A Unique Use of Regional Information Exchange by a Statewide Health System Serving Refugees: “Operation Allies Welcome”

Abstract

Background In September 2021, a military camp in the United States was identified for an initial relocation of over 6,600 Afghanistan refugees. This case report describes a novel use of existing health information exchange to expedite and provide health care for a large refugee population throughout the state during the duration of their entry into the United States.

Methods Medical teams of the health systems and military camp partnered to provide a scalable, reliable mechanism for clinical data exchange leveraging an existing regional health information exchange. Exchanges were evaluated for clinical type, originating source, and closed loop communication with the refugee camp and personnel military camp.

Results Approximately 50% of the camp residents were under the age of 18 years. Over 20 weeks, approximately 4.51% of the refugee camp residents were cared for in participating health systems. A total of 2,699 clinical data messages were exchanged, 62% of which were clinical documents.

Conclusion All health systems participating in care were offered support to utilize the tool and process set up using the regional health information exchange. The process and guiding principles may be applied to other refugee health care efforts to provide efficient, scalable, and reliable means of clinical data exchange to health care providers in similar situations.

Keywords

electronic health records - vulnerable populations - provider-provider communication - economic barriers - interoperability

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by Indiana University Institutional Review Board. It was deemed a non-human subjects research.

Publication History

Received: 02 January 2023

Accepted: 11 April 2023

Accepted Manuscript online:
13 April 2023

Article published online:
28 June 2023

• References

• 1 “More Than 6,000 Afghan Evacuees Being Housed at Indiana Base.” Associated Press, September 17, 2021. Accessed April 24, 2023, at: https://apnews.com/article/health-indiana-indianapolis-6346b3d099c31b9e6c977bf0e2ac4edc
• 2 Indiana Department of Health. Indiana COVID-19 Home Dashboard. Published March 2020. Accessed May 9, 2023 at: https://www.coronavirus.in.gov/indiana-covid-19-dashboard-and-map/ 2022
• 3 Indiana Health Information Exchange. About Us: Delivering services that make a difference. January 1, 2023. Accessed May 9, 2023 at: https://www.ihie.org/about-us/
• 4 Staff Reports. Mission Complete: Camp Atterbury officially ends work with Afghan refugees. The Republic. January 25, 2022. Accessed May 9, 2023 at: https://www.therepublic.com/2022/01/25/mission-complete-camp-atterbury-officially-ends-work-with-afghan-refugees/ 2022
• 5 Office of the National Coordinator. 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program. Published May 1, 2020. 85 FR 25642. Accessed May 9, 2023 at: https://www.federalregister.gov/documents/2020/05/01/2020-07419/21st-century-cures-act-interoperability-information-blocking-and-the-onc-health-it-certification 2022
• 6 Semere W, Yun K, Ahalt C, Williams B, Wang EA. Challenges in identifying refugees in national health data sets. Am J Public Health 2016; 106 (07) 1231-1232
• 7 Dobrow MJ, Bytautas JP, Tharmalingam S, Hagens S. Interoperable electronic health records and health information exchanges: systematic review. JMIR Med Inform 2019; 7 (02) e12607
• 8 Bozorgmehr K, Biddle L, Rohleder S, Puthoopparambil SJ, Jahn R. What is the evidence on availability and integration of refugee and migrant health data in health information systems in the WHO European Region? Themed issues on migration and health, X [Internet]. Copenhagen: WHO Regional Office for Europe; 2019
• 9 Norredam M, Kastrup M, Helweg-Larsen K. Register-based studies on migration, ethnicity, and health. Scand J Public Health 2011; 39 (7, Suppl): 201-205
• 10 Robertshaw L, Dhesi S, Jones LL. Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research. BMJ Open 2017; 7 (08) e015981
• 11 United National High Commissioner for Refugees (UNHCR). Refugee Data Finder: Born into a refugee life. Updated June 16, 2022. Accessed May 9, 2023 at: https://www.unhcr.org/refugee-statistics/insights/explainers/children-born-into-refugee-life.html
• 12 Department of Health and Human Services, Office of the Secretary. Federal 2020–2025 Federal Health IT Strategic Plan, page 26. Accessed March 8, 2023, at: https://www.healthit.gov/sites/default/files/page/2020-10/Federal%20Health%20IT%20Strategic%20Plan_2020_2025.pdf