The onslaught of 2005 storms that turned New Orleans into a swamp and annihilated the Gulf Coast came as a reminder of the need for healthcare providers to have adequate disaster plans. While many healthcare facilities weathered the storms quite well, others faltered in the catastrophes.
The clarion wake-up call of Hurricanes Katrina, Rita and Wilma is prompting many hospitals to re-evaluate their readiness. A survey of 350 hospital leaders released in October by VHA Inc., a national healthcare alliance based in Irving, Texas, showed that nearly half of them planned to modify their institutions? disaster recovery plans.
Larger hospitals are more likely to revamp their disaster recovery system, the survey revealed. Sixty percent of surveyed hospitals with 100,000 or more adjusted patient days reported they intend to review their disaster policies and evaluate the need for non-cellular communications systems and/or the implementation of a Hospital Emergency Incident Command System.
Experts also suggest that future disaster preparation will likely include regional approaches to organizing emergency medical services and sharing communications systems. One thing is certain?healthcare providers, even those in less disaster-prone areas, are beginning to heed the call for better preparation.
Thinking regionally
Nothing brought disaster preparedness back on the radar of the nation's healthcare providers more than 9/11. But Hurricanes Katrina, Rita and Wilma acted as a reminder of the need for better regional response planning.
Pressure is coming from federal, state and local agencies as well as industry associations, including the Department of Homeland Security and the Joint Commission On Accreditation of Healthcare Organizations (JCAHO), Washington, D.C., says Paul Dimitruk, CEO of PortBlue Corp., a Los Angeles-based business intelligence company. JCAHO has made emergency preparedness one of its seven public policy initiatives and has increased its accreditation requirements in that area, Dimitruk points out. Meanwhile, the Department of Homeland Security has helped fund programs addressing the role of hospitals in emergencies.
Healthcare providers have begun to take into account the need for more regional planning since disasters can cross city and state boundaries, Dimitruk notes. And the growth of hospital networks has helped enable informa-tion sharing across their systems, he adds. Hospitals spend about half as much on information technology as do companies in transportation, finance and other industries, and a vast amount of government spending in disaster preparedness has concentrated on first responders rather than hospitals, Dimitruk explains.
Andy Nunemaker, CEO of EMSystem, West Allis, Wis., believes the regional health information exchange networks show great promise in helping providers deal with large emergencies. California, Indiana and several states in the Southeast have begun to form such networks, he says: "They're working really well together in the South. The problem is one region might be doing really well, and the region next to it may not be doing anything at all."
The Houston-based Southeast Texas Trauma Regional Advisory Council (SETTRAC) discovered the importance of regional planning while dealing with an influx of patients from Hurricanes Katrina and Rita. David Rives, the organization's executive director, says EMSystem's software was used to distribute patients from the Houston Astrodome and a local convention center—both serving as temporary homes for more than 27,000 refugees—to more than 50 area hospitals. Updated hourly, the software helped the agency to direct ambulances to available hospitals across a nine-county region, he says.
SETTRAC used the same system for evacuating some patients from Houston hospitals or diverting them to other facilities, Rives says. His staff reverted to using phones when they sent patients to areas without the EMSystem software. Texas is now considering a statewide approach where organizers could monitor hospital capacity dynamically across regions, he says: "We could see where there are beds available and who could take patients without having to call them."
Another regional approach may come in the communications area. Hospitals affected by a disaster often encounter problems with cell phones because of tower damage or other issues. "Cell phones are not as invulnerable as we thought," says Harry Anderson, director of IT sales at VHA. The alliance found many members in the regions affected by storms were interested in buying satellite phones, but the expense has left them searching for alternatives, he says.
VHA is exploring the idea of buying satellite phones and placing them at several of the 1,500 member hospitals across the alliance's 18 regions. If one region suffered a disaster, the phones could be redistributed to hospitals that need them.
Protecting data
Maintaining regular data backups and multiple storage sites are procedures more hospitals have begun to embrace.
When Ron Kelley, senior director of information services, first arrived at Washington Hospital in Fremont, Calif., the first thing he did was create a better approach to backing up data. "I have found the [backup] technology has been so complex in the past that many times you don't easily understand how to restore [data] and where to restore it," he says.
The hospital eventually chose a system from Evault, Inc., Emeryville, Calif., which backs up clinical and administrative data every three hours at a data center across the street from the hospital. Kelley says the system has performed well in mock drills. He also plans to add a remote backup location, perhaps in Tucson, Ariz., next year.
Dave Ott, vice president of technical services for Next- Gen Information Systems, Inc., a Horsham, Pa.-based practice management vendor, says that application service providers (ASPs) can make sense in disaster situations because the data will be housed off-site and will be available to providers even at remote locations as long as they can access the Internet.
Providers that use ASPs will find "the data will be in a data center and providers will be able to get their data in a secure environment," Ott says. "Since we host the application, too, they will be able to start working right away if they have to relocate staff to another location."
Remote Control
Allowing hospitals to access their data immediately from a remote location has also been the focus of a data synchronization project at Dallas-based Affiliated Computer Services, Inc. By using a host of software tools, a client's data and applications can be accessed without delay from remote locations in case of an emergency, says Kenneth Bradberry, regional vice president of the company's health solutions division. Business process outsourcing clients also test disaster recovery programs without having to shut down their IT departments, the usual procedure in the past, he says.
Data synchronization quickens the recovery process dramatically, shaving hours off a once laborious process of restoring backup tapes. "I think synchronization is where data centers are going," Bradberry suggests. "We're finding our clients have to be able to access data from another location during a disaster, and synchronization allows us to deliver applications and data back to whatever environment in which they're working."
Even a thorough disaster plan can falter amid a particularly challenging event. VHA's Anderson says many hospitals in Louisiana tried to rework disaster plans on the fly, but that approach may not work next time.
Frank Jossi is a freelance writer in St. Paul, Minn.
