The Path to Paperless

Have an EMR Disaster Plan

Practices should learn from Hurricane Katrina.

By Peter J. Polack, M.D., F.A.C.S.

If a natural disaster should strike your medical practice, you need to recover critical information and get back in operation as soon as possible. Many practices got their first test of a disaster-recovery plan during Hurricane Katrina. Those who relied on paper records are still recovering from this catastrophe. The few who had EMR systems and a good disaster-recovery plan in place were able to recover their records resume normal operations.

An effective disaster recovery plan needs to plainly spell out what has to be done, who does what, where is it done, why is it done, when is it done and how is it done. When dealing with electronic systems, actions are primarily focused on protection of critical data.

We use a backup tape system for both the practice and our surgery center at the end of each workday. A courier takes copies of each backup tape offsite for storage in a locked fireproof safe. Using a system like this, one can reconstruct that day's business with possibly just a few hours of lost data.

More sophisticated, and more expensive, backup solutions can be layered on top of this system. These include online remote backup services. But these can be prohibitively expensive for the typical small-to-medium-sized medical practice.

It is very important to periodically test your backup system. We test the previous day's backup by restoring it to a different server that is used for training. If the training database is faulty, we know we have a problem with the backup system. Also, many backup media like tapes have a finite life and need to be periodically replaced. But don't just throw the old ones away. They need to be properly erased and disposed of to protect your practice's vital information.

Don't forget that your plan should ensure compliance with HIPAA regulations. We have all heard about laptops gone missing from the Veterans Administration system and the possibility of patient information falling into the wrong hands. Our couriers are our own employees and both the tape container and the room where they are kept have different keys.

A scenario more likely than a flood is a server failure or a lightning strike to the system. Do you have redundant servers as a backup? Are the hard drives "hot-swappable?" Do you have a redundant power supply?

What is your business continuity plan? Perhaps your office is intact but the streets leading to it are flooded. Do you need to reroute patients to another office? Do you need to cancel appointments for several days? If your practice has more than one location and a disaster renders one office inoperable, a satellite office can become a "hot" site, taking over the function of your main office in a pinch.

Critical paper records should be kept in a fireproof or waterproof safe. This is not feasible for patient records. Documents that cannot be replaced be kept in a separate safe location.

Finally, you should strongly consider business continuity insurance. This can help pay your bills until your revenue stream is back online and could mean the difference between soon getting back on your feet or financial disaster. OM

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