New Orleans Health Commissioner on Critical Lessons Learned After Katrina

KatrinaNewOrleansFor those on the outside looking in on the morning of Aug. 30, 2005, the day after Hurricane Katrina made landfall in southeastern Louisiana, it seemed that New Orleans might just be alright. This was the storm that the city had always feared. It brought intense winds, of about 127 mph when the eye passed over Buras, L.A., but the coastal regions east of the city appeared to be bearing the brunt of the storm.

However, within the next two days more than 80% of the community was flooded. Levees and floodwalls failed in multiple places, causing water to inundate New Orleans, much of which sits below sea level. Long-time resident Dr. Karen DeSalvo was making her way back from vacation in Alaska. She and her husband imagined the worst-case scenario; if that’s what they found when they got home, they said they’d collect what they could of their things and leave.

It’s hard to imagine worse than a ravaged city, in many places sitting under 12 feet of water, which is what DeSalvo saw when she arrived. And yet she ended up not turning right back around. Instead she stayed, and she and others resolved to begin a long and arduous effort to rebuild. DeSalvo today is New Orleans’ health commissioner. Just five years after Hurricane Katrina, Department of Health and Human Services Secretary Kathleen Sebelius called the city’s reformed health care delivery system a model for the rest of the United States.

DeSalvo spoke last week at HIMSS13 about how a city, which had been on the decline before Katrina, in a state, which the Dartmouth Atlas of Health Care said provided the poorest quality care for the most amount of money, got to where it is today. The story of how a community on the rebound designed a successful system focused on primary care and health information technology is directly linked with Katrina.

After the storm blew through and the water receded, pop up clinics were established throughout the area. There was no alternative, as Charity Hospital, the medical center where tens of thousands of the city’s uninsured received care, was closed. Clinicians went out on the street with ice chests, shots and medications. Hundreds of patients showed up to each location saying that they didn’t know what their usual drug regimen consisted of and they couldn’t find their physician.

The clinicians came back to the same locations day after day, since people came to rely on them being there. Eventually they stuck. Some even moved into abandoned buildings which were renovated and transformed into medical homes for the uninsured and underinsured. This is why more than 100 of these kinds of health care facilities exist across the New Orleans area today. Before Katrina there were just two.

Prior to the local medical community setting out to rebuild the health care system, it formally committed to its goals. Health care providers and leaders agreed on 12 principles, then put them in writing, and set a date for a public signing. In summary, the signatories pledged that health care would be patient-centered, quality-driven, sustainable, and accessible to all.

“One of the guiding principles was that we would refer to the use of health information technology in the practice of medicine,” DeSalvo said. “I can’t believe I was just saying this in 2006.” But it isn’t that surprising given the state’s written stance on HIT at the time. Then president of the Louisiana State Medical Society approached DeSalvo the day before the signing and told her that the society was going to have a vote that afternoon. One of the society’s positions was at odds with one of the 12 principles.

“Their policy as the state medical society in 2006 was that they did not support the use of computers in medicine,” DeSalvo said.

The state medical society did sign on, and the use of electronic health records across the area is now widespread. A lot of energy behind the transition to EHRs came from physicians themselves, driven by the angst they felt when they weren’t able to locate their patients or their paper records after the hurricane. New Orleans is also working on its health information exchange infrastructure. Five hospitals in the state have live exchange capabilities, and several others are in the queue to have the same. DeSalvo said information exchange won’t just impact care, but it will give physicians piece of mind knowing that in future disaster situations, their patients’ records can be accessed by another facility.

New Orleans’ health care system is an example of health care reform done right, but it of course faces obstacles. For example it has to cope with declining funds. Leaders made budget decisions with the assumption that Medicaid coverage expansion would occur in 2014, but Gov. Bobby Jindal has opted not to expand coverage in the state. Regardless, DeSalvo said her approach is to make do with what the city has.

Realizing she had a national audience in front of her at HIMSS, made up of representatives from budding diverse health care systems with their own unique set of problems, DeSalvo offered a last word: if New Orleans can do it, so can you.

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