcher and statistician at Surescripts, LLC, a company that links physicians, insurers and pharmacies through transmission of electronic health records.

Hurricane Katrina, which hit the U.S. Gulf Coast in August 2005, was a good example of how vulnerable paper records could make the healthcare system, Smith said. During that hurricane, many paper records were destroyed, leaving patients without easy access to medication refills or their medication histories.

To see if electronic records have improved access to medications and medical information in the aftermath of natural disasters, Smith and a colleague analyzed prescription-related records kept by Surescripts from areas directly affected by the three 2017 storms.

The new study looked at the numbers of e-prescriptions and requests for medication histories by pharmacies, emergency departments and other providers before, during and after the storms in the areas affected. Overall, they covered the period from August 7, 2017 through May 17, 2018.

For each area, the study team established what the typical level of e-prescribing activity was by looking at transactions during the six business days before the storm, and then tracking activity for as long as it took to return to normal levels.

In Houston, an average of 63,200 e-prescribing transactions took place daily before Hurricane Harvey hit on August 25, 2017. In the days right after the storm, that level dropped as low as 8,000, but was back up to an average of 64,300 per day after nine business days.

In a sample of five major Florida cities plus the Keys, average daily transactions were at 121,700 before September 10, 2017, when Irma made landfall. They fell by 95 percent in the aftermath of the storm but were back up to 123,000 by September 25.

While the system appeared to start getting back up to speed within days of Harvey and Irma, it had not yet returned to normal in Puerto Rico by the end of the study period. Before Maria hit the island on September 20, 2017, average daily e-prescription transactions numbered 56,500.

In the days immediately after the storm, that fell to fewer than 100, and even eight months later, they had only returned to a peak of 51,600. Calls for medication histories, which had averaged about 1,000 per day before the storm, took until May 14, 2018 to return to that level, the study found.

Although the prescription data couldn’t explain why there were such big problems in Puerto Rico, a report by the Federal Emergency Management Agency (FEMA) did, blaming “infrastructure difficulties,” Smith said.

That report showed that the adoption of electronic health records and related technology is not enough to maintain patients’ access to their prescriptions and health information, she explained.

“Within 10 days of Hurricane Harvey’s landfall, power was restored to more than 80 percent of the 300,000 Texans who were without power during the storm. More than 98 percent of the 6 million Floridians affected by Hurricane Irma had their power restored 10 days after that storm’s landfall.”

In Puerto Rico, by contrast, the majority of the main power grid was still down nearly two months after Maria’s landfall, with sporadic outages continuing across the island eight months later, the researchers note.

The new study shows that electronic medical records won’t solve all our problems, said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Though the “e” in e-prescribing stands for electronic, it could also stand for electricity, Wu said.

“I think it is disgraceful that while the power was restored to most people within days after Harvey and Irma hit, that wasn’t the case in Puerto Rico until eight months later,” Wu added. “I think this paper reminds us of the important relationship of our existing infrastructure to maintaining the health of our population.”

SOURCE: bit.ly/2GbWZuc Health Affairs, online February 4, 2019.