One-on-One With Mercy Medical Center CIO Jeff Cash, Part I

June 24, 2011
This past June, Iowa was hit some of the worst flooding in the state’s history, and right in the thick of it was the 370-bed Mercy Medical Center.

This past June, Iowa was hit some of the worst flooding in the state’s history, and right in the thick of it was the 370-bed Mercy Medical Center. More than 4,000 homes in the area had to be evacuated, and the hospital was forced to move 176 patients to nearby facilities. However, despite the fact that water levels rose so high that sandbags had to be piled up outside the doors, physicians were never left in the dark, as the facility’s network, EMR and communication systems stayed up during the entire ordeal. For Jeff Cash, Mercy’s vice president and CIO, it was the ultimate test for his staff’s preparedness.

KH: How long was Mercy Medical Center directly impacted by the flood?

JC: The flood waters themselves impacted us directly for about three days. What happened was, we got hit with the flood on June 12, and that was the day that the water came into the hospital. We made the choice to close our doors to new patients and evacuate our existing patients on June 13.

On June 14, the flood waters started to recede away from the hospital and that’s when we were able to start our flood mitigation. So it was about 48-72 hours after water hit that we had the water receding enough where we could go in and start taking care of things in a serious way.

KH: When you started evacuating, where were your patients displaced to?

JC: We worked with state of Iowa, they have an emergency command center that helped us work through the relocation of about 176 patients that we had in the hospital. Almost all of them were transferred to other hospitals in the state of Iowa. A percentage of them went to another hospital here in our town called St. Luke’s Hospital. Some went to the University of Iowa Healthcare Center, which is a tertiary health center, and the remainder went to smaller hospitals throughout the state.

The state did help us find places and coordinate that. They arranged for the transportation; we had ambulances from a number of services and a number of hospitals, and we also had the National Guard here and they were able to transport some of our patients as well.

KH: So what was the primary driver behind the decision to evacuate?

JC: The reason they chose to close and evacuate that part of the hospital was that as the water continued to come into the basement area, where is where our electrical distribution services are, we had lost power from the city and weren’t sure when that was going to come back. We were running on our generator services; we do have adequate generator power that we could have run for an extended period of time, but at that point we weren’t sure if the water had crested or not. It was a little over five feet right outside the front doors and it was making its way in, so we were concerned that if water got into the switch distribution systems, that we wouldn’t be able to provide adequate electrical power, and we made the choice to evacuate the patients for that reason.

One of the things that happened with the basement was it wasn’t just water from the outside. The way our hospital sits, I guess you might say it was on the west side and south side of the hospital where there is a corner, and the flood waters came up, all the way to the front entrance. They had sandbags stacked five feet outside the building, and the waters came up over the top of those.

The bigger part of the problem for us, however, came in terms of groundwater that had so much pressure outside the facility that it was finding gaps in the foundation itself and there were areas where it actually started squirting in, under pressure, through the foundation. That’s what worried us about the electrical gears, so we had covered most of it with plastic sheets and plastic tarps. It wasn’t so much that the water was coming up from below and going to get into the switch gears — it was coming in from all around.

We also had a back-up of the waste water or sewage system, and we started getting that coming in. The pressure on that was pretty immense as well, in the extent that we had a lot of contracts come to help us during the flood itself. They tried putting what they call rubber bladders inside some of the plumbing fixtures like toilets to keep water from coming back up into them. And in some cases, the pressure was so strong that it burst the porcelain fixtures right off the walls. Water just continued to come in.

The flood water itself was only part of it. We got hit with three areas of flooding: the flood water, the ground water that was making its way into the hospital, and the back pressure on sewage systems. We ended drilling about 60 sand points into the basement of the hospital right through the foundation into the outside ground, and actually sucking water out of the ground through our foundation and then sending it back outside to some piping that we had set up to discharge it in an attempt to relieve some of the pressure from the outside of the building.

KH: How close to the river is your facility located?

JC: We are about 10 blocks from the river that flooded. If you were to draw little circles around the river, I think what they call the 100-year flood plain comes up about three or four blocks, the 500-year flood plain comes another three or four blocks past that, and we’re about three blocks beyond that. So we’re way outside where we ever thought we’d get water. I don’t think water has ever gotten to us in the history of all the flooding we’ve ever had.

KH: You mentioned that one of the biggest reasons for evacuation was the fear that the water could cause electrical damage in the basement. Did Mercy sustain significant damage in the basement?

JC: Fortunately we did not get enough water into our switchgear that caused us to lose them. There was enough water in those areas that we ended up replacing a fair amount of that switch gear just as a precautionary measure. But water didn’t end up getting inside them to the point where we lost power internally, so generator power continued to be available to us, but it was one of those chances we didn’t want to take.

KH: That’s good thinking. So throughout all of this, how were you able to maintain communications?

JC: That’s a great question. There’s two kinds of communication for us: internal and external. We have two data centers here in the hospital, one up on first floor, which was well above all of that, and one on the ground floor, which is sandwiched between the first floor and the basement. We didn’t end up getting any water in our second data center, but we did have water in the ground floor area, so we chose to move our equipment out of the second floor data center and relocate it into our primary data center, just as a precautionary measure.

We were able to maintain information services during the whole program. There was a period of time when we chose to shut down some of our nonessential systems just on a protectionary basis, because although we have ample power supplies for everything, there was concern that for the same reason we evacuated our patients, if we actually dropped generator power from the organization and couldn’t get it back, we weren’t sure we’d have adequate time to do a controlled shut-down of all of our systems before we would run out of battery power. As a precaution, we went ahead and took some measures to shut down some of the nonessential systems. But we kept running the network, the electronic medical record and all the communication systems for the entire time.

We never really went without data center services at all, with the exception of shutting down some of our systems for a short period of time.

KH: What type of communication systems did you use?

JC: Internally, we use Vocera communication systems, so that helped us since we had staff all over the hospital, because our wireless runs off a house UPS system. So the Vocera badges continued to operate, even on emergency power. We use the Cisco voice over IP call manager system for our telephones, so that was beneficial to us because the servers that make that operate, we have one in each data center and they are redundant. Even though we had to close down one data center, as that precaution, we still had one running in our second data center which kept it going.

That turned out to be a blessing as well when we did our relocations, because we had to evacuate the entire basement and ground floor, which was around 240,000 square feet, and that would have included all of our ancillary services like radiology, the emergency department, lab, cath labs, physician offices, our supply area, central sterilization — all of those were located in the ground floor and the basement. To resume operations as a hospital, we had to relocate all those within the facility. In terms of moving them, as long as we could find space and a network drop, it was quite easy. All we had to do was have them put a desk in, take with them their computer and telephone and plug it back in, and they were back in business as just quickly as it would boot up. We didn’t have to have technical people there to rewire and reprogram the computers or the telephones at all.

That didn’t really help us that much during the flood itself, but it helped (in that) we didn’t have a PVX to lose because it was in a single data center. The redundancy of having a call manager in both data centers is what kept our internal communications going.

Being able to use the Vocera for mobility was a wonderful asset. The call managers’ redundancy allowed us to continue to provide services even though we lost a single data center, and the call managers’ portability allowed us to relocate departments after the flood on a very quick turnaround basis.

KH: As far as the patient records, were clinicians able to access EMRs the entire time?

Part II Coming Soon

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