The Path to Paperless

Coming Back From a Natural Disaster

Be resourceful, act quickly and have redundant systems in place.

By Peter J. Polack, MD, FACS

Have you stopped and considered what would happen if a natural disaster wiped out your office? What would you do first? How would you get your practice back in business?

Phillip Bobo, MD, of Emergi-Care, in Tuscaloosa, Ala., learned this the hard way. In practice for 28 years, he suffered the complete demolition of his office by a killer tornado. Because he heeded the bad-weather warnings, there were no casualties among his staff, but his office was not usable for a long period.

Dealing With “Black Swan” Events

Many of us have had to deal with a power outage or severe weather, and we may have a plan on how to handle that type of common situation. These are events that are considered to be above the “Black Swan Line,” according to Dr. Hank Christen, an expert in emergency management and terrorism response. Many consultants in disaster recovery and business continuity have canned plans of action that you can follow in those situations.

But what if you experience an event below the Black Swan Line? There are no existing case studies for these. They are, in essence, a “sucker punch,” says Dr. Christen. Some examples of these include the Hurricane Katrina flooding, the Fukushima nuclear reactor disaster and the massive twister in Tuscaloosa.

In the case of Katrina, medical staff at New Orleans General Hospital saw their facility degenerate from state-of-the-art technology to primitive care when backup rescuers were nowhere to be seen.

What if your town had no power or water for a week? What if your employees lost their homes and had to move out of town to stay with relatives? What if a fire threatened your area and you were forced to evacuate within one hour? And all of your patient records were electronic (and you didn't get around to storing the backups off-site)?

This is the area of business resiliency, where planning isn't enough. Dr. Christen says that the goal is trying to bounce back above the line, where the core capabilities of your business are, and your planning can once again kick in. It depends on the “resourcefulness, redundancy, robustness and rapidity” of your business and its people, and often involves thinking outside of the box.

In Dr. Bobo's case, a combination of quick thinking and some good fortune helped get his business back on its feet. He was able to lease the office building of a local physician who had been deployed overseas. But since it only had half the number of exam rooms that he needed, he also leased a modular building as well as an adjacent parking lot.

Within 17 days, he was back to his normal pre-tornado schedule.

Since these Black Swan events are fortunately rare, it is important to have a good disaster recovery plan for the more likely events. For practices with an EMR system, this means:

► Ensuring that your EMR has a good backup system.
► Having off-site storage of the backup media, preferably in alternating locations.
► Periodically testing the backup media to ensure its integrity.
► Having access to a backup power supply with sufficient reserve to gently power down servers or key computers.
► Considering a standby generator to keep the cooling systems going and prevent hardware meltdowns until they can be safely turned off.
► Keeping a laminated disaster plan available for any personnel that have access in an emergency.
► Considering the use of a “hot site”—a secondary location that can quickly take over for your primary data center, thus minimizing business down time. OM

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multisubspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice management resource for physicians and administrators.