Hurricane-Resilient Electronic Medical Records: A Distributed Architecture for Small Island Developing States.

Hurricane Dorian (2019, GLIDE TC-2019-000099-BHS) permanently destroyed decades of patient records in Grand Bahama, The Bahamas, exposing critical vulnerabilities in centralized health care information systems. This study proposes a distributed electronic medical record (EMR) architecture to maintain patient data availability during and after catastrophic hurricanes in small island states. The architecture connects The Bahamas' approximately 75 community health facilities through regional replication hubs, each maintaining a full local database replica with bidirectional synchronization, enabling autonomous operation when facilities are isolated. An external off-island backup site adds resilience against region-wide events, though site selection must weigh correlated hurricane risk. Critical information, including active medications and allergies, receives priority synchronization under bandwidth-limited conditions. Cost projections indicate feasibility for resource-constrained settings ($2.00 per capita capital cost; $0.59 per capita annual operating cost). Governmental support, including national patient identification infrastructure, would strengthen implementation. This proposed framework awaits pilot implementation and has not been deployed operationally.