Business Continuity for the Healthcare Field:

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1 Business Continuity for the Healthcare Field: Critical steps to keep your facility up and running both during and after a disaster. The Harvard School of Public Health suggests that every dollar invested in disaster preparedness yields savings of $4 $11 in disaster response, relief and recovery. Source: Harvard School of Public Health, Harvard Humanitarian Initiative ARE YOU AS PREPARED AS YOU THINK? The intensity and frequency of major natural disasters is increasing, from 100 per year in the 1970s to more than 500 per year today, according to the Harvard School of Public Health. From hurricanes to fires and floods, ice storms and earthquakes, natural disasters are on the rise, and in no field is it more critical to be prepared than healthcare. Healthcare facilities have much to lose if they are down for even a short time. They have patients to protect, keep safe and possibly move, and new ones to care for as a result of the disaster. They also have facilities and support systems to maintain and keep running 24/7, and critical records that must be accessible at all times. A painful case in point is the experience of the University of Texas Medical Branch during Hurricane Ike. According to FEMA s Hurricane Ike Impact Report, the facility lost $276 million in revenue after Hurricane Ike as a result of closure of the hospital s facilities and the resulting downtime of business operations. While major disasters are a critical risk, the majority of business interruptions are caused by unforeseen circumstances singular events that can t be predicted, such as fires, power outages, and server failures. One facility in Virginia s Clarion Health System, CRCH, was closed for 16 days as the result of a fire. This event was completely unpredictable; yet still a major disaster for the impacted organization. For a hospital, being down for even one day can result in a financial loss of millions of dollars. Conversely, the Harvard School of Public Health suggests that every dollar invested in disaster preparedness yields savings of $4 $11 in disaster response, relief and recovery. For the healthcare field, however, there is much more at stake. Unlike some other industries, in healthcare, being prepared can make the difference between a life saved and a life lost. As injuries occur, having a place to deliver patient care, as well as the ability to access a complete patient record including their health history, medications and known allergies can make a big difference. It only takes a split second to save or lose a life.

2 2 Ensuring patient safety goes far beyond physical care. To be fully operational, a hospital must cover all bases. For example, hospitals must have a plan to find, communicate with and care for staff. Restore critical administrative and operational functions. Restore connectivity to phones and internet so the hospital can remain connected to the outside world A hospital must think in terms of holistic recovery planning multiple pieces must be in place for a hospital to provide quality patient care during a disaster. Finally, even if the hospital is not directly impacted by a regional disaster, it may be required to help others recover from the disaster, resulting in an overwhelming burden. Hurricane Ike damaged a total of seven hospitals in Texas. What if you had to cover for another facility and take in their overage? From setting up a satellite location for triage to shifting personnel to help at another facility, or doubling technical and/or human support, the healthcare industry has unique business continuity needs. In this white paper, we create a blueprint specifically for helping healthcare organizations set up a disaster recovery and business continuity plan. We also provide information about disaster recovery solutions that fit a hospital s complex recovery needs. KNOW YOUR LEGAL REQUIREMENTS After Hurricane Katrina, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) made it a requirement that all healthcare facilities have a disaster plan in place to minimize risk and exposure. JCAHO mandated that healthcare organizations maintain an emergency management program that enables them to respond to disasters within their healthcare network and the community they serve. The mandate includes directives on identifying roles in disasters, the training of network staff, alternative communication systems and hospital sites. Their ultimate goal is that healthcare organizations be able to provide uninterrupted primary care access to members in all situations. In addition, HIPAA requires data backup plans for electronically protected health information, as well as disaster recovery plans and procedures to restore any lost data. HIPAA also requires emergency mode operations plans and procedures to enable continuation of critical business processes involving electronically protected health information (EPHI) while operating in emergency mode. Keeping your healthcare delivery system up and running with minimal to no downtime during a disaster is the goal of disaster recovery (the process of bringing back systems and processes immediately following a disaster) and business continuity planning (a long-term strategy for maintaining quality care during any disaster, large or small).

