Public Health Emergency Preparedness

Chapter 7. Patient Information

Information management issues will arise as patients are:

• Discharged from tertiary care hospitals.
• Admitted to the surge facility.
• Discharged from the surge facility.

Records will also need to be maintained while patients are being cared for in the surge facility.

There is very little in the way of information technology remaining in vacant portions of these former hospitals. While Internet and wireless access may be available, reconnecting and testing these systems will unlikely be a priority during the 3-7 days leading up to opening of the surge facility. Each of the discharging hospitals has different electronic health record systems, which are not interoperable. Experts therefore anticipate that a paper discharge record is preferable as is a manual record system at the surge facility itself. A paper system removes the interoperability issues of dissimilar EHRs, is easily transported, and would not be subject to IT interruptions (and would therefore require no IT support staff).

To facilitate the transfer of information from discharging hospital, to transport staff, to surge facility staff, we suggest the use of a tri-fold 8 ½ x 11 brochure-style form that can be inserted into a clear plastic pocket and placed around a patient's neck during transport. This form is included in the Tool Kit accompanying this report. The front page of this trifold lists basic information and information regarding transportation methods. Page 2 contains more detail about patient condition and immediate needs. Page 3 provides space for discharging doctors and nurses to provide information about the patient pertinent to discharge and continuing care needs. Page 4 shows a 12-hour schedule for ongoing needs to assure that key medication doses are not missed during the discharge process. Page 5 lists additional information material and medications that arrived with the patient (if any), and page 6 provides a list of contact and insurance information. This form should provide the receiving surge facility staff with the minimal information required to provide continuity of care for the medically stable patients under their care.

Recommendation: Regulatory requirements regarding medical records systems and maintenance among the requirements that will need to be at least partially waived for a surge facility.

While care is being provided at the surge facility, a records system must be maintained. Experts recommend a paper-based medical records system for the surge facility, rather than trying to establish an electronic medical record system, for several reasons:

• First, any electronic medical record system would probably not be interoperable with the systems at the tertiary hospitals from which the patients originate (and possibly to which they return). As a result, patient movement would not be facilitated by an electronic system. A paper record can travel back and forth from one facility to another and, if necessary, can be entered into an electronic format at a sending/receiving tertiary hospital (just as normally occurs when patients move between hospitals that do not use electronic records systems).
• Second, electronic systems require hardware, software, technicians, and clinical personnel who are trained in that particular system. The equipment will most likely not be available on short notice, and staff coming from many other settings will not be familiar with the selected system.
• Finally, the effort does not appear warranted because the surge facility will be in operation for only a few weeks.

For all of these reasons, we recommend reliance on a paper-based medical record, which will require the establishment of a small medical records department at the surge facility, staffed by trained professionals.

Ownership of the medical records after the facility has closed will be a concern. Current regulations require that a hospital maintain a copy of medical records for several years (up to 20) after discharge, which will clearly not be possible at the surge facility after it is shut down. There are several options for records control. The records could be merged into the records of the tertiary hospital from which the patient is discharged (which could be problematic if the tertiary hospital uses electronic records and the surge facility uses paper medical records). The records could be stored by the State health department or the records could be stored by the present owner of the facility, which may be a health-care entity.

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