Lessons Learned from Natural Disasters around Digital Health Technologies and Delivering Quality Healthcare

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TL;DR

This mixed-methods review examines the resilience and effectiveness of digital health technologies (DHTs) during natural disasters, using case studies from events such as the 2015 Nepal earthquake, Australian bushfires and floods, and Hurricane Florence. The authors find that while DHTs like telehealth, electronic health records, and mobile health apps have proven valuable for disaster preparedness, response, and recovery, their utility is severely limited by infrastructure vulnerabilities (power outages, damaged telecommunications), the digital divide, and lack of prior planning. The paper calls for climate-resilient DHT design, workforce training, and community co-design to ensure safe, quality healthcare delivery under increasingly frequent and severe climate-related disasters.

Full summary

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**Background:** Climate change is increasing the intensity, duration, and severity of weather-related events that can lead to natural disasters and mass casualties. Digital health technologies (DHTs) — including telehealth, electronic medical records (EMRs), electronic prescribing, mHealth, artificial intelligence, the Internet of Things (IoT), robotics, wearables, and cloud computing — have been rapidly deployed worldwide, particularly during the COVID-19 pandemic. However, the resilience and effectiveness of these technologies in the face of natural disasters remain poorly understood. This review aims to map what is known about DHT resilience in disaster contexts, using case studies to identify what works and what does not, and to propose future directions for building climate-resilient digital health interventions.

**Methods:** The authors conducted a mixed-methods literature review. Electronic databases PubMed/MEDLINE, Scopus, Web of Science, and CINAHL were searched iteratively with no time or geographical limits, using the search string: (digital health technolog*) OR (digital health) AND (natural disasters) AND (healthcare). Only English-language literature was included. Bibliographies of included studies were reviewed, and media publications reporting DHT issues impacting healthcare systems were also examined. The aim was not exhaustive coverage but to capture a breadth of literature contributing to understanding DHT use in disaster preparation, response, and recovery. Narrative analysis and group discussions were used to examine case studies, guided by the UNDRR ISC Sendai Hazard Definition and Classification Review Technical Report, focusing on floods, wildfires, earthquakes, and severe storms.

**Key Results:** Several themes emerged from the analysis:

1. **Infrastructure vulnerabilities:** Natural disasters severely damage the electricity grid and telecommunications. Hurricane Sandy knocked out 25% of mobile phone towers on the US eastern seaboard. Hurricanes Maria and Irma destroyed over 90% of mobile sites in Puerto Rico, St Martin, Dominica, and Antigua and Barbuda. During the 2019–2020 Australian bushfires, smoke and heat caused MRI and CT scanners to stop working in one hospital. During the 2022 UK heatwave, two of London's largest hospitals lost EMR function due to IT infrastructure failure.

2. **Case study evidence:** - **2015 Nepal earthquake (magnitude 7.6):** Killed 8,856 people and injured 22,309. The earthquake debilitated 90% of local healthcare systems. Volunteers used WhatsApp to identify medical resource needs. Major barriers included power outages, stress among relief providers, and limited local capability to use available technology for medical care. - **Australian 2019–2020 bushfires:** 44% of all My Health Records held no information about people seeking help in rural services outside their residence. Where access existed, pharmacies with power and My Health Record information could safely dispense medications. - **Hurricane Florence (2018, North Carolina):** Telemedicine use by shelter evacuees reduced the load on hospital emergency rooms by deferring transport of up to 35% of potential patients who would otherwise have gone to the hospital. State legislation providing for prescription refills without medical consultation in declared emergencies further enhanced the service's utility. - **2010 Haiti earthquake:** The iChart mHealth system, functioning with or without internet connectivity, improved patient tracking, triage, postoperative care, and patient handovers using gas-powered generators and satellite antennas. - **2011 Japan earthquake (Fukushima):** A low-bandwidth, low-cost cloud-hosted EHR using laptops and portable Wi-Fi devices successfully enhanced coordination and communication for the medical response.

3. **Digital divide and literacy:** Access to DHTs and capability to use available technology were major barriers, particularly in resource-limited settings. Community members in Nepal expressed concerns about authorities failing to place digital technologies at the disposal of health services.

4. **Citizen science potential:** Citizens are often first responders. During the 2022 Lismore Floods in Australia, a local business owner used social media to compile the only database of people needing rescue. The AirRater app provided guidance on reducing hazardous environmental exposures from bushfire smoke. The LEO Network enables Indigenous people and scientists to report environmental observations.

**Clinical Implications:** The review demonstrates that DHTs can significantly improve disaster healthcare delivery — enabling continuity of care for displaced populations, reducing emergency department loads, facilitating prescription refills, and supporting mental health services. However, their effectiveness is contingent on: (1) robust, redundant infrastructure (power, telecommunications) that can withstand extreme events; (2) advance implementation and population uptake of systems like national EHRs; (3) workforce training in both DHT use and disaster response; (4) addressing the digital divide to ensure equitable access; (5) incorporating non-digital backup pathways; and (6) co-designing systems with communities, including citizen scientists. The WHO's Operational Framework for building climate-resilient health systems and the Sendai Framework for Disaster Risk Reduction 2015–2030 provide guidance, but specific frameworks for climate-resilient DHT infrastructure remain scarce. The authors call for future research on making DHTs function under extreme climate events while minimizing their carbon footprint, and on developing sustainable, repairable, recyclable DHTs with long shelf-life.