Wednesday, April 21, 2010

UTMB Responds to Disasters

Alexander H. Vo, PhD, Executive Director of the Center for Telehealth Research and Policy at the University of Texas Medical Branch (UTMB) described how telehealth technologies and mobile communications have helped the university face significant healthcare delivery challenges. He was speaking at a panel discussion held at Bookings Institution on April 19th held to discuss modern emergency preparedness activities.

Dr. Vo one of the authors of the White Paper “UTMB Telemedicine Disaster Response and Recovery: Lessons Learned from Hurricane Ike” discussed how UTMB was able to manage and use telemedicine technology when Hurricane Ike hit Galveston Texas on September 12, 2009. That hurricane turned out to be the most destructive hurricane ever to hit the continental U.S.

UTMB immediately activated its Incident Command System and Emergency Plan that released nonessential personnel and prepared for patient evacuations several days before Ike’s arrival. Due to the evacuation of Galveston Island and a significant portion of Houston, many residents were without access to local medical care and few primary clinics were available to use for non-emergency medical care.

UTMB’s county telemedicine patients were part of this displaced group and did not have access to non-emergency care. By using cell phones, the UTMB telemedicine team moved their patient scheduling system to cell phones used by UTMB team members.

Within the first post Ike recovery week, UTMB used the cell phones to establish physician primary care consultations for the displaced telemedicine patients residing in and around the Houston area. In addition a statewide primary care telephonic physician consult service was put in place and enabled patients to call and speak with a primary care physician for non-emergency care issues within the first two weeks of the recovery period.

The impact of the hurricane was also mitigated because years ago UTMB decided to build a fault-tolerant system capable of continuing operations despite marked interruptions or disruptions in parts of the system. The concept uses wide grid networks like the kind that exist in the electrical, natural gas, telecommunications, and banking industries. While there may be disruptions to certain components of the grid, the disruptions are localized and do not always hurt the remaining system. As a result of this forward thinking, UTMB’s distributed network of physicians was able to conduct telemedicine clinical sessions with minimal interruptions.

Some of the important lessons learned from Ike:

• Providing the locally-based network with a geographically dispersed group of physicians linked by modern telecommunications can really help reduce disruptions in healthcare

• Developing the protocols needed for mobile communications devices in advance of disasters can really help to ensure the rapid deployment of telemedicine. It is necessary to use mobile communications devices to provide routine care, triage, shelter-in-place medical care, and other services to the affected communities

• It is vital to locate data backup remotely and it needs to be far away from the disaster area. UTMB’s data backup facilities were located in Huntsville Texas, about 108 miles from the parent site in Galveston. Although storm damage in Huntsville was relatively modest compared to Galveston, the geographic separation was inadequate for the size and path of Ike’s destructive path. Also, equipment for critical systems should be housed at main data centers to allow for easy access and deployment

• Network design that reduces the reliance on individual failure points such as network hubs can limit service disruptions. The network at UTMB is now being reconfigured so that an outage at a hub would only affect one satellite site

• Written plans that identify critical systems and ways to protect, conserve, continue, recover, and restore the systems are all crucial elements needed to incorporate into disaster preparedness plans.

Dr. Vo emphasized that there are many telemedicine programs actively involved in providing care. In the 90’s UTMB worked with grant programs 90 percent of the time but now they only work on grant programs about 5 percent of the time which means it is very important to develop mechanisms to sustain projects many years beyond the grant period. As he noted, sustainability, interoperability, and productive reimbursement policies are essential today for telemedicine and telehealth projects to succeed and operate effectively.

For more information on the UTMB program, email Dr. Alexander Vo at