{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T07:59:55Z","timestamp":1790236795210,"version":"4.1.0"},"reference-count":25,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"unspecified","delay-in-days":266,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Disaster med. public health prep."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u2019 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.<\/jats:p>","DOI":"10.1017\/dmp.2026.10444","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T07:13:08Z","timestamp":1790233988000},"source":"Crossref","is-referenced-by-count":0,"title":["Hurricane-Resilient Electronic Medical Records: A Distributed Architecture for Small Island Developing States"],"prefix":"10.1017","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0893-1335","authenticated-orcid":false,"given":"Dennis","family":"Quijano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"S1935789326104443_r2","volume-title":"Hurricane Dorian: PAHO\/WHO Response Situation Report 3","year":"2019"},{"key":"S1935789326104443_r14","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2019.00149"},{"key":"S1935789326104443_r15","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2010.0119"},{"key":"S1935789326104443_r16","article-title":"Data privacy in healthcare: global challenges and solutions","volume":"11","author":"Conduah","year":"2025","journal-title":"Digit Health."},{"key":"S1935789326104443_r18","volume-title":"NOAA Technical Memorandum NWS NHC-6","author":"Blake","year":"2011"},{"key":"S1935789326104443_r20","volume-title":"National Hurricane Center Tropical Cyclone Report: Hurricane Irma (AL112017)","author":"Cangialosi","year":"2018"},{"key":"S1935789326104443_r7","first-page":"69","article-title":"Emergency and disaster preparedness for chronically ill patients: a review of recommendations","volume":"6","author":"Tomio","year":"2014","journal-title":"Open Access Emerg Med."},{"key":"S1935789326104443_r21","unstructured":"21. World Bank. Current health expenditure per capita (current US$)\u2014Bahamas, The. World Bank Open Data\/WHO Global Health Expenditure Database. Data for 2023. Accessed July 2026. Available at: https:\/\/data.worldbank.org\/indicator\/SH.XPD.CHEX.PC.CD?locations=BS"},{"key":"S1935789326104443_r24","doi-asserted-by":"publisher","DOI":"10.1111\/disa.12545"},{"key":"S1935789326104443_r12","first-page":"386","volume-title":"Stabilization, Safety, and Security of Distributed Systems. Lecture Notes in Computer Science","volume":"6976","author":"Shapiro","year":"2011"},{"key":"S1935789326104443_r9","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph110606335"},{"key":"S1935789326104443_r23","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.01119"},{"key":"S1935789326104443_r3","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2005.084475"},{"key":"S1935789326104443_r8","doi-asserted-by":"publisher","DOI":"10.1097\/DMP.0b013e31816452f0"},{"key":"S1935789326104443_r11","doi-asserted-by":"publisher","DOI":"10.2196\/45242"},{"key":"S1935789326104443_r10","doi-asserted-by":"publisher","DOI":"10.2147\/RMHP.S12985"},{"key":"S1935789326104443_r1","volume-title":"Hurricane Dorian (AL052019) 24 August-7 September 2019. National Hurricane Center Tropical Cyclone Report","author":"Latto","year":"2021"},{"key":"S1935789326104443_r19","doi-asserted-by":"publisher","DOI":"10.1175\/JCLI-D-11-00026.1"},{"key":"S1935789326104443_r25","doi-asserted-by":"publisher","DOI":"10.1007\/s11069-020-04197-0"},{"key":"S1935789326104443_r17","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.40.9.9686"},{"key":"S1935789326104443_r13","doi-asserted-by":"publisher","DOI":"10.1260\/2040-2295.6.3.325"},{"key":"S1935789326104443_r22","doi-asserted-by":"publisher","DOI":"10.5334\/aogh.4755"},{"key":"S1935789326104443_r4","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2007.0031"},{"key":"S1935789326104443_r6","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(18)30209-2"},{"key":"S1935789326104443_r5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1803972"}],"container-title":["Disaster Medicine and Public Health Preparedness"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1935789326104443","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T07:13:12Z","timestamp":1790233992000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1935789326104443\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":25,"alternative-id":["S1935789326104443"],"URL":"https:\/\/doi.org\/10.1017\/dmp.2026.10444","relation":{},"ISSN":["1935-7893","1938-744X"],"issn-type":[{"value":"1935-7893","type":"print"},{"value":"1938-744X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e158"}}