In the wake of this month's wildfires, residents of Southern California may not be sleeping in their beds, but at least they should have access to their meds. Once the president declared a state of emergency in the area, a public/private initiative known as ICERx.org went into action. Established in 2005 in the wake of Hurricane Katrina, the prescription history service makes available vital medical records to personnel in an emergency zone.

The system has a lot of moving parts, bringing together a wide range of groups who may have access to patients' pharmaceutical histories. Partners include the American Medical Association (AMA), Informed Decisions, the National Association of Chain Drug Stores (NACDS), the National Community Pharmacists Association (NCPA), RxHub, and SureScripts. The organization has no budget, as all partners donate their services pro bono.

It works like this. When emergency workers need access to patients' drug histories, they call the AMA on a toll-free line. The AMA validates their credentials and grants them passwords giving access to the ICERx (In Case of Emergency Prescription) web portal.

"A critical piece in the delivery of ICERx.org is a concise user interface that allows the prescriber to quickly find the information he or she needs, when treating patients in an unpredictable and potentially unstable environment," said Kathy Mosbaugh, executive vice president of Informed Decisions.

Through the portal the practitioner can find a listing of prescription medications taken by the evacuee including quantity and day supply, the pharmacy that filled the prescription, and the provider who wrote the prescription.

"We try to make it very simple for the people who need the information to get to the information," Mosbaugh said.

Through prescription management services like RxHub and SureScripts, the system is able to pull data from community pharmacies, pharmacy benefit managers, and state Medicaid programs. Mosbaugh estimates that these services together can provide drug histories on 70- to 75 percent of all Americans.

Participants connect to the system via a proprietary ASCII-based messaging tool. This connectivity arrangement incorporates standardization tools crafted by the National Council for Prescription Drug Programs, Inc. (NCPDP) and by Health Level Seven, one of several American National Standards Institute (ANSI) -accredited standards developing organizations operating in the health care realm.

All this falls within the context of a HIPAA-defined Standard Transaction Format.

Even with the pipe in place to connect all players to the system, Mosbaugh says it still took a lot of planning to connect the dots. When doctors call the hotline, for instance, the AMA has to have ready access to the ICERx system in order to deliver valid pass codes.

The California fires will be an important test of the system, as this is its first full-scale implementation since being organized in the wake of Katrina. If all goes as planned, medical personnel will have access not just to patient histories but also to clinical-decision support tools including drug identifiers and drug interaction data.

This information is a key piece of the puzzle in an emergency, Mosbaugh said With thousands of evacuees in need of help, "you need whoever can give their time to help you, and they may not all be familiar with all the medications," she said. When pediatricians are caring for the elderly, for example, "they may not be used to prescribing the medication you are taking."

All of this centers upon the partners' open exchange of confidential, personal medical information. This ought to ring HIPAA bells, but organizers say the system is in the clear.

A 2002 HHS revision to HIPAA gave providers, payers, and claims clearinghouses the right to exchange patients' protected health care information without the patient's consent when the information is needed for treatment. Mosbaugh said ICERx is covered. "This information is only being accessed in the instance of providing care, and for no other reason, and only in time of emergency," she said.

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