The fire next time: Sharp HealthCare's effective use of an ambulatory EHR during the California wildfires meant uninterrupted healthcare for displaced patients and clinicians

Health Management Technology, May, 2008 by E. Victor Brown

Catastrophic events affecting thousands, such as last fall's California wildfires, may be the truest indicator of how electronic health records (EHR) are helping to transform patient care. That was the experience of San Diego-based Sharp HealthCare an integrated regional healthcare organization that includes four acute care hospitals, three specialty hospitals, three medical groups and a number of other facilities and services.

With some 2,600 physicians on the hospitals' medical staff, 1,500 physicians in affiliated medical groups and more than 14,000 employees, the Baldrige Award-winning healthcare system is a recognized leader in California healthcare. In 2005--two years after the last devastating wildfire and two years before the recent conflagration--two of Sharp HealthCare's three medical groups, Sharp Rees-Stealy and Sharp Mission Park, began the process of implementing TouchWorks, an ambulatory EHR system from Allscripts. While optimum care for Sharp's large patient population was the driving force behind the implementation, the events of the week of Oct. 21, 2007, revealed an unanticipated benefit.

The Approaching Danger

Long before sunrise on Monday, Oct. 22, as southern California residents slept, wildfires were already wreaking destruction up and down the state. Around 4 a.m. on Monday, the Sharp HealthCare executive team began to receive calls from leaders informing them of reports from police and fire departments that fires were approaching several Sharp medical facilities. Brent Steineckert, Sharp Rees-Stealy and Sharp Mission Park's ambulatory EHR manager, prepared for the worst. "The fires grew so quickly and Past that by early Monday morning, we knew we'd need to close at least two clinics in close proximity of fire ground zero, says Steineckert.

Pages went out to administration and physicians giving them news and instructions. Conference calls with key administration and physician leaders occurred multiple times a day to develop plans, communicate updates and route resources as needed. "A challenge faced right off the bat was that our existing clinics that remained open expected staffing shortages due to numerous mandatory evacuations and school closures," says Steineckert.

Sharp Rees-Stealy operates a centralized patient contact center which typically handles more than 5,000 calls per day from patients scheduling primary care appointments and leaving messages for their doctors. Fortunately, the call center is located in an area that was not affected by the fires. Since the call center was operating 24/7 it was the ideal communications hub to interact with patients in need of medications and medical advice. Decisions flowed from the administration and physician leadership team, which included the associate medical director, the CEO, VPs and key directors, who gathered twice a day for a conference call to decide which clinics to keep open or close, based on road closures, air quality and staff availability.

Monday

Early Monday morning, a large Sharp Rees-Stealy clinic was closed in the Rancho Bernardo area of San Diego County as simultaneously a smaller clinic met the same fate in the Carmel Valley/Del Mar region. The two clinics house anywhere from 40 to 50 physicians and more than 200 staffers and see an average of a thousand patients each day. Within three hours of the first two closings, Sharp Rees-Stealy was forced to close a third clinic due to fast-moving smoke and fire. The approaching evening would see even more closures, finally reaching a total of five.

Across San Diego County, more than 100,000 people were evacuated with little notice and few resources, making employee tracking of those without cell phones difficult at best. The overloaded cell networks made cell phone communication unreliable as well. "We employed whatever means to get information out such as establishing central call-in lines with numbers posted on the Sharp Web site, so if someone tried to contact us anywhere within the Sharp HealthCare organization, they could be routed to the appropriate party," says Steineckert.

In order to deal with people calling in with smoke-related and other medical problems, the decision was made by the administration and physician leadership team to put several physicians in the call center to assess these types of calls. "In many cases, the physician was able to take care of the patients concerns completely, right over the phone, primarily due to the availability of the EHR," says Steineckert.

Call Center

Theresa Siefken, D.O., Family Medicine department at Sharp Rees-Stealy, was one of the physicians asked to work the call center. Siefken's clinic, which is near the border in the Otay Ranch area, had already been closed by Monday afternoon due to smoke. Procedurally, several "runners," which consisted of the call center manager, supervisors, leads and a scheduling systems analyst and a scheduling systems specialist, would print out the tasks for each patient calling in and alternate dropping them off to each physician working the phones in the call center.