Have you stopped and considered what would happen if a natural disaster such as a massive tornado or flood 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, Alabama, learned this the hard way. In practice for 28 years, he recently suffered the demolition of his office by a killer tornado – the only medical practice in town that was completely lost. Because he heeded the warnings of meteorologists, he closed shop early as severe weather approached. As a result, there were fortunately no casualties among his staff. But he was out of business for five weeks.
Many of us have probably had to deal with a power outage or some temporarily severe weather, and we may have a plan on how to handle that situation: send the patients who are there home, notify the rest that their appointments are canceled, etc. These are events within the scope of disaster recover and business continuity, considered to be above the “Black Swan Line,” according to Dr. Hank Christen, an expert in emergency management and terrorism response. And many books or consultants who will have canned plans of action that you can follow.
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 twisters in Joplin (see photo) and Tuscaloosa. In the case of Katrina, medical staff at New Orleans General Hospital saw the health care in their facility degenerate from state-of-the-art to primitive – from hand-ventilating patients with untrained personnel to helping patients die comfortably as the hospital flooded – when backup rescuers would not arrive.
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 town and you were given one hour to evacuate? And all of your patient records were paper charts? Or they were on electronic medical records (EMR) system, but 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. And this 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. Since it only had half the number of exam rooms that he needed, he also had to lease a modular building as well as an adjacent parking lot. Within 2 ½ weeks he was back to his normal pre-tornado schedule.
Since these Black Swan scenarios are fortunately rare, it is important to have a good disaster recovery plan for the more likely events above ‘the Line.’ For practices with an EMR system, this means:
- ensuring that your EMR system has a good backup system
- off-site storage of the backup media, preferably in alternating locations
- periodic testing of the backup media to ensure its integrity
- backup power supply with sufficient reserve to gently power down servers or key computers
- considering a stand-by generator to keep the cooling systems going and prevent hardware meltdowns until they can be safely turned off
- keep a laminated disaster plan available for any personnel that have access in an emergency
- consider the use of a ‘hot site’, a secondary location that can quickly take over for your primary data center, thus minimizing business down time
[ed.note: the image above is from the Joplin, Mo. super-tornado May 22, 2011]
About Peter Polack
