PACS Continuity in the Eye of Hurricane Sandy: Bellevue Hospital Center

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Eli Tarlow When Hurricane Sandy and its aftermath devastated New York, New York, in October 2012, perhaps no one was more vulnerable than the patients needing care in area hospitals. Eli Tarlow, CIO of the city’s Bellevue Hospital Center (BHC), recalls, “It was the best of times and worst of times—a natural event that no one could have prevented. You really see the best of your staff in moments of crisis, and that held true during Hurricane Sandy. Staff members at all levels volunteered to do anything necessary, from bringing needed supplies up and down many flights of stairs to helping with preparing or delivering food for patients. Nothing came between the employees and the work that needed to be done to maintain patient care.” As the hurricane swept over the city on October 29, BHC lost primary power following an explosion at a nearby electrical substation. At that point, the IT team at BHC put in a call to its PACS vendor, Sectra, requesting assistance in coordinating a graceful shutdown of the system before hardware damage and possible loss of imaging data could occur. The hospital’s generators took over as expected, but soon, flooding in the basement submerged the pumps that were providing fuel to the generators. A human chain was quickly created to bring fuel from the ground level to the generators on the 13th floor. Tarlow says, “People from human resources, IT, finance, clinical areas, and administration—whoever happened to be at the right place at the right time—were deputized, were given safety equipment (such as masks and gloves), and began lugging the fuel up, hand over hand, to ensure life-safety power was provided continuously, in order to keep patients safe.” Soon, however, the basement flooding created other problems. “On October 30, we began losing the full compliment of potable water, and on October 31, the decision was made to evacuate,” Tarlow says. “By November 1, we had safely evacuated over 400 patients, and of those, over 250 were moved safely down staircases.” Emergency Informatics Tarlow explains that access to health information systems, including PACS, is especially critical in emergency situations. “When a patient is discharged and technical issues remove the ability to provide electronic discharge information, staff can revert to downtime procedures and complete the necessary work manually. When hundreds of patients are being discharged or evacuated in a short amount of time, on the other hand, it’s nearly impossible, without access to electronic records. That’s why access to the patients’ history, including images, is so vital,” he says. Under these circumstances, IT staff, equipment, and services can be as valuable to patients as clinical staff. He adds, ”Your job in IT, at a hospital, is as time sensitive as any physician’s job.” BHC’s electronic medical record (EMR) is based in remote primary and secondary data centers that were not affected by the storm, so hospital staff could access the EMR through redundant WANs in areas of the facility that still had power. “It wasn’t always convenient, but we had access to the required information,” Tarlow says. The PACS was another story; not only had it been shut down to prevent hardware damage, but it also was hosted on-site, meaning that its data had not previously been made accessible from remote locations. “Patients who had had imaging done locally were now going to other hospitals, and there was a critical need for the receiving hospitals to do historical comparisons or review previous exams,” Tarlow says. “Being able to access our PACS locally and being able to provide remote access from other facilities within our organization were as critical as ever.” Support and Solutions To address this issue, the IT team at BHC put in another call to Sectra. The company’s US help desk (in Connecticut) had also been shut down by the hurricane, but remote engineers were able to restore the PACS, the hardware of which is hosted on the hospital’s fourth and fifth floors. The PACS was mirrored between the data centers at BHC on different floors, so BHC’s staff and Sectra were able to bring it back online. The hospital’s inpatients were being discharged to various other New York City Health and Hospitals Corp. facilities, many of which used other nonintegrated PACS platforms, Tarlow recalls. In coordination with Sectra, BHC was quickly able to publish a secure link enabling physicians at those hospitals to access the BHC PACS remotely. “Once we had established remote access from other hospitals, credentialed physicians could continue to provide patient care without any interruption,” he says. “I think that speaks volumes.” It would be some time before BHC’s patients returned to the facility. The hospital used the opportunity to make improvements to safeguard it against future hurricanes. “The reality is that we are seeing more and more of these hurricanes each year, so we took advantage of the time to move things from the basement to ground level, so that if water did come in, it wouldn’t have the same impact,” Tarlow says. “We relocated the water feed and the house pumps for medical gases, steam, and hot water above the level that was deemed not at risk for flooding.” Inpatients returned to the hospital on February 7, 2013; in the meantime, the physicians treating them at other hospitals continued to have full access to their clinical histories, including images. In fact, the remote PACS access proved so convenient that BHC’s own physicians are now hooked, Tarlow says. “IT systems are typically not designed with the evacuation of an entire hospital in mind, but with these newfound gains, the level of service we provide to the clinical staff has improved significantly—and there’s no turning back” he says. Cat Vasko is editor of and associate editor of Radiology Business Journal.