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Act now to disaster-proof clinical, business records.

The recent disaster along the Gulf coast may be a wake up call for all physicians to establish some kind of emergency backup system for their businesses.

"Physicians don't always think of themselves as running a business, but they're going to think of it now," Rosemarie Nelson, a Syracuse, N.Y.-based consultant with the Medical Group Management Association, said in an interview.

Otolaryngologist Michael Ellis, M.D., is hoping that technology might have retained some of his records. His practice in Chalmette, La., south of New Orleans, is in an area flooded to the rooftops in the aftermath of Hurricane Katrina and the subsequent breakdown of the levees in New Orleans.

"Like most physicians, I have billing electronic records, but my office clinical records are paper. I assume all that--and our supplies and equipment--will be unsalvageable," he said in an interview shortly after the flood.

Dr. Ellis said that he had backups in place for his billing records, both hard copy and "off campus," (outside computer services) assuming that certain computers weren't damaged or backed up during the flood.

As Ms. Nelson noted, "there is just no way to secure paper records. They're there or they're not. You're not going to copy and store them off-site."

However, a fully integrated electronic medical record might not have been completely safe for stricken medical communities, either.

Anne L. Shirley, a spokeswoman with the Louisiana State Medical Society, said an undetermined number of records have been destroyed.

Some electronic records weren't able to be accessed as most computer servers have been destroyed, Ms. Shirley said. The Louisiana State Board of Medical Examiners is located in a hard-hit flood area in new Orleans, and the society's Web site and database were inoperable, even from remote locations, Ms. Shirley said. "This, as you can imagine, poses a problem with license verification and credentialing for displaced physicians."

One way to solve backup problems such as these is to have electronic medical records stored in a secure, remote site by a vendor, Ms. Nelson said. "And it doesn't have to be a vendor you bought your software from. There are tons of vendors out there providing remote access."

Such vendors also can offer Internet-based backups, which "add a whole new sense of security," she noted. "When something happens in an area or region that [backup disk] you took home is as insecure as your records."

Even if they don't use an electronic medical record system (and only about 15% of doctors have them), physicians should consider storing their administrative records, such as financial and scheduling information off-site, Ms. Nelson said.

"You need to think about using off-site backup for your financial applications, scheduling, patient list, and some receivables. You still have insurance receivables there, and you're going to need that cash inflow because you're going to have to buy new equipment. So securing your financial records is equally as important."

The patient list will be essential when you need to inform patients that you've set up your practice in a new location or will be reopening on a particular date, she added.

An advantage of backing up financial information is that it also includes some clinical information, Ms. Nelson said. "That's because you need to have a diagnosis code to bill the insurance company."

At press time. Dr. Ellis was able to communicate only by e-mail because all the phone prefixes in Louisiana and Mississippi were unreachable.

He could reach his practice associate in Birmingham via e-mail. "Two of my staff communicated that they are in upper Mississippi," he said.

Other physicians sent him e-mail from Houston and Baton Rouge to let him know their whereabouts.

He wasn't able to receive traditional mail. "No one has said what is happening to it, or how we can contact insurers, Medicare, etc., to change our address. I don't know what patients are doing about getting their prescriptions filled since they can't reach doctors."

At press time, the Louisiana State Medical Society was working with the state's Department of Health and Hospitals, the Office of Emergency Preparedness, the Department of Homeland Security, and the Federal Emergency Management Agency to contact physicians.

"We are trying not to confuse the situation by coming up with our own information. Simplicity is best at times like these. Things in this regard change from minute to minute, and I am sure that even more information will become available to us and to our physicians as the days go by," Ms. Shirley said.


Associate Editors, Practice Trends


If your practice was affected by Hurricane Katrina, what have you learned about preparing for a disaster?

Share your thoughts!

Send e-mail to; write to Internal Medicine News, 12230 Wilkins Ave., Rockville, MD 20852; fax to 301-816-8738; or click on the Talk Back box at

RELATED ARTICLE: The Call Goes Out for Volunteers

The federal government is seeking volunteers from the health care and relief professions listed below to deploy to the Gulf region. Deployment may last 14 days or longer and may include 12-hour shifts under austere conditions, according to the Health and Human Services department.

Volunteers will be unpaid, but will receive travel reimbursement, a per diem, and coverage under the Federal Tort Claims Act for liability coverage and workers' compensation, HHS said in a statement. To volunteer, visit or call 866-528-6334.

Administration/finance officers


Clinical physicians


Dental forensics personnel




Environmental health personnel


Facility managers


IT/communications officers

Laboratory technicians

Licensed practical nurses

Medical clerks

Medical examiners

Medical record/health information managers

Mental health workers


Mortuary assistants

Nursing assistants/nursing support technicians

Nursing staff directors


Patient transporters/volunteers



Physician's assistants or nurse-practitioners

Physician chiefs of staff

Radiologic technicians

Respiratory therapists

Registered nurses

Safety officers

Security officers

Social workers

Substance abuse counselors

Supply managers


RELATED ARTICLE: Flood-Proofing Tips for Businesses

Here are some general tips from the Federal Emergency Management Agency on flood and hurricane preparation for businesses:

* Ask your local emergency management office whether your facility is located in a flood plain. Find out the history of flooding in your area, and determine the elevation of your facility in relation to streams, rivers, and dams.

* Learn about community evacuation plans from your local emergency management office.

* Establish facility shutdown procedures. Make plans for assisting employees who may need transportation.

* Purchase a National Oceanic and Atmospheric Administration weather radio with a warning alarm tone and battery backup. Listen for flood watches and warnings.

* Get information about flood insurance from your insurance carrier. Regular property and casualty insurance does not cover flooding.

If a hurricane or other major weather event is being forecast, consider taking these actions ahead of time:

* Clear out areas with extensive glass frontage as much as possible. If you have shutters, use them; otherwise, use precut plywood to board up doors and windows.

* Remove outdoor hanging signs.

* Bring inside or secure any objects that might become airborne and cause damage in strong winds.

* Store as much equipment as high as possible off the floor, especially goods that could be in short supply after the storm.

* Move equipment that cannot be stored in a secure location away from glass and cover it with tarpaulins or heavy plastic.

* Place sandbags in spaces where water could enter.

* Remove papers from lower drawers of desks and file cabinets and place them in plastic bags or containers on top of the cabinets.
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Author:Silverman, Jennifer; Frieden, Joyce
Publication:Internal Medicine News
Geographic Code:1USA
Date:Oct 1, 2005
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