This is SETMA’s story.  The full Harvey story from the Golden Triangle Community perspective will be told in many places by many who lived it.  Recognition of the hundreds and thousands of people affected by the storm and the equal numbers who responded courageously, compassionately and financially will be told elsewhere.  This is the story of one organization and how it responded to this challenge.

In later August, we watched the tracking of Hurricane Harvey for days.  Finally, Harvey made landfall Friday night, August 25, 2017, between Port Aransas and Port O'Connor, Texas, as a Category 4 storm with winds of 130 mph.   SETMA continued to make preparations for our response. 

First, we reviewed our disaster recovery plan which included:

• The ability to notify all employees when all six clinics would be open in Orange, Lumberton, Port Arthur and Beaumont. 
• Security of our information technology infrastructure in case of power outages or flooding.  Automated reporting of power failure or other crisis has been in place for a number of years.
• Safety of our laboratory equipment and supplies.  Because our Lumberton Location is supported by a fuel generator, we had already purchased refrigerators and placed them at that location.  They are kept at appropriate temperatures so they are available when needed and they have secure locks to insure the safety of the supplies which would be stored there.  We also have in place transportation coolers so as to move any medications, laboratory reagents and other heat sensitive materials safely.  We have also made sure that we can chronicle and document this process so as to prove to any inspection or inquiry that the materials were never compromised.
• We had meetings beginning on Friday to make sure that all of our plans, people and protocols were in place, operational and that everyone knew what their roles would be.
• Throughout the weekend, we communicated as we watched the storm’s course and planned our response.
• Throughout the storm and its aftermath, we had either face-to-face meetings and/or conference calls among our Executive and Provider staff, as well as with hospitals, nursing homes and others to coordinate our efforts and maximize the safety and quality of care being given.

SETMA kept all six of our clinics open on Monday, August 28th, but it became obvious that many of our patients and staff would be unable to be at work on Tuesday, August 29th. 

HealthCare IT News

On September 8th, Healthcare IT News published an on-line article, written by Jessica Davis, entitled, “While Harvey exposed health IT hurdles, some providers weathered the storm.” The article told the story of two practices in Houston which had continued to serve patients through the storm and flooding.  The article stated in part, “Devastation wrought by Hurricane Harvey, and likely Hurricane Irma, highlights the pressing need for healthcare EHR interoperability, but a few providers said cloud-based tech help them deliver care when many couldn’t.” 

On September 11th, SETMA’s CEO wrote Ms. Davis about SETMA’s response to the storm:  ”Southeast Texas Medical Associates, LLP (SETMA) with six clinics in Beaumont, Orange, Port Arthur, and Lumberton, Texas, was able to keep all six clinics open until August 28th.  On Tuesday, August 29th, we were unable to keep our offices open but our IT Department maintained our connectivity. 

“Our CEO kept a team in our Call Center open everyday. With a comprehensive EMR in use since 1999, and with a centralized Call Center which connects all clinics and patients, we handled over 1,000 calls a day.  The Call Center was operational August 29th, 30th, 31st, September 1st, 2nd and 4th (Labor Day).  With electronic prescribing, including e-prescribing of controlled substances, ALL patient medication needs and health care inquires were dealt with. All care was documented in the active EMR and follow up needs were communicated to providers by secure text, secure EMR portal and secure cell phone connectivity.  

“As stated, the Call Center was active on the weekend and all day Labor Day.  Two of our clinics opened on Tuesday, September 5th, and two others opened on Thursday, September 7th.  all clinics were opened again on Monday, September 11th.  

“ In addition to flooding, our care was complicated by the loss of all water and then the unavailability of potable water until September 11th.  As of September 11th, we have potable water and for the first time in two weeks, SETMA's reference laboratory will be back on line. Over the past two weeks of no clinic or limited clinic and without potable water, we have used our Future-Lab scheduling capability to maintain continuity of Care with laboratory functions. 

“Until our local hospital care was interrupted by one hospital being evacuated due to no potable water, SETMA maintained EMR connectivity with all hospitals through Citrix, portal and HIE capabilities which never lost connectivity.  The continuity of care was maintained seamlessly due to this connectivity.  SETMA’s provider staff that could get to work maintained uninterrupted service to our patients in the area hospitals and emergency rooms.”

Back to August 29th  -- The First Day SETMA’s Clinics Were Closed

For the almost twenty years SETMA has had electronic medical records, we have always realized that our continuity of care was not driven by personality, i.e., by “each patients’” personal provider being available but by the provider who is available having access to the patient’s robust EMR.  The flooding blocked many patients from being able to come to any clinic and many of staff and healthcare providers were unable to come to the clinic.  But every person who called during the time our offices were closed had personalized care which was supported by their complete medical record.  And, in that all of our clinics operate with the same digital telephone system and all patients call into a central local number no matter what community they are in, that continuity was seamless.

Starting on Tuesday, August 29th, our call center was open and was focused on meeting our patients needs for prescription refills, health counsel and triage of emergencies..  That day, we received and handled over 1,000 telephone calls.  The same was true on Wednesday, Thursday, Friday, Saturday and then on Monday which was Labor Day.  There was no interruption of care. And because of our electronic prescribing, and the fact that every pharmacy in Texas and Louisiana is accessible from our EMR, we were able to make sure that every patient had the medications they needed.

One anecdote which is worthy of relating was a telephone call from a family who had a new born baby and were flooded in.  They could not get to us and we could not get to them.  Their baby had an important medical need.  I asked them, “Do you have a pencil?”  They did and I said, “Please write down this number:  9-1-1.  Call that number and tell them you need a helicopter to take your child to Tyler, Shreveport or Baton Rouge.”  They laughed, having expected a long phone number and did just that.  Problem solved because they had access to their provider’s clinic and to their child’s medical record.

When two clinics opened on September 5th, our Call Center had 2,700 calls that day; the next day, we received 3,600 calls.  In total for that week, not counting Labor Day, we handled over 12,000 telephone calls.  In monitoring the quality and effectiveness of the responses to these calls, it was obvious that these patients received excellent care.

Since September 18th, SETMA’s operations have back to normal completely.  That means we were out of clinic for fourteen working days but our patients were never without access to SETMA and to needed care and counsel.