3 3 4 CRITICAL STEPS TO CREATING A BUSINESS CONTINUITY PLAN 1. Pull together a team. 2. Develop a plan. 3. Test your plan, then fill gaps and fix problems. 4. Repeat step PUT YOUR TEAM TOGETHER. When deciding who should be on the disaster recovery or business continuity team, hospitals often make the mistake of thinking this is a job for facilities and IT, and no one else. This couldn t be further from the truth. In fact, it is critical that every department be represented on the team. Consider the types of care or unique services that your hospital provides to the community. Identify the departments or services that must operate during and after a disaster. Each one of these departments should be represented on the team. Here are the first three things you need to do when putting a team together: 1. Invite each department head to an initial meeting and give everyone a chance to go around the table and describe the critical functions in their department (record the meeting and have the conversation transcribed). Include key vendors in these meetings, such as medical equipment suppliers and IT and telecommunications technicians. 2. Make a list of everyone s contact information, then share that list with everyone on the team, in multiple media formats. For instance, hand out a printed copy, but also provide a link to the document online or via a smartphone. 3. Discuss and record each person s non-office-related strengths, and how they might be utilized in a disaster situation. For instance, perhaps the computer repair staff is a volunteer EMT on the weekends, or the IT tech is an avid sailor and is adept at tying a wide variety of knots. Once your team is in place, the next step is to work toward developing a plan. 2. DEVELOP YOUR PLAN. Your business continuity plan is literally a how-to manual for keeping your hospital up and running during and immediately after disasters. From repairs to redundant systems to setting up in an entirely new location, your plan will tell your employees what procedures to follow for each situation. Because a hospital has complex recovery needs, it is critical that the plan is flexible and adaptable. Also, make sure you have a secure, online location to store, share and access the recovery plan. The following steps will help you develop your business continuity plan: 1. At the first meeting, list each function within the hospital organization and prioritize them by whether they are critical or non-critical. Examples of critical functions might be setting up temporary emergency care facilities, maintaining the systems that run security, voice, data, emergency care and radiology (for evaluating trauma victims), while non-critical functions might be records storage, the cafeteria and the gift shop. Areas involving the safety and maintenance of patient care may require different protocols than non-patient-related recovery. 2. Conduct a threat analysis. Make a list of potential disasters that have or could conceivably occur, then prioritize their likelihood. For instance, an earthquake might be considered a low threat on the east coast but a high one on the west coast. Be sure to place unknown or unexpected disasters at the top of the list.

4 4 3. Determine what resources and funding you would need to restore critical functions if they went down, or how to replicate them in another location. Discuss each threat separately and determine how much downtime each function could withstand (ranging from none to 24 or 48 hours, for instance). 4. Pull together go bags or emergency supply kits that include everything you would need to recover from a disaster, including insurance policies so you can report claims, emergency phone numbers, security keys and keycodes, a complete list of all employees to assure everyone is accounted for, basic medical supplies and small, transportable field equipment, extra prepaid cell phones and dry food. 5. Don t forget your people. People are the most important asset to any hospital organization. It is critical to have plans and systems in place to locate, communicate with, organize and care for staff following a disruption. If you can t locate and communicate with staff, you can t recover your hospital. And, if staff needs are not met, they are in no position to attend to the needs of patients. 6. Have a thorough facilities recovery plan. This includes everything from having an alternate location for patient care, to relocating hospital administrative staff in order to continue administrative functions, to establishing a location for a command center in the event of a large disaster. The recovery facilities must have access to reliable power, computers, servers, Internet and telephones so the hospital can continue functioning. 7. Ensure the hospital is able to retain a connection with the outside world. During a regional disaster, phone systems may become inoperable. Internet may be down. Cell phones may be unreliable. A hospital will need to communicate with vendors, the community and possibly the media, access patient medical records and payroll and billing systems in order to conduct daily administrative functions. Make sure to include a plan to restore connectivity following a disaster, and one that is not reliant on local infrastructure. 8. Back up your patient, employee and vendor data off site and at a reasonable distance. Redundancy will keep your vital information safe and available to you at a moment s notice should your primary data location go down. Also, it s important to maintain a reasonable distance. If your facility is in a flood zone, you don t want to pick a redundant data location that also sits within that flood zone. 9. Budget for and partner with a disaster recovery specialist who can get your healthcare facility up and running in another, nearby location with a single phone call. They will also have the experience and know-how to prepare your company for disaster recovery in ways you can t think of, and can help you establish recovery time objectives (how long recovery should take from start to finish) and recovery point objectives (how much data could potentially be lost during a recovery process). In March 2007, Gartner reported that the costs of high availability and disaster recovery capability can be reduced using vendor-hosted systems, and noted that, while these practices are common in all industries, they appear to be pervasive and potentially more critical in healthcare organizations. In addition, generators only last so long. By putting this plan in motion, you will be able to continue to service your patients during a disaster with minimal to no interruption.

