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| John C. Wade | Deborah Gash |
At every health care organization, information technology and its support staff are responsible for supporting business goals. One important and newly relevant part of that role is ensuring that electronic processing can occur even in the face of a disaster. But as health care systems bring automation beyond the business office and into emergency departments, intensive care units and ancillary departments, the activities that once were top priorities--such as payroll and billing--have to take a back seat to ensuring IT-enabled care processes are up as soon as possible.
Growing Complexity
There’s been no shortage of natural disasters during the past few years and as each occurred, most hospitals revisited their own disaster recovery (DR) plans. In many cases, they learned that these plans were unlikely to provide ongoing business support, and the next step was to either secure funds or run further tests to ensure that the hospital could pay its employees and collect the bills for those patients that received care.
While those plans and successful tests have brought some level of assurance to hospitals, the era of being able to conduct a successful system recovery over several days or weeks is rapidly coming to an end. Today, hospitals need to ensure that their DR plans do not lead to their own extinction by failing to consider the growing dependence on clinical IT.
At Saint Luke’s Health System (SLHS) in Kansas City, Mo., dedicated disaster recovery personnel make up part of the IT workforce. These experts, in conjunction with some well spent consulting funds, enabled the organization to develop a sophisticated DR/business continuity plan based on the organization’s business priorities as established by the clinical and operational end users. The main priorities are implementing an electronic health record to promote patient safety and quality, and creating a digital health system to facilitate information sharing and communication.
As part of the IT disaster recovery plan, SLHS has invested in resources that have allowed the IT group to build redundancy into key enterprise applications and to develop a hot site, a secondary location that houses redundant hardware and technology solutions to support business processes in the event of a failure at the primary site. While key leaders on the IT team had experience in making a DR site operational in the past, getting it to work in the world of distributed processing--that is, multiple sites with sophisticated LAN/WAN infrastructure--was an eye opener. In the first year, the DR test wasn’t successful. It was a long, arduous process, and it took hundreds of hours to get each component of the original DR plan to work.
At the same time, SLHS’ operational leaders developed business continuity and emergency preparedness plans that defined how the organization would function during a crisis. This added a new dimension to the DR plan.
Sea Change Ahead
Even as organizations point to their successful IT disaster recovery/business continuity strategies, the reality is that health care is at the end of an era. Today, electronic medical records, PACS and digital hospitals turn traditional DR and business continuity plans upside-down because they force organizations look beyond sustaining business processes to sustaining care processes.
Just as SLHS was about to celebrate its success in developing a recoverable IT environment, the organization began building its first all-digital campus. This addition to the health system changed what it meant for the IT department to achieve a successful business continuity strategy. In the world of paper records, it might be acceptable to take four days to successfully transfer IT operations from the primary site to the hot site in another city. But when you add a digital hospital, that window of recovery has to be brought down to minutes, not days or even hours. The filmless, paperless organization that trained clinicians to access real-time information online can’t tell a doc in the ICU that patient records won’t be available for three or four days.
It’s still important for organizations to successfully run their payrolls, billing and lab operations but those functions can be performed offline without seriously jeopardizing the health of those that we care for daily. Every minute counts when it comes to ensuring that patients’ current status is immediately available to their caregivers, even when the data center is 10 feet under water.
As health care speeds toward a reliance on ubiquitous electronic support for all our caregivers, hospitals’ approach to the challenge of ensuring that that signal is always available to those same caregivers is a new and critically important responsibility. This was a wake-up call for SLHS, and it should be a wake-up call for hospitals around the country.
John C. Wade, FHIMSS, FCHIME, is vice president information services, and Deborah Gash, M.B.A, CPHIMS, is vice president and CIO, at Saint Luke’s Health System, Kansas City, Mo.
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This article first appeared on August 8, 2006 in HHN's Magazine online site.
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