Editor's Note: When all the switches are thrown at once

The response to Katrina provided a unique chance to identify the thinnest strands in the health care delivery web.

The battering the Southeast took this fall showed that all health care is local. With Katrina, Rita and Wilma, this year's hurricane season provided an appalling demonstration of how the country's health care delivery network performs at maximum load -- when all the switches are thrown at once. The answer: Not very well. Within hours of the waters flowing over the levees and down the streets of New Orleans and elsewhere, evacuees were separated from their medical identities.

But the response to Katrina also provided a unique chance to identify the thinnest strands in the health care delivery web, from local points of care to the regional and national networks for data, money, resources and services. The process gave officials valuable insight into devising a plan for repairing the health care safety net.

In the end, the work-arounds were often more noteworthy than the system itself. As our reporting on the health care response to Katrina shows, individual bursts of effort and ingenuity often resulted in large-scale returns. That was certainly the case in Harris County, Texas, where an alert medical officer was able to pull together an ad hoc regional network of child immunization registries. And a group that included an industry executive, a military officer, a foundation executive and the country's leader on health information technology policy launched a Web-based medication database in a matter of days.

Ultimately, the response to Katrina showed us that the effort to create a nationwide health record system, which the Department of Health and Human Services' Office of the National Coordinator for Health IT leads, is overdue but on target. Now local jurisdictions and their government and commercial health care allies must commit themselves to a system for sharing health records.

In this special report, we talk to proponents and skeptics of that concept. Indianapolis and Alberta, Canada, are building regional information systems that will be the building blocks of a national electronic health record (EHR) network. Elsewhere, health IT planners are testing a mechanism for sharing information that would enable cross-town competitors to exchange records without endangering their commercial interests. We also examine the inherent difficulties in creating standardized records that can be passed among disparate systems.

Katrina showed that such local IT projects are vital to the health of individual citizens and the country as a whole. In a way, Katrina's storm clouds might have a silver lining. The environmental disaster was horrendous, but the experience could spur completion of a national EHR system, which could save lives during a pandemic or terrorist attack.

-- Paul McCloskey, Contributing Editor

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