5 5 3. HOLD REGULAR MEETINGS, TESTS AND DRILLS. Building a disaster recovery plan is not a one-and-done strategy. It is a continually changing and evolving process. Consider what could go wrong if you didn t test and retest. As mentioned earlier, one facility in Virginia s Clarion Health System, CRCH, was closed for 16 days as the result of a fire. Its disaster recovery and business continuity plan called for locating the command center in the hospital s east wing, but when the team arrived, they quickly realized as they began to put their plan in action that this location wasn t practical and immediately moved it to the west wing. These are the types of things you can only know by doing. Testing and drills will help you determine how much your facility can handle should you have to take on another facility s overflow, and where and how to distribute functions when you yourself are at full capacity. As a result of the abovementioned fire, CRCH had to reroute emergency patients, the paging system, and the food center. Surgery had to be completed by flashlight. When they tried to implement their calling tree, the hospital s phone system was down, so they had to use personal cell phones to make the calls, but discovered they didn t have enough phones to move quickly, so they asked the local phone company for additional phones. As a result of the additional workload, a nearby sister hospital declared its own disaster and had to call in support teams. Regular testing can make situations such as these go much more smoothly. Some companies prefer to test annually, other s quarterly. Some test everything at once, others test in phases, such as doing the data backup system one day and emergency services relocation on another. Based on the size of your building, your medical specialties, your location and the location of your partner facilities, among other things, your team must decide what model will work best for you. However, if you are in the beginning stages of plan implementation, more testing is better than less. There are four types of testing formats: 1. Tabletop exercise. This is where you choose a scenario (or several) and everyone sits around a conference table and walks through each situation, discussing the order in which things would get done, who would handle certain priorities and the procedures they would follow. 2. Walkthrough/simulation. This allows your team to see and feel things as they would be in a disaster situation. With this method, you might find a closet door where you were expecting a path, a lock that you can t find a key for, or a portion of the security process that won t go back online because you have the wrong security code. Here, you go through the motions of setting up a full recovery, including timing responses from ambulance crews, IT, etc. 3. Full-scale live training situation. This is the most thorough effort, where a hypothetical disaster is replicated in real life, utilizing all the systems, processes and staff as would be required if this were a real situation. You will need to ensure that actual systems and patient care are not reduced or otherwise affected during this type of activity. Also, be sure to consider all types of weather conditions. We suggest you start with the tabletop exercise first, fine-tuning anything you can before you move on to phase II, the walkthrough. At the end of the tabletop exercise, discuss the results and how things could be improved. Have each person take the results back to their respective department, discuss the areas that affect them and solicit feedback from their coworkers. Then incorporate the feedback at the next meeting.

6 6 Next, develop a crisis communication plan that determines who will call whom. Include the following: A 24 hour phone tree A password-protected web page An alert system A call in recording system During a tabletop exercise, test your calling tree to determine whether you have enough callers and your assignments are appropriately planned. If you rely on landlines, ensure that you have a cell phone-based backup plan in case the telecommunications system goes down. If you plan to rely on cell phones, have enough spare batteries and ensure they are fully charged. Finally, cell phones are not always reliable during a regional disaster, so ensure you have a solution (for example, satellite) that is workable during a large, regional event. Finally, practice using laptops to access critical patient admittance and claims processing information. Troubleshoot any difficult challenges. Also, set up a disaster box on every floor that includes items such as flashlights, an emergency prepaid cell phone, and basic medical supplies and emergency equipment that can be easily accessed when needed. 4. RETEST, TWEAK, FINE-TUNE (I.E., WHEN YOU GET TO STEP 4, GO BACK TO STEP 3). So you ve tested your plan from A to Z, filled in the gaps and fixed any discrepancies. You re done, right? Not hardly. Keep in mind that business continuity is a journey, not a destination. After you fix or rework a protocol, you must retest it. Employees change jobs. Vendors are acquired. Your patient data is constantly growing and your servers are bulging at the seams (when was the last time you upgraded a server?). Batteries get old. Emergency supplies get used and when everything is fine, people don t think to check them. Outside, you must remember that the landscape can affect your ability to respond to a location or to relocate patients. Turning lanes, traffic lights and stop signs are added to city streets where they didn t previously exist. Street names, restaurants and other markers change, new buildings go up and old ones come down. Construction blocks roadways and slows cars down. And weather is always a factor. Internally, if response times such as how long it takes disaster recovery personnel to report in, how soon your server restarts and is fully operational, or how long it takes to move patients to another location are not fast enough, focus on drills that fix each specific situation before retesting an entire mock drill. Also, be sure to test your data redundancy protocols by holding a complete shutdown test of your data system. Finally, set up metrics for every aspect of your disaster recovery and business continuity plan, and establish incremental goals for improvement, with deadlines for meeting them every year.

