Chasing Paper

This article is reprinted with permission from Brad Stone of Newsweek.

Millions of irreplaceable documents were destroyed by Hurricane Katrina and are at risk from Rita. Will the catastrophe jumpstart efforts to digitize important records?

By Brad Stone
Updated: 4:51 a.m. MT Sept 21, 2005

Sept. 21, 2005 - Earlier this week, attorney Weibke Breuer and her boss, Matt Greenbaum, went back to the ravaged city of New Orleans to see what was left of their law office. Driving 200 miles from their temporary set-up in Jackson, Mississippi, the displaced lawyers, who specialize in Social Security disability claims, headed to their building across the street from the Louisiana Superdome and trudged up 15 flight of stairs to survey what they imagined would be utter devastation. What they saw shocked them. "Surreally, the office was just as we left it," Breuer says. The firm still keeps most of its case records on paper, in file cabinets that were fortunately untouched by the storm. Yet down the street, Breuer says, another building housing many law offices had lost nearly half its windows on one side. "I don't think a lot of paper in there survived," she says.

Across the Gulf Coast, people are taking stock of what remains. Hurricane Katrina inflicted incalculable billions in damage, altered millions of lives and destroyed thousands of small companies. Another one of its biggest blows may have been to an old-fashioned way of doing business-on perishable, irreplaceable paper records that are easily destroyed by water and scattered by wind. The storm left many evacuees without drivers' licenses, wills, credit cards or health care records - something for which the disjointed government response didn't plan. Without these paper records, the storm victims face fundamental challenges getting back on their feet in the 21st century economy.

In response to the disaster - and the looming threat of Hurricane Rita - local officials, volunteer organizations and the federal government have started to beat the digital drum. They want to move from paper-based records to computerized records that can be stored off site, backed up cheaply and moved easily out of harms way. There are reasons to embrace technology that helps hospitals, law offices and citizens fully join the digital economy, but there are also reasons to move prudently - and not simply reactively in the wake of a major disaster.

Health care: More than a million people were separated from their primary care physicians, hospitals and pharmacists during the disaster, shining a fresh spotlight onto the debate over electronic health care records (EHRs). For the past decade, health care experts have tried to push paper out of doctors' offices in favor of computerized records. But in the absence of federal grants, most health-care providers have opted to spend their own money on more practical concerns, such as new MRI machines that quickly earn back their investment.

For that reason, a majority of the health care providers on the Gulf Coast operated paper-based offices. When Katrina struck, hospitals couldn't send their records out of the region and evacuees had no documentation of their health conditions and drug regimens. Ad hoc clinics at evacuation sites such as the Houston Astrodome set up new computer networks to register evacuees, but doctors mostly had to start from scratch with individual patients.

Since it took office almost five years ago, the Bush administration has been trying to set up a nationwide computer network of patient information. Last week, its point man on EHRs, David Brailer, announced the creation of a central database of records for hurricane victims. But that's just a start. The challenge is offering the financial incentives that will push hospitals to act. Brailer's office is setting technical standards for the new system but doesn't yet have the funding to support a widespread conversion to digital records.

Katrina, however, may serve as a spark. Last week, Brailer's boss, Health and Human Services Secretary Mike Leavitt, appointed a 16-person task force charged with "advising the secretary on how to make health information digital and interoperable." And Leavitt said after the hurricane, "There may not have been an experience that demonstrates, for me or the country, more powerfully the need for electronic health records."

Financial services: Thousands of evacuees fled Katrina's winds and the rising tide waters without bringing along any trace of their old lives. In many cases they had nothing: no IDs, check books or ATM cards. It was a new twist on the modern scourge of ID theft, except in this case, the perpetrator wasn't human but Mother Nature herself.

Unlike health care, the financial services industry has seen the creation of numerous databases and open markets where - usually to our collective chagrin - personal information is bought and sold like specialty cheeses at a farmers' market. In the case of Katrina, these databases were valuable in helping evacuees replace their identities. For example, ChoicePoint (the firm that earlier this year exposed millions of customer credit card numbers to hackers) gave volunteer organizations access to its databases to confirm identities of victims filing to receive benefits.

State governments, not surprisingly, lag behind private industry in digitizing records. To enable Katrina evacuees to replace their driver's license, for example, local Department of Motor Vehicle offices checked Social Security numbers against the Web site of the Social Security administration. But for years states have lobbied the federal government for a more seamless system. They want money to upgrade their computer DMV networks and link them together so that, for example, the DMV in one state can make real time requests to the DMV in another state for an applicant's driving history. The states also want to store and exchange electronic copies of personal documents, such as birth certificates.

Those provisions were finally passed earlier this year as part of the Real ID Act, the law that will outfit each American with a federally issued, machine-readable identification card that will store pieces of our personal information. But states won't get the federal dollars to fully implement them until 2008. According to Jason King of the American Association of Motor Vehicles, "The act gives states the capability to build a 21st century drivers' license framework," he says.

Legal Services: By all accounts, the Gulf Coast justice system remains in shambles. Most courtrooms are dark, many evidence rooms are swamped and reportedly more than a third of Louisiana's lawyers have lost their offices. There were 3,000 criminal cases in progress in New Orleans alone when Katrina struck, but the District Attorney might be forced to suspend many of those prosecutions because tangible evidence, including police reports, interview transcripts, fingerprints and DNA samples are lost. "We're going to look at each case and make a determination whether we can carry our burden our proof," district attorney Eddie Jordan told NBC last weekend.

Jonathan Baker, a professor of law at Louisiana State University, says local government lawyers knew they should have modernized a long time ago but "it was a question of money. Improvements have come, but not institution-wide. They were driven by particular people who were able to find the cash in federal pockets."

With Congress approving billions in aid, those pockets are about to get a lot larger. But before they rush to embrace digital records, businesses and government officials need to consider what information they are digitizing and who will be able to access it.

Already some moves to digitize and open access to records full of personal information have privacy advocates worried about unintended consequences. For example, the FBI opened its national crime information database and waved its $24 fee for volunteers and donors who want to ask local law enforcement agencies to conduct background checks on evacuees (if, say, a donor family wants check up on Katrina victims they are considering hosting). Katrina has also sparked discussion of tagging children with RFID chips to help prevent the tragic cases where kids get separated from their parents. While these schemes might sound reasonable now, in a non-disaster context, they're the grist of dystopian sci-fi novels and nightmare surveillance-society scenarios.

Marc Rotenberg of the Electronic Privacy Information Center (EPIC), is among those watching closely the renewed push toward digital records. "I think it's important to distinguish between temporary measures that are necessary to respond to an emergency and permanent changes that may have long term consequences for privacy in the country," he says. He points out that in the rush toward digital technologies such as new databases and RFID chips, the government shouldn't forget that basic human needs-like providing water, food, and a place to sleep-should always come first.