Most Wired, HIT, preparedness, redundant technologies, backup systems, disaster recovery

A week of storms and earthquakes in August sent a collective shiver down the spines of hospital executives and disaster recovery managers. It was a familiar chill, similar to one that many felt in 2005, during Hurricane Katrina.

First, a 5.9-magnitude earthquake rattled the East Coast Aug. 23. Then, before nerves could settle, northbound Hurricane Irene made landfall in the Carolinas, with Washington D.C., Philadelphia, New York and Boston directly in the path of its 100-mph winds.

Days before Irene's arrival in Connecticut, Ed Fisher, vice president of information technology services at Yale New Haven Health System gathered his team.

"We discussed recovery scenarios, everything from high winds to flooding and power outages," Fisher says.

Hospital information systems are more complex than ever and reliance on information technology is firmly entrenched in organizational success. Backup and recovery mechanisms are essential. Using redundant technologies at multiple sites, Yale New Haven facilities like Bridgeport Hospital can have remote-hosted clinical systems back on the air in four hours or less, depending on the disaster. Business systems have a slightly longer recovery time.

Good plans don't avert disaster, they remove surprise from the equation. Prudent hospitals and health systems review their disaster recovery plans once or twice a year.

Christopher Cannon, international administrator of the Yale New Haven Center for Emergency Preparedness and Disaster Response, says today's more encompassing recovery environment for hospitals, which includes people, processes, equipment and facilities requires a more comprehensive business continuity approach.

Cannon says hospitals historically have done a good job in preparing for community-based disaster response, but not as good a job in preparing hospitals themselves in the event they're included in the disaster.

"Many hospitals aren't adequately prepared for internal disasters or disaster recovery," he says.

Barriers to preparedness include lack of executive support and funding. "Adequate funding for business continuity planning requires a shift in priorities of a hospital's IT disaster recovery efforts that are more inclusive of other operations," Cannon says. The result should be a culture of preparedness that takes a holistic approach with business continuity plans for all essential departments and service areas of the hospital.

System outages compromise patient safety when important diagnostic information and decision support tools are unavailable to clinicians.

"Even short periods of exposure can increase business risk and lead to considerable costs and loss of revenue for the organization," says Tom Winter, IT manager at Columbia Memorial Hospital in Astoria, Ore. "For these very reasons it is incumbent on us to provide and implement reasonable disaster recovery plans."

Winter says Columbia can recover clinical and business systems from complete server failure in one hour or less, all while maintaining access to clinical information through a redundant archive. "If we lost both servers in two campus locations, we could still recover in about 24 hours," he says. It also takes Columbia's clinics up to 24 hours to restore operation, although there are plans to increase redundancy there as well, Winter says.

Columbia performs annual disaster drills if it doesn't actually have something resembling a disaster that year. Hospital renovation over the past 18 months sometimes felt like one. "We've had opportunities to recover from system interruptions," Winter says.

So far, Columbia has experienced only one major server-related failure. A storm knocked out power and communications for four days. Despite losing main servers, Columbia was able to maintain its electronic health record system. "Like the storm, our drills are not completely unannounced, but happen with little warning," Winter says.

Fisher says what drives Yale New Haven's disaster plan is a desire to deliver effective, safe, high-quality health care, no matter what. Banks and airports may close in calamitous times, but the public expects hospitals to remain open — especially during disasters.

"Health care executives still have Katrina in the backs of their minds, asking, 'Are we prepared?'" Fisher says.

Douglas Page is a freelance writer in Pine Mountain, Calif.