7 7 5 THINGS YOU CAN TELL YOUR MANAGER TO ENCOURAGE THEM TO FOCUS ON DISASTER RECOVERY AND BUSINESS CONTINUITY PLANNING. 1. The number of declared disasters in the U.S. is growing each year. 2. Hospitals can lose millions of dollars per day if not prepared 3. Being prepared saves patient lives. 4. Lawsuits can result from not being available to patients. 5. A hospital that handles a disaster properly receives long term brand equity from the proactive and smooth response. CONCLUSION Disasters happen every day. They range from every day events, such as server failure, to catastrophic regional events such as ice storms, hurricanes, earthquakes and floods. Because the healthcare delivery system plays such a critical role in community recovery, a hospital needs to be prepared for any eventuality. Hospitals have complex recovery requirements; a hospital s recovery plan must be robust and thorough. A hospital should establish outside relationships with other healthcare delivery systems and with disaster recovery vendors that offer flexible and adaptable recovery options. A hospital recovery plan should be comprehensive, covering restoration of data, staff, facilities, operations, power, connectivity and technology. While revenue loss is obviously a critical issue for hospitals, which are often operating on razor thin margins, ensuring patient care is the most important priority for any hospital concerned with disaster recovery. For a healthcare delivery system, preparation is a matter of life and death. READYSUITE FROM AGILITY RECOVERY ENDORSED BY THE AMERICAN HOSPITAL ASSOCIATION Agility Recovery is pleased to report that the American Hospital Association has endorsed Agility s disaster recovery solution: ReadySuite. ReadySuite is a flexible, adaptable, a la carte solution that delivers power generation, office space, technology such as computers and servers, and telephone and Internet connectivity to hospitals in the event of a disaster or disruption. ReadySuite also includes access to a secure, online recovery planning portal and an alert notification system known as myagility as part of membership. Agility understands the unique and complex needs of a hospital organization: our ReadySuite solution is a critical addition to any hospital s recovery plan. The AHA reports, In the event of a disaster, it is imperative that the healthcare delivery system remain intact. The ReadySuite solution addresses this challenge through offering an affordable, responsive and comprehensive service. In the event of a disaster, it is imperative that the healthcare delivery system remain intact. The ReadySuite solution addresses this challenge through offering an affordable, responsive and comprehensive service. The American Hospital Association

8 8 ABOUT AGILITY RECOVERY For over 20 years, Agility Recovery has been the premier provider of recovery solutions across the United States and Canada. Formerly a unit of GE Capital, Agility has a long and successful history in the business continuity industry. Agility serves over 10,000 businesses, including numerous hospitals. The company responded to over 2,700 events just last year and maintains a 100% recovery success rate. In the event of a city- or county-wide disaster, everyone counts on hospitals and health care professionals, so it s crucial that the healthcare system remain fully operational. The ReadySuite solution offers an affordable, responsive, flexible and comprehensive service that addresses this challenge. ReadySuite is an excellent solution for recovering a hospital s staff, administrative functions, technology, power and connectivity. No disaster is too big or too small. When disaster strikes so does Agility, mobilizing immediately, getting your hospital the assets you need to get up and running. For more information about Agility Recovery s ReadySuite program, contact Andy Boyd, Vice President of Emerging Markets at andy.boyd@agilityrecovery.com.

9 9 The American Hospital Association has awarded its exclusive endorsement to Agility s ReadySuite solution. After a comprehensive due diligence process by the AHA, it was determined that Agility s ReadySuite solution aligns with the complex needs of a hospital organization. In the event of a disaster, it is imperative that the healthcare delivery system remain intact. The ReadySuite solution addresses this challenge through an affordable, responsive and comprehensive service. Value Proposition For more than 100 years, the American Hospital Association has been a powerful symbol of quality. AHA Solutions, a subsidiary of the AHA, awards the AHA endorsement only to products and services that help hospitals achieve organizational excellence. Healthcare organizations that select AHA-endorsed products support the AHA s efforts on behalf of the nation s hospitals. AHA Solutions is proud to reinvest its profits in the AHA s missions: creating healthier communities. To learn more about why the ReadySuite solution has earned AHA s exclusive endorsement, contact: Jolena Betts, Account Manager, AHA Solutions jbetts@aha.org Legal Disclaimer: AHA Solutions, Inc., a subsidiary of the American Hospital Association, is compensated for the use of the AHA marks and for its assistance in marketing endorsed products and services. By agreement, pricing of endorsed products and services may not be increased by the providers to reflect fees paid to the AHA.

10 10 ADDITIONAL RESOURCES Business Continuity Planning Workgroup for Healthcare Organizations DRI International In addition, there are several guides (SP and SP800-84) from the National Institute of Standards and Technology that can provide further insights on developing and testing a BCP/DRP plan for an organization. Lessons from Hurricane Rita: The University of Texas Medical Branch Hospital s Evacuation Lessons Learned From the Evacuation of an Urban Teaching Hospital Emergency Preparedness: Hospital Evacuation PubMed Disaster Recovery Journal Industry Resources Executive Healthcare Management Disaster Recovery HIMMS Disaster Recovery AHA Response and Recovery Resources HIPAA The Business Continuity Institute Contingency Planning & Management Disaster Resource Forrester Research: Leading Disaster Recovery Service Providers FEMA Best Practices Library At Time of Disaster Checklist The Institute for Business and Home Safety Emergency Communications Plan Checklist Recovery Overview Checklist Ten Steps Every Business Should Take to Prepare for a Disaster Search HealthIT Disaster Recovery

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