Several dozen more hospital EHRs were similarly affected as Sandy knocked out an Allscripts data center in Mountain Lakes, N.J., about 30 miles northwest of New York City; severed communications links to a second, “fail over” data center in Piscataway, N.J., about 30 miles north of Mountain Lakes; and then delayed repair crews by more than an hour, according to Laurie McGraw, chief client officer for the Chicago-based EHR developer.
McGraw said fewer than 50 clients were “severely impacted” by the outages, which began around 6 or 7 p.m. Monday and ended, for most, around 2 a.m. Tuesday. Allscripts had a “handful of clients—fewer than five,” with systems down nearly a full business day, McGraw said. The outages did not affect Allscripts' EHR systems for office-based physicians, she said.
The EHR system flicked off at 7:30 p.m. at 290-bed Holy Spirit Hospital in Camp Hill, Pa., across the Susquehanna River from Harrisburg and roughly 150 miles from the data center in Mountain Lakes. The system did not return until the following noon, said Dr. Richard Schreiber, the hospital's chief medical informatics officer.
Schreiber said he doesn't blame Allscripts. “They had their servers in New Jersey, and New Jersey got clobbered. Can you plan for that? Well, they tried.”
Being out for 16 hours was “a long time,” Schreiber said, even longer than what's usually required for software version upgrades, which can take 12 hours or so and are needed about every 18 months. More routinely—once a month or so—the hospital goes without its EHR for system maintenance. As they routinely do during those scheduled downtimes, staffers at Holy Spirit who were caught last week without an EHR reverted without a fuss to using paper and separate, on-site computer systems for radiology and labs. “People just come together here,” he said. “You do the work and you get it done.”
Schreiber said the hospital's leaders “constantly rethink” the decision to have their EHR system kept offsite. But the virtues of remote hosting remain a part of those thoughts, he said. “We have a modest IT shop of 40 people,” he said. “In order to have a system on our own site, we'd have to increase our staff by at least 50%. We've had massive floods and power outages here in the Susquehanna Valley. What if our data center got wiped out?”
The statewide New York eHealth Collaborative health information exchange stores partial copies of member hospitals' patient medical records on its own servers and has “a fully redundant data center in Texas,” said Richard Whitlinger, the exchange's executive director. “We're as disaster-proof as possible in modern practice.”
The 78% of New York hospitals connected to the exchange had quick access to at least some parts of a patient's records, no matter what happened to the hospital where the records were created, Whitlinger said. Available patient information through the exchange varies based on hospital participation, but it can include demographics, lab test results, medication and allergy lists, referral notes, discharge information and diagnoses, he said.
“We didn't have to do anything special for the time of this disaster,” he said. If a patient was evacuated from one hospital to another, the receiving hospital simply “did a lookup of the records,” Whitlinger said. “In reality, this is really what the network was designed to do.”
The exchange, however, doesn't have all its members' records stored in Texas. Some, like those from exchange member NYU Langone Medical Center, were kept on an “edge server” at the hospital, and these were initially inaccessible when the power went out, Whitlinger said. Access by exchange members to Langone's server was to be restored Friday. The exchange also started linking office-based physicians, “so, two years from now, we should have a better story, but the story today is not bad,” he said.
Whitlinger previously served as director of healthcare policy and standards in the digital health group at Intel Corp. When Katrina hit, he said, the chipmaker pitched in to help patients replicate their records.
“We set up a huge tent and tried to do personal health records,” he recalled. “We worked with the Red Cross and it was a train wreck, a disaster in every sense of the word. It was mostly still paper in the time of Katrina, and that paper was lost.” With data stored on computers, he said, when disaster strikes, “you might not have it instantly available, but at least it's still there.”