In Hurricane Maria’s Wake, a Puerto Rican Health System Emerges Stronger Than Ever

When five-hospital health system HIMA San Pablo sent an imaging contingent from its home base in Puerto Rico to RSNA in Chicago back in 2003, no one in the group could have foreseen how fortuitous their trip to the Windy City would prove almost a decade and a half later. But as it happened, the group selected a technology partner whose products would help keep the system up and running when Hurricane Maria brought the U.S. territory to its knees in September of 2017. To this day, much of the island has no electricity. And through everything, HIMA San Pablo continues to turn to that partner, Novarad, to help provide patients with the state-of-the-art healthcare services they need.

To be sure, it wasn’t just Novarad’s technologies installed at HIMA San Pablo—NovaPACS and NovaRIS, along with NovaMG for mammography image management and NovaCardio for heart-care support—that survived the hellacious storm and its aftermath. Thanks to some prudent planning by the system’s leadership, a sophisticated system of power generators and internal infrastructure safeguards kept the lights on at the hospitals as well as at other facilities operated by the system, including four dedicated imaging centers. 

(One of HIMA San Pablo’s smaller hospitals, a 65-bed facility on Puerto Rico’s east coast, did go dark for several days when its main generator’s diesel fuel ran out. Fortunately, FEMA was on the spot with a temporary solution.) 

Still, it’s no stretch to say that Novarad’s solutions have been instrumental in maintaining operational continuity throughout HIMA San Pablo ever since Maria came and went, leaving behind a trail of mass destruction. In such times, entire communities look to HIMA San Pablo for care services as well as visible signs of stability and normalcy. 

So says Carmelo del Valle, the health system’s director of enterprise imaging.  

“We lost all the communication from all the electrical facilities that give support to us,” del Valle explained. “But each facility has its own PACS server, and we had a plan in place to manually keep each one up and running” on generator power. “The functionality of our PACS and RIS was not affected at any facility. It functioned perfectly during the hurricane and after the hurricane.”

The experience only strengthened his trust in the resiliency of Novarad software, he adds. 

“Over the years I have worked with mainframes, enterprise resource planning software, manufacturing control systems, you name it,” del Valle says. “All of them have different issues. I can tell you that Novarad software is extremely reliable.”

A true ‘high-tech, high-touch’ healthcare system  

HIMA San Pablo’s commitment to care for its communities with topnotch technology as well as humanitarian-level compassion is written into its mission—and is evident at every level of the organization. In fact, its chairman and CEO, Joaquín Rodríguez Sr., JD, was part of the 2003 RSNA team that first selected Novarad. 

Along with up-to-date equipment to support its strong imaging service line—the main hospital alone has five CT scanners—HIMA San Pablo offers such technological touches as a fully robotic delivery system for radiation-therapy patients, state-of-the-art biplane cardiac catheterization lab and all that goes into running the first pediatric neurology center on the island. 

As for sites and facilities, the system operates advanced and specialized centers to care for patients with cancer, primary stroke, epilepsy and multiple sclerosis, along with a maternal-fetal medicine center. It is affiliated with several medical schools and has numerous accreditations, including from JCAHO, the American Heart Association and the American College of Surgeon’s Commission on Cancer. And its catchment area extends to the U.S. mainland, as a number of companies contract with HIMA San Pablo to let their employees benefit by its combination of clinical excellence and attractive pricing. 

Thinking back to what made NovaPACS seem like a good fit for HIMA San Pablo on that 2003 RSNA trip, del Valle recalls being struck by its ease of use and range of capabilities. 

“It’s a complete application and extremely easy to use,” says del Valle, who has been with HIMA San Pablo for more than 20 years (and has worked in IT for nearly 40). “You don’t have to go through cumbersome manuals; everything is in place and very intuitive to find. It’s very easy to navigate.”

Satisfied Specialists

For del Valle, one benefit of turning to NovaPACS has been the happiness of HIMA San Pablo’s radiologists. They might occasionally have an initial negative reaction to a PACS upgrade, he adds, but they always come around once they get used to the solution’s new look. 

“Once they start seeing how the upgraded system works, they always say, ‘It’s okay. I like it now,’” del Valle says. “Beyond that, I don’t see any other issues with the users.”

Meanwhile the only hurdle the radiologists faced in the aftermath of Hurricane Maria was needing to travel site to site in order to read imaging exams. This was solved by scheduling practices to provide each site with 24-hour onsite coverage. 

“They came up with a schedule for each of our radiology groups to read locally at each facility,” del Valle says. “The sending and receiving of radiology reports was not affected. In one satellite site, we did lose the ability to get the reports into the health information systems, but you could see the report in the NovaRAD at the nurse’s station. So even there, the reports were not affected.”

Radiology Business Builder 

The same went for image management involving products from vendors other than Novarad. 

“HIMA saw what a bulletproof application does when you get chaos,” says local Novarad distributor Alfonso Serrano Cortes of Medika Inc., who works closely with del Valle and his team. “When the hurricane hit, we saw that [another vendor’s software] was not doing the work that HIMA needed it to do. It was not letting doctors see some studies. I said to HIMA, ‘Just route those studies to my server.’ They did, and that was it. The doctors could view the studies remotely.”

That’s how NovaPACS works—in an emergency and every day, Cortes underscores.

To this, del Valle adds how impressive the technology has been in supporting HIMA San Pablo’s dedicated imaging centers—before, during and after Hurricane Maria.

“We are sending all those sites’ images through the Internet to our server here in the main hospital, and it is seamless,” he says. “The imaging center staff go into the web application, they print the reports, and they are very happy because the radiologists are reading the studies immediately. They can promise a report in maybe half a day to their referring physicians, which means that their business is going faster than before. They can have more patients.”