Disaster Preparedness for Your Medical Practice

Julie Brightwell, JD, RN, Director, Healthcare System Patient Safety, The Doctors Company

Recent fires, hurricanes, and floods nationwide have highlighted the importance of planning for disasters. Wildfires in California forced several physicians to quickly relocate their practices―some permanently―and to move scheduled procedures to different facilities. Hurricane and flood damage in Texas and Florida left practices without power for days or even weeks. Is your practice prepared for this type of situation?

A disaster can overwhelm a medical practice, with damage that can include shattered windows, flood debris, power outages, disrupted telephone systems, computer and system outages, unsafe drinking water, destroyed medical records, medication exposure to temperature and humidity extremes, contaminated instruments, and building structure failure.

Disaster preparedness requires a continuous cycle of planning, organizing, training, equipping, rehearsing, and evaluating. Physicians are critical participants in disaster preparedness, ensuring that patient care and critical services are not interrupted—especially for at-risk individuals who may have special medical needs.

Plan Ahead Now

Before the next disaster strikes, make sure your practice has a plan in place. A checklist, ordered by priority and customized to specific types of disasters, can provide the framework for a comprehensive plan. The checklist should include these elements:

• A full-circle call tree that outlines who contacts whom.

• Instructions for setting up instant messaging technology that enables staff to communicate without a wireless network or cellular data connection.

• Instructions for securing records of patients undergoing diagnostic testing and a list of outstanding diagnostic studies.

• Guidelines for maintaining Health Insurance Portability and Accountability Act (HIPAA) compliance. Although the HIPAA Privacy Rule is not suspended during a natural disaster or other emergency , the Secretary of Health and Human Services may waive certain provisions of the Privacy Rule.

• A Certificate of Insurance for your medical malpractice coverage, or instructions for contacting your agent or insurer directly to obtain proof of coverage. This document will be necessary if you are forced to temporarily relocate your practice or procedures.

• Verification that home health agencies caring for your patients have plans in place to provide adequate services in a disaster.
• Steps to follow upon returning from evacuation.

When Disaster Strikes

Planning today makes accomplishing the following tasks more feasible during a disaster:

Communication

• Contact staff immediately to determine realistic return-to-work time frames.

• Notify external vendors and business associates of your practice interruption and targeted resumption of operation.

• Implement staff briefings at the beginning and end of each day.

• Create temporary phone, fax, and answering services.

• Establish patient telephone triage.

• Implement temporary controls to ensure HIPAA compliance.

Computers and systems

• Contact computer service vendors to ensure integrity and recovery.
• Verify insurance coverage for repair or replacement costs and losses.
• Evaluate applicable warranties and consider an information technology restoration service contract.
• Inventory and document hardware and software.
• Document the type and extent of both lost electronic and paper data.
• Ensure data back-up and periodically test compliance.
• Reestablish filing systems and internal programs.

Medical records

• Determine the extent of damage to, or loss of, patient records and filing systems.
• Attempt to restore all damaged charts and document inventory findings.
• Notify the state medical board for specific guidance pertaining to lost or damaged records.
• Document all efforts to restore and protect existing records.
• Reconstruct lost charts at the next patient encounter.
• Contact your insurance carrier for restorative services and/or claim procedures.
• Reestablish a filing system and temporary storage if necessary.
• Obtain legal guidance for patient notification during recovery efforts.
• Contemporaneously date and initial all late entries and duplicate information in context of recovery efforts.

In addition, create an inventory of all equipment and medications that may have been exposed to water or extremes in temperature. Repair, replace, or discard damaged items appropriately.

Once your plan is in place, regularly reevaluate its steps and update all contact information. Practice and rehearse the plan’s protocols. An effective disaster preparedness plan will help keep your practice focused on delivering care during an emergency.

How to prepare your technology, before a storm arrives

Here are a few things you can do to prevent a serious data loss.

1. Backup of your important data and take it with you.  You probably already know that it’s good practice to frequently backup your data and files to an external hard drive or off-site location. This practice is extra important during times of inclement weather.
2. Turn off all computers and on-premises servers at the close of business before storm arrival.
3. Take time to completely power down all computers and on-premises servers before you leave your home or office. If your computers and on-premises servers are not plugged into a surge protector, they should be unplugged from the power source. Electricity can come and go during the storm, and these fluctuations can cause major damage to electronic devices.
4. If your area is prone to flooding, put all computers on top of desks or other high and dry locations, away from windows.
5. Water is obviously the enemy of electronic technology.  You don’t want to risk even a little bit of water coming into contact with your electronic devices. Even if your area is not prone to flooding, you may still want to take this precaution.
6. Do not turn on any equipment until the storm has passed and power is stabilized.  You may be tempted to turn on your computer, to check for internet access or other news.  However, it’s important to keep your electronics unplugged and off until the storm has passed.  As we mentioned above, electricity surges can be damaging to your hardware during a storm. Power surge damage can also be difficult or even impossible to repair.