Lessons from Hurricane Maria: Puerto Rico and the Importance of Disaster Preparedness

HX360 recently spoke with Luis Belen, CEO of the National Health IT Collaborative for the Underserved, Inc., a non-profit organization catalyzing the development and use of health information technology (HIT) to address health disparities and attain optimal health for underserved communities.

Over the past few years, from the streets of Houston to a hospital in the Bronx, from the halls of Congress to meetings at the White House, the National Health IT Collaborative for the Underserved (NHIT Collaborative) has accomplished a great deal in service to underserved communities nationwide.

The NHIT Collaborative aims to engage underserved populations in the development and use of health information technology (HIT) as a means to support and sustain health equity and economic viability. Something happened on Sept. 20, 2017, though, that caused the organization to stop in its tracks: Hurricane Maria.

“When a disaster like Maria happens, it simply can’t be business as usual, “Belen explained.

Accordingly, the NHIT Collaborative, with guidance from PricewaterhouseCoopers (PwC) and supporting partners, immediately launched the NHIT Care Campaign to help rebuild the health IT and healthcare infrastructure in Puerto Rico and the U.S. Virgin Islands (USVI).

The Campaign has been focused on restoring the health care safety net, providing emergency medical response, healthcare supply chain and technology-enabled care coordination to expand the capacity of Federally Qualified Health Centers (FQHCs) to provide care in the impacted areas. The goal: To bring FQHCs and supporting primary care facilities back online and to provide access to care for the islands’ underserved populations.

For Belen, the mission in Puerto Rico was also personal. Not only is he from Puerto Rico but he lost two aunts in the disaster, with a third aunt requiring brain surgery one week after she fell in the aftermath of the hurricane.

The Importance of Community

As in the rest of the United States, FQHCs and affiliated community health centers are a critical part of the healthcare system in Puerto Rico and USVI, serving underserved areas and populations, specifically those who are at or below 200 percent of the federal poverty line.

The 24 FQHCs and affiliated health centers distributed across Puerto Rico and USVI support comprehensive services including preventative health, mental health and substance abuse, and transportation and care coordination with hospitals and specialty care services for more than 450,000 patients (11 percent of the population of Puerto Rico and USVI) and accommodate more than 1.7 million patient visits. FQHCs and associated clinics represent the only healthcare providers in some of the more rural and underserved parts of the islands.

Because of the NHIT Care Campaign, Sprint, Healthcare Ready, and partners on the ground such as Javier Jimenez, who leads the primary care association across the island’s 21 FQHCs, received and distributed two-way radios to connect and coordinate care in some of the more rural places in Puerto Rico, far ahead of the return of cell phone service, electricity or even water.

The NHIT Care Campaign through its partners Healthcare Ready and Sprint's Emergency Response Team in collaboration with the Information Technology Disaster Resource Center (ITDRC) to restore cellular and internet connectivity and deploy much needed communications equipment to approximately 100 facilities and care providers in the most underserved areas in Puerto Rico.  The campaign included the inclusion of all INSPIRA and PRPCAN identified facilities in Sprint's priority network restoration activities. Sprint also donated 80 two-way radios and 175 Samsung smartphones that were distributed between INSPIRA Health Puerto Rico, Puerto Rico Primary Care Association Network (PRPCAN) and local providers. ITDRC, through its volunteer member resources, deployed satellite internet access, cloud -based telephony services, IT equipment and services, while also providing on-scene technical and logistics support. In addition, several “NHIT Clinic in a Box,” comprised of a laptop, an electronic medical records and billing system and other necessary equipment were prepared for deployment in the region.

For INSPIRA Mental Health Centers, which is comprised of 12 Centers and one hospital, the NHIT Collaborative worked with Sprint and Information Technology Disaster Resource Center (ITDRC) to set up satcomms/Internet, phones and firewalls/routers.

The Silver Lining: Hope for the Future

If there’s a silver lining in any of this, Belen explained, it’s that this experience has given the NHIT Collaborative and its partners a foundation upon which to provide invaluable and sustainable assistance in support of health equity to build thriving communities every day, not just during disasters.

“There needs to be a cultural change,” Belen stressed. “People need to think about disaster preparedness and response not just in terms of a plan but in terms of how to execute and mobilize the ideas you have on that piece of paper, over time.”

Belen added that some disaster response tools are inexpensive and don’t require a significant investment, like mobile phones. The real challenge, though, lies in investing in personnel who can be activated and connected at a moment’s notice.

“If we can mobilize hospital staff in the case of an active shooter in Las Vegas, we can do it in other areas of healthcare,” Belen offered. “We need to figure out how to activate our health system during a disaster, like an Amber Alert, with methods in place to share and access data anywhere, anytime.”

The NHIT Collaborative has a clear path forward, a mission focused on catalyzing innovation and workforce integration, with community always at the center. As Belen concluded, “We have been doing important work as an organization at the local, regional and federal levels, but now it’s time to have a discussion with the national community too.”

Engaging the National Community

In order to involve national and global thought-leaders in the discussion, the NHIT Collaborative, in collaboration with HIMSS and HX360, is hosting the Leveraging Health IT to Address Health Disparities: A Leadership Conference on March 6th – March 7th at the Wynn Las Vegas, bringing together professionals representing multiple stakeholders to devise actionable solutions in the areas of innovation, workforce, research, and policy to enable the effective design and deployment of health IT. Despite considerable benefits, health IT cannot effectively reduce health disparities if it remains out of the hands of safety net providers, such as FQHCs in Puerto Rico and USVI, and the vulnerable patient populations they serve; an issue only amplified during times of emergency. For more information, please visit the website for the NHIT Collaborative