Hurricane Florence: Lessons Learned for HIM Professionals

HIM professionals are offered advice for hurricane preparedness.

EDITOR’S NOTE: At press time, Hurricane Florence, described as an “extremely dangerous” Category 4 hurricane, was headed for the southern North Carolina coast. In a written statement to RACmonitor, Atrium Health, formerly Carolinas Healthcare System, said that its teams “remain focused on the safety of our employees, the coordination of resources across affected healthcare facilities, and most importantly, our commitment to provide the best care for all patients. We are monitoring the situation closely with the most up-to-date information and are working to coordinate care with local and state agencies. We have also activated our emergency operations center to ensure that we are fully prepared in all of our hospitals across the region.  We are currently taking patients from evacuated areas and working diligently to manage our facilities to further assist people evacuating from the affected coastal areas, and our team is well prepared to care for our local patients, communities, and all who need us.”

Slightly more than 12 months ago, Laurie Johnson, a senior healthcare consultant, found herself at Fort Lauderdale-Hollywood International Airport, waiting for, as the Monkees once sang, the “Last Train to Clarksville.” For Johnson, however, it was the last flight to Pittsburgh International Airport. 

In the few remaining minutes before the gate would close, Johnson, her bags packed, sat in the terminal and typed out a dispatch to ICD10monitor on her laptop about hurricane preparations she had just experienced as she was leaving her consulting job in a health information management (HIM) department at a South Florida regional hospital. Hurricane Irma was approaching. Johnson would be among the very last to leave the facility – and when she did, Irma was 700 miles from the region, bearing down with sustained winds clocked at 170 miles per hour.

When Irma finally departed, she had left a reported 134 dead, wreaking havoc throughout the Caribbean islands and, particularly, the Florida Keys.

“Gasoline is in precious supply, the traffic on I-95 is very heavy, the shelters in Miami-Dade County are getting full, there are mandatory evacuations, and bottled water was getting scarce, even on Labor Day,” Johnson wrote. “This is a scary storm.”

Johnson continued to report on the situation, informing readers that in ICD-10-CM, exposure to a hurricane is identified with code X37.0-. (The code for the current hurricane is X37.0XXA).  Johnson noted that this is an external cause code that is listed as a secondary code that will identify all the injuries associated with the hurricane.

At the time of her report, the Official Coding Guidelines for the Coding and Reporting of ICD-10-CM external cause codes had no national requirement for reporting, she added, noting that “A,” “D,” and “S” were available as seventh characters.

Johnson offered recommendations for hurricane preparedness that are valid still today, as the United States is in the middle of the Atlantic hurricane season, with other potential hurricanes lining up like box cars on a freight train across the ocean.

Here’s what Johnson said at the time, on Sept. 8, 2017:

1. Communicate clearly your organization’s expectations to the staff. Everyone is trying to prepare for the hurricane, take care of friends and family, and work their job. This situation brings with it the potential to over-communicate. There should be communication from administration as well as from departmental management. It should include a phone list, including cell phone numbers, the organization’s emergency line, and any other important phone numbers. Encourage staff to check the emergency line frequently, or the method that has been identified, so that staff will know when to report.
2. Prepare early. Time goes by very quickly, and there is much to do. It takes quite a while to prepare equipment and departments for potential damage. For preparations, tape and plastic are needed. Acquire these materials early.
3. Technology takes much time to prepare for transport. All the computers, printers, and fax machines must be covered with plastic and moved from the floor, if appropriate.
4. Consider wind and water damage. It’s the reason all important documents and equipment must be moved from the floor. Each staff member should remove any personal items that are valuable/sentimental to them. Turn bookshelves away from any windows and remove pictures from the walls. References should be packed and taken to a safe location. Remember that good back mechanics must be used during this packing process to avoid injury.
5. Identify medical records/documentation that have not been converted to electronic files. These must be moved into a secure file covered with plastic. These files are important, as they are the only version of the clinical documentation.
6. Plan a debriefing session after the hurricane. Identify what preparations worked and what procedures need updating. You may find as the hurricane approaches that your policies and procedures have not been updated since the last time, and the organization’s (and/or department’s) situation may have changed since the last hurricane.

Health information management (HIM) is the custodian of all patients’ protected health information (PHI). That duty cannot be forgotten, even in these times. That requirement is another reason the HIM department must be prepared well.  

In her summary, Johnson, a senior healthcare consultant with Revenue Cycle Management, LLC, offered this parting advice.

“Please keep all people impacted by Irma in your thoughts in the coming days,” she wrote. “Be safe, and limit your X37.0.”

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