On California’s Big Sur Island, the Cloud Proves Critical to Patient Care

Natural disasters have become inevitable in California, as in 2018 alone, the state experienced 12 states of emergencies. This means that provider organizations in the region—especially those that are located in areas where care delivery options are extremely limited for patients—need to constantly be prepared for the expected as well as the unplanned.

As the only full-service healthcare facility for a 100-mile stretch of California’s central coast, Big Sur Health Center resides on a rugged and mountainous section of the coast, comprised of a single winding, narrow highway with one lane going in each direction that has been closed more than 55 times as the result of landslides.

In 2016, the infamous Soberanes Fire that burned 57 homes and more than 130,000 acres along the Big Cur coast was followed up in early 2017 with torrential rains, day after day. With nothing to hold the hillsides in, Big Sur experienced two major mudslides that blocked the highway and closed people in from the south, leading to the collapse of the Pfeiffer Canyon Bridge. Because approximately 75 percent of Big Sur Health Center’s patients lived south of the bridge, they were literally stuck on what came to be called “Big Sur Island,” meaning there was no way in and no way out, save for helicopter.

As Sharen Carey, executive director at Big Sur Health Center, recalls, the medical center—which provides primary and preventive services for all ages and conducts 3,500 patient visits annually—lost all power in February 2017 during those mudslides, resulting in a 10-day closure. “During that time, we were not only trying to take care of patients by telephone, but we had the added difficulty of trying to figure out how to take care of them remotely,” says Carey.

Although Big Sur Health Center began using a cloud-based electronic health record (EHR) from eClinicalWorks in 2009, the organization’s executive believe that the decision truly paid off during that winter of 2016 to 2017, when the landslides and bridge collapses left the community isolated. “Being on the cloud allowed us to carry on business without physically being in the health center,” says Carey.

Because the EHR was on the cloud, the health center’s medical director, Brita Bruemmer, M.D., was able to work from home, enabling her with remote access to patient records. Even though the facility was closed, its telephone answering service would pick up patients’ voice messages two times a day, and if the need was urgent, the call was immediately put through to a doctor. Dr. Bruemmer was able to remotely access the EHR to see which medication refills were appropriate and then transfer those prescriptions to the local pharmacy that the patient used, explains Carey.

Bruemmer would then drive around to the local pharmacies at the end of the day to pick up the medications, securely seal them in a brown paper bag with the right patient’s name on each one, and take them to the specialized helicopters that would fly in, pick up anyone who was going down the coast, as well as the medications, and fly them all over the downed bridge. “Without the ability to have [remote] access of medical records, you could imagine how cumbersome it would be to figure out which medical refills were appropriate, and if there was a new problem that needed [attention],” says Carey.

She gives a specific example of patients who were experiencing medical symptoms and needed to go to the ambulance crew to get evaluated by a paramedic, who would then call Big Sur Health Center with the evaluation so a doctor there could prescribe a medication. “Without being able to look at the medical record and make certain we weren’t giving a medication that the patient would be allergic to, or that was contraindicated with his or her current medications, we would be very challenged to effectively transmit those prescriptions and make certain the process was done in a safe manner,” Carey attests, further noting that the likelihood of medication errors becomes greatly reduced since the computer screen offers clear visibility that handwriting often does not. “And if there is any contraindication when you put the medication in, the system flags you with an alert that there is a problem,” she adds.

Since Big Sur Health Center has a staff of just eight people with all its providers working only part-time, there are only enough resources for an IT consultant rather than a full-time professional in-house. Accordingly, the medical center’s leaders knew they needed an EHR on the cloud so they would have strong backup sources so that if one site goes down, another is still accessible.

And of course, on Big Sur, tomorrow is always a new day. “It’s not if we will have another disaster, but rather when it will be,” says Carey. “It’s reassuring that we don’t have to count on one location to make sure we have access at all times.”