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"Not rain, nor sleet, nor snow…" This used to apply only to the United States' postal service, but today it rings true for almost all organizations.

A health care facility's disaster recovery plan must rise to the occasion when severe weather, terrorism or a simple accident occurs.
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Sept. 11, the North East black out and most recently, the Florida Hurricanes, have raised the importance of having solid disaster plans in place for all companies.

And health care facilities are no exception.

Paper Needs Protection Too!

"Every type of company really has a need for putting disaster plans in place. But for hospitals, as well as insurers and health care providers, it's especially critical because it's a life and death situation," stated Ryan Koopmans, principal, Corigelan LLC.

Most health care organizations have some type of plan in place due to government regulations and legislative bodies, but have these plans thought of everything?

"The most important thing to remember is there are very few health care facilities that are totally electronic today. Almost all hospitals have some clinical electronic systems, but paper records still need to be protected," reminded Carol Quinsey, professional practice manager, American Health Information Management Association (AHIMA).

And Holly Woemmel, director of health information management (HIM) for Health First, Bervard County, FL, can attest to the importance of protecting the paper records. "We always have to buy a lot of hurricane supplies at Health First's Cape Canaveral Hospital in Cocoa Beach, FL. But we had run out of the cellophane wrap to protect the paper records when Hurricane Francis hit, so we ended up with 30 wet records," she told ADVANCE. But by the time Hurricane Jeanne hit Florida, Cape Canaveral's cellophane wrap order arrived. "We wrapped around all the big files and covered them up like mummies before we evacuated," Woemmel explained.

Health First has three main hospitals: a 60-bed hospital in Palm Bay, FL; Holmes Regional, a 518-bed level II trauma center with helicopter flight service in Melbourne, FL; and Cap Canaveral, a 150-bed hospital in Cocoa Beach, FL. Cap Canaveral had to be evacuated during Hurricanes Francis and Jeanne.

"It was very fortunate that we got our cellophane wrap supply, because Jean caused holes in the roof and all the flooding," explained Woemmel.

AHIMA's Quinsey currently lives on the West Coast, and when she was an HIM department manager, she had to make sure she thought of all the possibilities. "What if there was an earthquake?" she would ask herself. "I had to make sure all my shelving units were bolted to walls and were stabilized so they wouldn't fall over and spill records; microfiche file cabinets also had to be bolted to the walls."

Department managers and/or organizational disaster recovery leaders need to step back and take into perspective the disasters that are likely to happen and the best way to prepare for them.

"It's something important to understand, a disaster doesn't have to be on the scale of Sept. 11. It could be a flood from a sprinkler system, a power outage, a lost file, etc.," assured Koopmans. "Putting a solid disaster recovery and business continuity plan in place will meet all those needs," he stated.

Electronic Systems Can't Do it Alone

Speaking of certain needs, what's needed to protect information technology (IT) systems containing patients' medical records? Well of course a backup system is required, but what works the best?

"The HIPAA Security Rule for April 2005 has a big component for disaster recovery, but it's nothing new," Quinsey stated. "IT vendors have been worrying about it for a long time, and many of them have put together protocols where once a day, once a week or once a month-whatever the right timing is, depending on the work volume-they run a backup tape or document that's stored off site so it can be retrieved if a disaster occurred."

South Nassau Communities Hospital (SNCH), Long Island, NY, experienced a manmade disaster when a record was deleted accidentally. Frank Jablonski, FilesX, explained to ADVANCE that SNCH was using FilesX and was fortunately able to retrieve the deleted file.

"FilesX takes a full copy of a disk and then we track changes from then on. So at SNCH, FilesX backed up all incremental changes and put them on its server every 30 minutes," Jablonski explained. "They saved time and money with such a quick recovery."

In addition to having an updated backup system, Quinsey pointed out that a health care facility's backup copy shouldn't be a block away. "I worked for one company that was based in California, but its data was stored in Silver Springs, MD," she offered.

LifeWatch, a cardiac monitoring company that uses telemedicine, has two call centers. "We have a call center in Illinois and one in Boca Raton, FL; different calls go to different locations.

