Before the
Next Storm: Protecting Patient Records

Hospital staff during Sandy

Staff at Roosevelt Hospital review action plans prior to taking in patients from hospitals shuttered by Hurricane Sandy. Above: A patient is evacuated from NYU Langone Medical Center.

When disaster strikes and servers lose power, or worse, get flooded, what happens to patients' electronic health records? After Hurricane Sandy, New York City hospitals are making sure they have a good answer.

By Gale Scott

Hurricane Sandy pummeled the Atlantic coast in October 2012, causing massive flooding and power outages. At Manhattan’s NYU Langone Medical Center, ten feet of water poured into the elevator shafts. The power failed, then backup generators failed too. In the dark, hospital staff would have to evacuate over 200 patients.

With no electronic medical records accessible and no working photocopiers, nurses and doctors hand-copied patients’ medical charts so that the hospitals that received them would have some knowledge of the patients’ conditions.

In the year since Sandy, hospitals have taken steps to make sure that information technology systems keep running in future emergencies. Many have found new ways to keep IT equipment from getting flooded, installed backup power devices to keep computers running, and found alternatives to housing all their medical information in one on-site location. The changes include constructing flood-proof rooms for computers, using cloud storage for some medical records, and rethinking ways to make sure patient information can be quickly retrieved in an emergency evacuation and how doctors can get access to it later.

Hospital building codes now require that new facilities withstand a “500-year flood."

Officials at hospitals that received evacuated patients from NYU Langone and other crippled institutions recalled the challenge of not having full medical records.

“It was very much a manual paper process,” said Nicholas Cagliuso, corporate director of Emergency Management at Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital.

“Patients were arriving in the middle of the storm by ambulance and for us it was about not only getting patients in and admitted but getting appropriate clinical information,” he said. Even with those notes, many tests, imaging scans, and examinations had to be redone. That added to both the costs of care and the stress of the situation, he said.

In preparing for future disasters, the approaches can be as simple as having backup generators and emergency batteries to run copiers on each patient floor, or to be able to quickly copy a patient’s record onto a compact disc.

“The idea is to make sure that the patient’s information travels with the patient,” said Susan Waltman, executive vice president of the Greater New York Hospital Association. “We are identifying ways to do that either with hard copies or electronic access,” she said.

The New York State Department of Health has been among the entities looking for solutions. In October, 2013, after lifting a five-month hospital construction moratorium, it made changes to hospital construction codes.

While it did not enact specific measures regarding protecting IT, the department’s Public Health and Health Planning Council recommended broad steps that would keep critical equipment and services functioning. Those include installing flood resistant generators and fuel supplies.

The biggest change is that new facilities or major renovation projects must be built to withstand a “500-year flood.” Previously, the code required hospitals and other facilities to build for a 100-year-flood crest.

That means hospitals need to prepare for another foot or two of flood water. Even before the change, several hospitals along New York City’s East River, including NYU Langone Medical Center and Bellevue Hospital Center, announced they were installing flood gates that can be activated during a storm.

If keeping the water out is not feasible or too expensive, the council’s report noted there are ways to flood-proof areas that house critical infrastructure and to design utility connections that will work even under water.

A year after the storm, NYU Langone has relocated some computer servers to a secure site in New Jersey. That should reduce outages in the hospital’s patient records system and also keep its email running.

“The data network no longer converges only at the main campus,” said Nader Mherabi, chief information officer at the hospital. By 2015, the hospital will have a new power tower to provide its own electricity.

“Redundancy, redundancy, redundancy, that’s the lesson.”

NYU Langone and many hospitals systems are looking into cloud technology to keep medical information available during disasters. Radiology, in particular, lends itself to the technology, with many hospitals storing scans in remote warehouses.

“That’s mostly because storing them on the system is a huge expense, they are the biggest files out there,” said Bert Robles, senior vice president and chief information officer at the New York City Health and Hospitals Corporation. Like many other hospital IT executives, he is taking a conservative approach to using cloud facilities for more sensitive personal medical data. “Use of the cloud is growing, and we’re watching to see what other institutions are doing, but there’s not enough scientific evidence that they are secure,” Robles said.

Regardless of the specific approaches, one overarching lesson from the storm is clear: “Redundancy, redundancy, redundancy, that’s the lesson,” said Robles.

“Sandy was a real eye-opener,” said Cagliuso, “The Internet can be a crutch. When it’s kicked out you have an issue, but we learned we need redundancies and resiliencies built into our systems.”

Gale Scott, a writer in Cranbury, N.J., covers health care in New York and New Jersey.

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