After the Storm

If any organization can be said to have weathered a storm, it is Ochsner Health System. The organization, known as Ochsner Clinic at the time of Hurricane Katrina in 2005, has expanded and changed. After Katrina slammed into New Orleans and the below-sea-level city's levees broke on Aug. 29 of that year, a series of developments unfolded that caused great devastation to the Crescent City and made headlines around the world. Importantly, the executives at the Ochsner organization had planned extensively for a hurricane; and though ultimately the vast scope of Katrina did cause some system failures, Ochsner was among the few New Orleans hospitals able to function continuously during the storm and in its long aftermath. Even more importantly, Ochsner executives have converted what they learned in Katrina into even more comprehensive and rigorous disaster planning for the future.

In fact, reports Ochsner Vice President and CIO Lynn Witherspoon, one of the main developments of the past two years has been the creation of a regional health information organization (RHIO) that was created in pilot form and that Ochsner officials and other healthcare leaders in Louisiana hope to obtain funding for on a semi-permanent or permanent basis.

In fact, Witherspoon has been actively involved in lobbying for continued funding to keep the south Louisiana health information exchange (the term HIE is often used interchangeably with RHIO) going, arguing that the gains made by it need to be reinforced by ongoing funding and support from all stakeholder groups. The RHIO's stakeholders include Ochsner Health System, Our Lady of the Lake and Baton Rouge General Hospitals in Baton Rouge, Louisiana State University, Catholic Charities, and Blue Cross Blue Shield of Louisiana.

Of course, the same catastrophic events that led to the unprecedented level of cooperation among groups in south Louisiana have also changed Ochsner's planning for the future. After Katrina, numerous area hospitals ended up being closed permanently or semi-permanently, and the large Tenet Corporation chose to divest its Louisiana hospitals, selling three of them to Ochsner — a development that created the Ochsner Health System. Now, instead of preparing for future disasters with just the former Ochsner Clinic (hospital) in mind, Witherspoon and his colleagues have to think system-wide.

If another hurricane the strength or impact of Katrina comes along, Witherspoon says, being able to allow as many clinicians as possible to remotely access electronic patient records will be vital. What's more, the Ochsner folks have built a complete disaster command center at the main hospital facility. "One of the biggest issues after the hurricane was communication," Witherspoon says. "It was so difficult to know what was going on elsewhere. Since then, the community has created a Web site that tells everyone about bed availability and ED status, and that site is available, and we and other hospitals contribute to it daily."

And, like UCLA's leaders (see coverage in our West Coast region), Witherspoon says he and his colleagues believe that drills and rehearsals, and having a nailed-down, highly detailed and thought-through,disaster plan, are vital. Beyond that, he says, "All of us have disaster plans ... and most practice a plan at least once a year, and I certainly advise that. But certainly, most of us fail to think beyond the first day or two. And we need to think about what might happen in terms of what happened here in the days, weeks and months following a disaster. And we CIOs need to elevate our sights a little more comprehensively with regard to our organizations, and also with regard to the communities. It's really become about the community."

Keeping cash secure

In addition to comprehensive planning, hospital organizations are also working to secure specific aspects of disaster recovery, especially financial records. In Southeast Texas, Nancy Dumas, a regional administrator with the Business Services Group at the HCA-Hospital Corporation of America (headquartered in Nashville), which provides practice management and business office services for emergency physicians affiliated with Greater Houston Emergency Physicians, says that, for physician-focused organizations like hers, disaster planning "is really imperative, because we're a company that relies on other people to provide every piece of our business. We rely on the hospitals to provide the patient records we need to do our billing," which means that in the event of a shutdown of business processes, her physicians could quickly spiral into cash-flow and financial troubles.

She and her colleagues have turned to DST Systems Inc., Kansas City, Mo., to facilitate the day-to-day financial process for the Houston and Corpus Christi emergency physicians, and to protect records and processes in the event of a disaster. Dumas says she and her colleagues have learned a lot from past natural disasters.

"When Tropical Storm Allison hit in 2001, it shut down one of our hospitals for several months," she recalls. "And when that happened, we had to deal both with the clinical aspect of having our doctors and patients taken out of the hospital in a boat, and our records at that time were all paper, and the first floor, with the emergency room, some of our medical records were destroyed."

The emergency departments involved in Houston and Corpus Christi are currently transitioning to full EMRs, with paper documents now being immediately scanned into the system and retained offsite with DST. The company's ASP model appealed to Dumas and her colleagues as managers of geographically diffuse, disaster-vulnerable processes.

Practice makes perfect

And in the rain-pelted Southeast, practice is seen as essential to disaster recovery planning success. And that's as true at military hospitals as at civilian ones. A good example of this is at Martin Army Community Hospital, on the campus of Fort Benning, Ga. Managers and clinicians at the 250-bed facility very regularly drill in preparation for natural disasters and other emergencies, confirms Keisha Atwood, system administrator for the hospital's clinical information system (whose vendor is San Diego-based CliniComp Intl.).

One of the key learnings, Atwood says, is that drills uncover many gaps and vulnerabilities to be addressed. Being a military organization, she says, preparedness drills come naturally. Still, even military hospital personnel can be taken off guard, as happened earlier this year when a civilian plane had trouble bringing down its landing gear, and Martin Army Hospital personnel were put on what is called a "mass casualty" alert. Fortunately, the organization had drilled for such an incident, and though in the end the situation resolved itself positively, the army hospital clinicians and staff were prepared.

Having all their information constantly mirrored to a CliniComp-facilitated data center in San Diego has also been a key element in the hospital's plan, Atwood confirms.

Sidebar

Ochsner Health System Vice President and CIO Lynn Witherspoon and colleagues have made a large number of changes in the past two years. Among them:

• Drilled a second water well on the main facility's property for sustained water supply in the face of another disaster;

• Added additional generator power and more cooling units (it was the inability to keep the main facility's data center cool that led to a short-term draw-down of its computer system in the wake of Katrina);

• Created remote mirroring at a site elsewhere in the region;

• Created browser-based access for all appropriate clinicians to the organization's EMR, including to several specialist physician groups in the area;

• In the process of rolling out the former Ochsner Clinic's EMR across the now four-hospital system (the former Tenet hospitals had a different EMR product installed; a unified PACS system is already in place across the whole system).