AuntMinnie.com is pleased to present Part I of a three-part series on disaster recovery.
The September 11 terror attacks in the U.S. have prompted hospitals and radiology departments to take a hard look at disaster recovery. Imaging facilities are assessing how well their operations might function in case of massive natural or man-made cataclysm, how fast they could get back in operation, and whether they could retrieve images and data.
This series will discuss what can be done to enhance disaster preparedness, and will provide suggestions and examples of how to protect and recover digital images and data in case of disaster.
First, some basic considerations when talking about disaster recovery:
- What is "disaster recovery" for a radiology department? Basically, it means being able to function in the same fashion as before the disaster, and being able to retrieve and/or access images and data from pre-disaster studies.
- Medical facilities and radiology departments are moving inexorably toward digital imaging. New regulations are based on this presumption. However, the cost of converting to digital is daunting, especially for smaller institutions, and even large medical centers are still partially film-based.
- Can film be saved? Of course it can, and the technology hasn’t changed. For our purposes, though, we’ll focus mostly on the ramifications of recovering digital data.
As a disaster recovery plan is being formulated, you might ask these basic questions:
- How does the radiology department interface with the hospital information system (HIS)?
- Will the plan satisfy Health Insurance Portability and Accountability Act (HIPAA) requirements?
- Is the plan affordable?
- Will the images be retrievable over time?
Although financial institutions may dwarf hospitals and medical centers in terms of data and numbers of people who could be affected in a disaster, there are legal and moral reasons behind the need for the healthcare community to be prepared. In addition, state laws mandate that diagnostic images (both film and digital) must be kept for certain periods of time. Typically, all images must be kept active for at least five years, children’s images until the age of majority, and mammograms for the life of the patient.
What kind of disaster should we anticipate?
Two types of disasters may hit healthcare and other institutions: external and internal. An external emergency is focused outside a facility. An event such as the World Trade Center attacks in New York City is an external disaster. You’re in the middle and it happens to people around you. External disaster to most planners means huge numbers of trauma patients, and strategies for their triage and treatment. Preparing for external disasters is widely covered in the literature.
An internal disaster happens to a specific facility. In such an event, the hospital or medical center suffers great harm from fire, flood, hurricane, tornado, or earthquake, or civil disturbances, accidents, or emergencies within the organization.
An external event can sometimes lead to internal disaster. A major flood in June 2001 in Houston damaged a dozen hospitals in that metropolitan area. Fortunately, although Christus St. Joseph Hospital lost paper records and suffered permanent damage to some of its structures, no film was lost. The hospital’s data center had been located on the eighth floor, a practice that has become common.
Since the flood, the 40-hospital Christus Health System has accelerated its PACS plans and is integrating data storage offsite, while seriously considering contracting with an application service provider (ASP) for archiving services.
While a facility may experience significant loss of capability after an internal disaster, the surrounding community infrastructure is typically still intact and available as a resource. However, the September 11 terrorist attacks illustrate how an external emergency could also become an internal emergency and directly affect an organization's ability to keep operating. For example, a healthcare organization may be near the target of a terrorist bomb and suffer structural damage, as well as casualties or fatalities.
In addition, great external disasters may result in large numbers of patients coming in and nearly overwhelming a facility. Disaster preparedness journals and Web sites cover external disasters extensively, but radiology is usually given little attention.
To be fully prepared for an external disaster, an imaging facility should consider having more viewing stations available and more consulting radiologists on call. Having radiologists remain at home and review images remotely during a disaster can help significantly. A radiology department might also consider having distributed (decentralized) printing capabilities for hard-copy output in several places, rather than having everything feeding to one area.
By Robert BruceAuntMinnie.com contributing writer
January 17, 2002
Next week: The New York City experience; HIPAA on the horizon.
Related Reading
Disaster recovery case study #1: The Dallas VA alternative
Disaster recovery case study #2: UCSF’s model for PACS recovery from off-site storage
Bibliography
"Definition of the health record for legal purposes," American Health Information Management Association, October 2001, Volume 72-9.
"Disaster planning for health information," American Health Information Management Association, May 2000, Volume 71-5. Health Insurance Portability and Accountability Act of 1996 (HIPAA).
"Hospital resources for disaster readiness," American Hospital Association, November 1, 2001.
"Mobilizing America’s healthcare reservoir: emergency management in the new millennium." Special Issue of Joint Commission on Accreditation of Healthcare Organizations Perspectives, December 2001, Volume 21, Number 12.
"Picture archiving and communication system (PACS) security plan," Ward M. Terry, Dallas Veterans Affairs Medical Center, Dallas, April 2000.
"Plan for the worst before disaster strikes," Hospital Management Technology Magazine, June 2000.
"Protecting the privacy of patients’ health information," HHS Fact Sheet, Department of Health and Human Services, July 6, 2001.
A roadmap for implementing HIPAA in radiology, July 26, 2001
"Simulation of disaster recovery of a picture archiving and communications system using off-site hierarchal storage management," David Avrin et al, Journal of Digital Imaging, Vol. 13, No. 2, Suppl. 1, May 2000.
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