1. Business Continuity Planning from a Healthcare CIO’s Perspective July 28, 2010

3. 11 Hospitals 1,800 Patients 7,600 staff, family and refugees

4. Hospitals, which typically provide a place of refuge during a crisis, present a unique challenge in community-wide disaster. No other facility houses such large concentrations of people who cannot meet their own needs and may require ongoing life support. Determining whether hospitals should be evacuated in advance of a predicted disaster is a complex calculus.

6. Went from a hospital of 2002 to the hospital of 1972. All network traffic stopped. No clinician could order medications or laboratory tests electronically. No clinical decision support was available. ED went on diversion. Critical lab test turnaround time tripled. Clinical and administrative staff were pressed into roles as “runners”.

7. Layer 2 Design

8. Contributing Factors Network Engineer manager did not share knowledge, and was out of step with current practice. Halamka also acknowledged he did not know enough about the network topology and approved changes that made the situation worse. A trusted relationship with the network vendor had not been established. No Out of Band tools existed to gain insight into the network problems. No downtime plan existed for a total network collapse. No robust or redundant communication plan was in place. No change control process was in place.

9. We are entering an era of unprecedented change in the healthcare industry.

10. The Economics of Healthcare Delivery National healthcare spending = $2 trillion Health spending = 16% of GDP Healthcare growth = 8% per year

11. IOM Reports “To Err is Human”, 1999 – Occurrence of Adverse Events: 3.7% of hospitalizations – 13.6% lead to death – 44,000 – 98,000 deaths annually “Crossing the Quality Chasm”, 2001 – Knowledge is shared and information flows freely – Decision making is evidenced-based – Safety is a system property

12. EHR Adoption in U.S. Hospitals Remains Low Use of Electronic Health Records in U.S. Hospitals (NEJM, 2009) Ashish K. Jha, M.D., M.P.H., Catherine M. DesRoches, Dr.Ph., Eric G. Campbell, Ph.D., Karen Donelan, Sc.D., Sowmya R. Rao, Ph.D., Timothy G. Ferris, M.D., M.P.H., Alexandra Shields, Ph.D., Sara Rosenbaum, J.D., and David Blumenthal, M.D., M.P.P. Only 1.5% of hospitals has a comprehensive electronic- records system (all clinical units). 7.6% have a basic system. CPOE implementation is limited to 17% of hospitals.

13. EHR Adoption in MD Practices Also Low

14. American Recovery and Reinvestment Act (ARRA) Signed into law on February 17, 2009. Health IT for Economic and Clinical Health (HITECH) represents an investment of more than $20 billion towards healthcare IT related initiatives. Targets accelerating the adoption of EHR technologies and facilitating nationwide health information exchanges(HIEs) to improve the quality and coordination of care between health care providers.

15. Healthcare, already a data and knowledge- intensive industry, is becoming more reliant on technology that needs to be reliable and always available.

16. Some thoughts

17. Increasing complexity of healthcare IT requires collaboration between healthcare providers and their industry partners.

18. We need new, more flexible ways of planning for different kinds of emergencies that stress communication and integration across systems, and distribution of knowledge.

19. Health Information Exchange

20. KatrinaHealth Collaborative effort to provide medication history from electronic transaction systems. Born out of the need to reconstruct medication records post-Katrina, given evacuees had become separated from their medical records. For health professionals working with evacuees and residents, it would be a useful reference for understanding the medical history of their patients.

21. KatrinaHealth Collaborators Markle Foundation Gold Standard Rx Hub SureScripts Veterans Health Administration In total, over 150 organizations contributed to the effort From inception to data provisioning, timeline was about 1 month.

22. At the CIO Level Become a trusted advisor to senior leadership. Establish and sustain strong IT governance. Educate around the need for BCP. Data is a strategic asset. Always ask about the weakest link: “What could go wrong?” Think systemically: “What are the interdependencies?” Look outside the walls of your organization: – What are the opportunities to collaborate and share risks/benefits?

23. Business Continuity should be not be approached simply as an “insurance plan”, but rather as a way to continuously improve the value of technology to organizations.

24. Thank You