"In preparation for the hurricanes in Florida, we re-routed all calls to the Illinois call center. And because we use an applications service provider, our employees can login to a Web site from anywhere at anytime, enabling them to see each patient's record. There was no lapse in coverage for our patients with potential cardiac emergencies," explained Dan Shwarzman, director of marketing, LifeWatch.

Health First also made sure its centralized IT center is located far enough away. It's located in Rocklidge, FL, about 30 miles from both Holmes Regional and Cape Canaveral. "Our IT guys had us up and functional through the storms. For Francis we only lost power for four hours because the generators ran out of gas, no one expected it to last that long and for Jeanne we didn't go down at all," said Woemmel.

Patients and Finance are Neck and Neck

But for a system not to go "down", more has to be addressed than clinical systems. One of Quinsey's major concerns is that HIM field focuses a great deal on information and clinical systems, but not enough on the business perspective.

"Patient care will always be priority number one, but if financial systems go down, like any business, the impact to the organization can be catastrophic," Koopmans pointed out.

"It's hard to get managers to identify something as seemingly self-serving as payroll as a critically important system, but the reality is if there's not money coming in the door from billing and accounts receivable and there's no payroll system, you're going to be out of business really fast," Quinsey agreed.

Koopmans emphasized to ADVANCE how important it is for health care facilities to understand the data and applications from a business perspective, and to know what the operational and financial impacts will be in a disaster.

Health First has a unique billing situation because of its three separate facilities. Although Health First is now one entity, Holmes Regional and Cap Canaveral are billed under different provider numbers. "So we basically had to discharge the patients from Cap Canaveral and readmit them at Holmes Regional," Woemmel explained.

Despite the organization's electronic documentation system, only the patient's history will pull up from a previous admission. But understanding their situation was key, and a solid plan was put in place. "HIM starts copying the face sheet, history/physical, any consults, living will, ECGs or labs, and any operative or procedure notes. And then we copy the last seven days of physician orders and progress notes because that is still on paper and hand written.

"Then the nurse is in charge of the transfer documentation record, because once the last patient is out of here, we're completely shutdown."

This, of course, leads to a skewed length of stay and seven-day remits, a Medicare detail. "And I spoke with Medicare and it looks like we're going to have to share the DRG money between both facilities," Woemmel stated.

Sharing money in any type of disaster is never sufficient, especially because of added ambulance prices and helicopter expenses from flying the ICU patients to Holmes Regional. And once at Holmes Regional, because it is a level II trauma center, Health First asked the Federal Emergency Management Agency to send the Disaster Medical Assistance Team (DMAT) to help manage all of the patients coming in.

"To put it into perspective, during the first 24 hours of Jeanne, between DMAT and our ER we saw 500 patients, and our average is about 200 tops," Woemmel stated.

"But," Woemmel emphasized, "we're here to serve the community, so that's what has to be done."

Unexpected Issues

Serving the community is why solid disaster plans are implemented, but Woemmel reminded that there are always unexpected issues that surface.

Health First had pre-, during- and post-storm procedures in place, and they do hurricane drills ever year preparing employees, "but you'd be surprised when the big one comes, how many employees can't handle it mentally," she stated. "They want to be with their families, and we're telling them that they can't leave the county."

Woemmel explained that an evacuation is a very stressful time and there is much to remember. "We have an entire staging area, where we take everyone out in the same spot and double check their records, medications, that their IV bag is full, that it's the right patient by checking the arm band, etc."

Stress is not only evident during the evacuation, but after the storm clears as well. "We all have employees with condemned houses and we're very lucky that Health First realized these issues."

Health First put tarps over more than 200 employees' houses for free, provided shelter for many and even stored employees' furniture because it kept raining in their houses. Cash advances and free 24-hour daycare was offered as well.

"Health First really tried to think about what the employees need. They've gone above and beyond," assured Woemmel.

Tricia Cassidy is an assistant editor at ADVANCE.

Copyright © 2004. ADVANCE for Health Information Professionals.