Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality improvement, clinical informatics, and health care policy affecting specialty care. He is the former medical director of a large,
Your plan should address the needs of patients, staff, providers, and the business.
Hurricane Michael came ashore in a heavily populated area of the Florida panhandle on Oct. 10, 2018. As I wrote this article 3 weeks later, two major hospitals in the region remained closed to all but emergency room services, and many community medical practices were closed indefinitely. Others were scrambling to find temporary office space. The prognosis is guarded: A year following Hurricane Katrina, only one-fourth of physicians had returned to New Orleans to practice (Health Aff [Millwood] 2006; 25:w393-406).
Would your urology practice survive such a blow? The answer may lie in how well you have prepared to deal with a disaster-before it hits. In this article, I will review some topics in disaster preparedness from several different perspectives.
Meeting patients’ needs
The patients’ needs are the first to consider. The acute interruption of a busy urology practice will create a group of high-acuity patients with urgent needs. This group includes those scheduled for urgent or emergent surgery, those who just had a surgical procedure, and patients due for time-sensitive cancer medications (sipuleucel-T [Provenge], for example).
Natural disasters typically result in power outages and communication challenges, but you should have a plan in place to communicate with patients once it is possible. The foundation of this plan is the disciplined collection and updating of patient information during normal operations: phone, cell phone, secondary contact information, and especially email. Of course, you need access to this information, and the benefits of remote hosting or a cloud environment may become clearer during disaster recovery.
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Your business phones are probably going to be down, and your practice will be tough to contact. Patients may attempt to communicate through a patient portal. Is your practice really serious about registering patients for the portal, or are you doing the bare minimum for a government program like the Merit-based Incentive Payment System?
Finally, your practice website can be a valuable tool for communication. A flashing banner with instructions and contact information may help redirect patients and enable continuity of care. In summary, it is very likely that a disaster will interrupt power and land lines in your practice, and you should be prepared for electronic forms of communication with your patients-email, text, cell phone, patient portal, and website.
A less acute but equally important group of patients to consider and attempt to consists of those with elective surgery scheduled, those with a recent prostate biopsy, and those with upcoming appointments. If you have taken the time to configure your appointment scheduling templates, create appointment types, and enter appointment notes, it will be easy to generate reports or browse the schedule efficiently. If you have no standards, hundreds of templates, or aren’t using advanced functions in your scheduler, it will be a long and arduous process. If you keep your surgery schedule in a “notebook” instead of electronically, consider that that may be lost in a disaster.
This may be a good time to review your scheduling practices and ask if they would serve you well in an emergency. Appointment reminder systems can be leveraged in an emergency to blast messages to a controlled group of patients-again, if your collection of demographics has been thorough.
Once you are able to communicate with patients, it is inevitable that some will have been displaced or have another reason to transfer their care immediately. You should be prepared to facilitate the transfer of their medical records electronically and assume that the patient cannot “come by the office.”
If you have never tested direct messaging or other electronic forms of records transfer, now may be the time. It is possible that the number of requests may overwhelm your capacity to keep up even once normal operations are restored. There are third-party vendors that can assume some or all of this burden, and your preparation plan might include evaluating their programs’ benefits and costs.
If any of your information systems are hosted locally, you should already have an IT disaster plan that addresses power outages, battery backup, and backup/restoration of data. These plans typically anticipate a few hours or days of downtime, but a hurricane or tornado can leave a region without power for much longer.
You should have a plan that includes protecting and relocating servers and critical pieces of your infrastructure to a secure and climate-controlled environment where they can be brought back up and accessed. These relocations and restorations should be done by an IT professional who knows your practice, your systems, and your infrastructure. Identifying such a person and creating such a plan should be done before it is needed, and then tested.
Next: Consider staff/physician safetyConsider staff/physician safety
Think about your staff and physician safety and needs during an emergency. Have you identified a shelter or safe location? Do you have an evacuation plan? If you plan to stay, do you have enough water, food, and gasoline to last for more than a week? What will you do if there is no power for 2 weeks?
Your disaster plan should include a rendezvous point, time, and emergency contact number outside the disaster zone. Do you have access to all of your employees’ contact info online? If your practice is big enough, your plan may include transferring staff to other offices and filling open positions; physicians may be able to do locum tenens work in the region or elsewhere. Your plan should address retention of staff and employees, payroll, emotional support, access to benefits, and the basics of human resources.
Finally, you need a business continuity plan. Often when disaster strikes there are federal emergency funds allocated to small businesses-know how to apply for these funds. Most business insurance plans offer some sort of optional coverage for business interruption-coverage for lost revenue and expenses-including the cost of relocation. Review your insurance to see whether and how much coverage exists. While a hurricane is a rare event, it is a reminder that other forms of disaster (fire, flooding, power outage) may close your practice for an extended period of time, and you should have a plan.
Bottom line: Natural disasters serve as a reminder that most urology practices are small businesses and should have a basic plan in place for dealing with events that cause the temporary or permanent closure of the office. Your plan should address the needs of patients, staff, providers, and the business. Benjamin Franklin said, “By failing to prepare, you are preparing to fail.” While the chances are small you will face a natural disaster, preparation is your best defense.