Disaster PreparednessA NextGen® Case Study

NextGen®

EMR & EPM Systems SupportDisaster Preparedness, Prevention & Recovery

Like the rest of the country, America's healthcare community was

stunned by the overwhelming damage caused by hurricanes and

tropical storms that ravaged the southern states in 2005. The loss

of life and property shocked and saddened physicians from coast to

coast, and many rushed to provide support in any way possible.

While responding to the human tragedy was of paramount

concern, physicians in the affected areas also were faced with an

administrative nightmare. Damaged or destroyed were medical files,

patient charts, diagnostic studies, insurance claims, clinical records,

billing information - the myriad of invaluable and sensitive data vital

to effective clinical practice and the ongoing treatment of patients.

Some physicians fared better than others, however, specifically

those who had implemented highly flexible and accessible practice

management and electronic medical records systems from vendors

who plan and prepare for these potential emergencies. These

practices were not only able to prevent the loss of data, they

resumed operations in record time - in many cases offering

services to dislocated patients who had no other access to care.

Overview

Practice #1Southeast Texas Medical AssociatesBeaumont, TX

Practice ProfileSETMA has three clinical locations and 23physicians and implemented NextGen®

EPM and EMR in 1998.

Business ProblemHurricane Rita struck the Beaumont area,causing overwhelming physical damageand threatening to destroy clinical andadministrative records.

SolutionSETMA devised a fail-safe preparednessplan for its EPM/EMR so no records werelost and the practice was fully operationalwithin days of the hurricane.

Practice #2City of Austin Community Health Centers

Practice ProfileThe City of Austin CHC comprises 17clinics and provides outpatient primaryhealthcare to 45,000 low-income adultsand children.

Business ProblemPublic services in Austin were quicklyorganized to provide care to thousandsof evacuees from New Orleans afterHurricane Katrina; makeshift "clinics" inthe city's convention center were neededto provide and document basic healthcare.

SolutionNextGen EPM was used to capture andstore critical information about eachencounter with evacuees.

Practice Records Restored

Such was the case with SoutheastTexas Medical Associates (SETMA) inBeaumont, Texas, which lay in the path of Hurricane Rita late inSeptember 2005. This multi-specialtypractice uses both NextGen® EMR(electronic medical records) andNextGen® EPM (enterprise practicemanagement). SETMA experiencedminimal downtime and lost no patientor administrative data because it haddevised a preparedness plan that madeuse of NextGen's advanced technologyand ever-ready vendor support.

When NextGen Healthcare works withphysicians to implement its applications,it helps practice leaders institute back-up protocols for locally hosted servers.SETMA itself relies upon more than 30 servers with built-in redundancy tostore and manage its NextGen applications. (NextGen encourages the use of SQL servers that "cluster" systems, so one server can take over if another isn't operating.) Clinical andadministrative data are automaticallybacked-up several times a day.

The practice's disaster plan includes a shutdown sequence, which islaunched whenever a power outage or system failure occurs. Battery operated power sources ensure theservers shut down seamlessly, and noclinical or administrative data is lost.

In case of ultimate disaster, SETMAalso developed a "bare-metal" disasterrecovery plan, which would allow thepractice to restore systems and thenreintegrate its network from the baremetal of new servers if it experienceda total loss of software and hardware.

As the storm approached, SETMA CEOJames Holly, MD, triggered the shut-down protocol and instructed thedirector of the IT department toremove one back-up server to an off-site location remote from the storm-threatened area. This provided SETMAwith "plug and play" functionality, toensure the practice could resumeoperations as soon as physically able.

Within a week after the storm passedthrough Beaumont, the practice wasoperational at one clinic site, whichhad sustained minimal physical damage.The server was returned to Beaumontand, once turned on, gave physicianscomplete access to all patient carerecords. Once other clinics weredeemed safe and power was restored,physicians could examine patients withcomplete charts in those locations, too.

In addition to treating existing SETMApatients, the practice also cared for4,000 evacuees. NextGen

®EMR

enabled physicians to create a hardcopy "record" for these evacuees tocarry with them to ensure continuityof care when they found more permanent residence.

SETMA's central business office wasdamaged extensively, so staff memberswere unable to return to work at thatsite for several weeks. However,thanks to the flexibility of NextGen

®

EPM, leadership was able to establisha fully functional temporary businessoffice in an empty exam room, withlaptop computers set up on vacantcountertops. The claims submissionprocess was not disrupted, andSETMA suffered no lag in accountsreceivable.

Our electronic medical

records and practice

management system

allowed us to continue

seeing patients until that

last possible moment. Days

later, we were back up and

running - all of the data

was available as soon as

we turned the system

back on.”

James L. Holly, MD, CEO

Southeast Texas Medical Associates

“

Care for Katrina Evacuees

Healthcare officials managing disasterresponse operations in Austin, Texas,were also able to use a NextGen application with great success afterHurricane Katrina. Although not directlyhit by the storm, Austin became homefor thousands of New Orleans evacuees,housed in the local convention center.Many were in dire need of care, notonly for illnesses and storm-relatedinjuries, but also for chronic conditionssuch as diabetes and hypertension. Tofully support their new "citizens" whohad lost everything (including eyeglasses, prescriptions, dentures, etc.),the City of Austin set up pharmacy,psychiatric, dental, immunization, andchild care within the convention centerand turned to its community healthdepartment to coordinate services.

Initially, the City of Austin attemptedto record the care that volunteer physicians provided by using Excelspreadsheets. Unfortunately, thisapproach was highly disorganized andproved ineffective, as the software wasnot designed for healthcare documentation or emergency response.Registration personnel were forced towork from individual PCs with variousversions of the Excel spreadsheet, soinformation could not be shared oraccessed effectively. With no centralizedfunctionality, it was impossible for officials to track activities, identifyhealth or safety threats, or follow upwith specific individuals.

However, physicians and leaders withthe city's Community Health Centersdivision were using NextGen

®EPM,

and within days were asked to takeover the operation. They accessed theEPM server remotely via the city's

Internet network and used the application to more effectively manageoperations. Because the EPM is flexibleand easy to customize, the CHC wasable to deploy the application withinhours, earning kudos from local andnational officials alike. CHC leadershipenhanced its credibility within the community and helped bring order andcalm to an otherwise chaotic situation.

NextGen®

EPM allowed volunteerphysicians to see 500-600 patients aday and gave them easy-to-use toolsto create permanent records of theencounters. The application allowedemergency officials to capture:

demographic information about the patient's home in New Orleans, which allowed emergencypersonnel to track the wheraboutsand condition of individual evacuees;the patient’s chief complaint, thereby creating a permanent record for effective follow-up after the immediate crisis passed and evacuees were relocated;level of care provided, includingspecific diagnoses, treatmentsand follow-up recommendations;insurance information, which provided the City of Austin with a vehicle to track expenses for eventual federal reimbursement;a list of relatives so other emergency volunteers could notify worried family members; andrecords of where each patient would be staying in the Austin area (or elsewhere) after they were relocated from the convention center and how they could be reached.

Because the EPM is flexible

and easy to customize, the

CHC was able to deploy the

application within hours,

earning kudos from local

and national officials alike.

CHC leadership enhanced its

credibility within the

community and helped bring

order and calm to an

otherwise chaotic situation.

With the wealth of information available through the EPM's robustreporting functions, the City of Austinand other national agencies (such asthe Centers for Disease Control andPrevention [CDC] and the FederalEmergency ManagementAdministration [FEMA]) were able tomonitor and analyze the situation inreal time. The CDC could track andrespond to possible disease outbreaksor epidemiological threats, forinstance, while FEMA and theAmerican Red Cross could locate missing persons to put them in touchwith relief services or relatives. In addition, officials could monitor thevolume of patients being seen in orderto staff the effort more effectively.

Additional Protection

Fortunately, few physician practiceswill ever experience devastation of this magnitude. Nevertheless, lesseremergencies can also create havocwithin a physician practice. Whileexternal forces (fire, storms, and waterdamage, for example) can easily destroypaper-based records, electronic recordscan also be vulnerable. For instance,they may be at risk in the event ofpower outages when local utilities orgrids have failed, phone services areinterrupted, or LANs or WANs havecrashed. NextGen

®EMR and NextGen

®

EPM have been fully tested to ensurethey protect and recover data in caseof emergency.

NextGen® is a registered trademark of NextGen Healthcare Information Systems, Inc., and Free Yourself to Practice Medicine is a service mark of NextGen Healthcare Information Systems, Inc. Copyright

1994-2005. All rights reserved. *Indicates trademark or registered trademark of respective company. All other trademarks not owned by NextGen Healthcare Information Systems, Inc., or its subsidiaries

that appear in this document are the property of their respective owners, who may or may not be affiliated with, connected to, or sponsored by NextGen Healthcare Information Systems, Inc. or its subsidiaries.

NextGen HealthcareInformation Systems, Inc.795 Horsham Road

Horsham, PA 19044

(215) 657-7010

(215) 657-7011

http://www.nextgen.com

email: sales@nextgen.com

NextGen Healthcare, for instance, atits corporate center, is beginning toaccept transaction log transfers daily,to keep a mirror-image copy of a practice’s database for emergency re-creation and use by the practice.

In addition, NextGen Healthcare canserve as data center host in an ASPenvironment, allowing physician practices to access the applications inreal time without maintaining theirown servers. This type of access would allow physician practices tocontinue operations from remote locations for a longer period of timeuntil they can re-open local offices.

NextGen Healthcare also provides special maintenance features such asthe Wellcare program, whereSilverBack Technologies remotely andproactively monitors a practice'sservers. The program identifies reasonsa practice's back-up protocol mightnot have been successful; monitorsavailable disk capacity, warning usersand the NextGen support team whenit is nearly exhausted; and alerts usersto viruses and other security threats.

Unfortunately, disasters such as the2005 hurricanes serve as a rude awakening and underscore a business’vulnerability to forces beyond humancontrol. While it is impossible to preventmany crises, practices with access toappropriate tools and services can minimize disruption, speed recovery, andreturn more quickly to the importantbusiness of caring for patients.

The NextGen applications

added significant value to

our efforts during this dire

time. We were proud to be

using a system that was so

easy and flexible that it

could respond to these

unexpected demands.”

Dan Dugas, Medical

Informatics Administrator

City of Austin Community

Health Centers

“