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Information Systems Disaster Recovery Plan

SCOPE AND OBJECTIVE: 

This plan describes how the hospital will protect its primary information system.  It also describes processes and actions to be implemented in the event of interruption and subsequent recovery of the hospitals primary information system, CPSI.  The objective of the plan is to insure the integrity of processing information and retrieval.

RESPONSIBILITIES: 

It is the responsibility of the Board of Trustees and Senior Administration to monitor and approve requests for equipment and programs needed to protect the viability of the information management system.  

It is the responsibility of the Information Systems Coordinator to do preventive maintenance and maintain reliable backup systems.

It is the responsibility of the department Directors, Managers, and Coordinators to retain information and staff their departments for the recovery of information after any interruption of the information system.


I.  REDUCING RISKS

A.  Information Systems Coordinator will manage preventative maintenance.
1.  Information Systems Coordinator will do preventative maintenance quarterly or on an as-need basis.
2.  CPSI and Information Systems Coordinator will do preventative maintenance on the Operating System and File Systems Environment as required.
B.  Protection of Computer Data
1.  Daily backup on magnetic tapes will be performed nightly.  The system will automatically shut down at 2:00 a.m. to perform backup.  Backup tapes will be rotated daily by Coordinator of Information Systems or their alternate.
2.  The Information Systems Coordinator or their alternate will perform ADR backup every Friday.
3.  Off site storage of the most current backup tapes will be the responsibility of the Information Systems Coordinator.
4.  A monthly backup will be sent to CPSI on a timely basis by the Information Systems  Coordinator.
5.  The Information Systems Coordinator or their alternate will do verification of backup Monday through Friday.
6.  Current boot floppies will be kept in the safe.
7.  All backup Policies and Procedures will be the responsibility of the Information Systems Coordinator.

II.  PROTECTION OF DATA CENTER OPERATION
   
A.  Power loss
1.  CPU, hard drives, and primary system components are on battery backup and emergency power.
2.  TCUs
a.  All TCUs will be on emergency power
b.  Departments with receptacles on emergency power:

Department
DP
Receptacle
Y adequate

Department
FS
Receptacle
N need 1

Department
Med Surg / ICU
Receptacle
Y adequate

Department
Billing 
Receptacle
N need 2

Department
HIM
Receptacle
Y adequate

Department
Purchasing
Receptacle
N need 1

Department
Pharmacy
Receptacle
Y adequate

Department
Radiology 
Receptacle
Y adequate

Department
Dietary
Receptacle
N adequate

Department
OR / ASU / Clinics
Receptacle
N adequate

Department
Registration
Receptacle
Y adequate

Department
Laboratory 
Receptacle
Y adequate


c.  Department Managers will assess the need for emergency power
B.  Temperature Control
1.  Wall thermometer to monitor temperature
2.  Dedicated air conditioner
C.  Physical Security
1.  Data Processing locked between the hours of 4:00 p.m. and 8:00 a.m.
D.  Computer access security to be maintained by the Information Systems Coordinator
1.  Dial up password
3.  Passwords
a.  Information Systems Coordinator will maintain user defined login passwords
b.  Module passwords will be maintained by Information Systems Coordinator and will be distributed to departments on a need to know basis.
c.  Department passwords will be maintained by Information Systems Coordinator and be department defined.
d.  Physician passwords will be defined by physician number and maintained by the Information Systems Coordinator.


III.  COMPUTER INTERRUPTION OF FAILURE 

A.  Communication
1.  Notification of the Information Systems Coordinator
a.  During normal business hours, Information Systems Coordinator or their delegate will be notified immediately of any interruption or failure of the CPSI system.

b.  For any interruption or failure of the CPSI system in the evening or on weekends, notify the on call computer person by telephone or pager immediately.
2.  Information System Coordinator or the on call computer person will assess the situation to determine:

b.  Estimated time for the resolution of the problem
c.  The necessity of contacting the CPSI support technicians
3.  Coordinator of Information Systems or delegate would communicate this assessment to users.
a.  If downtime is more than fifteen minutes, notify the users via the hospitals  paging system that the CPSI computer system is down and the approximate time for recovery, i.e., fifteen minutes, thirty minutes, one hour.
b.  If the system will be down for more than an hour Information Systems  Coordinator will assign someone to take calls and communicate with the users.  This person would be located in the AP / Payroll office.
c.  Notify users when the system is restored by sending a message via the CPSI system.  Special instructions will be posted on the CPSI bulletin board i.e. recovery form back up date, etc.
B.  Manual processing modes and procedures
1.  Registration
a.  Outpatient completely fill out Disaster Information Registration form (attached)
b.  Inpatient, ASU, or Observation bed fills out the patient admission form completely.  
c.  Put last number used on patient numbering log and manually assign next patient number by patient type.
d.  Write patient number on outpatient requisition form or Admission form.
e.  Call Ancillary Departments or Nursing station to let them know that they have a patient.
f.  Emergency room patients will be triaged first, then proceed with registration  as above.
g.  Staffing or overtime will be at the discretion of management. 
2.  Nursing
a.  Implement protocols which include utilizing telephone and outpatient requisitions as below:

-  Laboratory - outpatient requisition
-  Radiology - outpatient requisition
-  Physical Therapy - outpatient requisition or telephone
-  Dietary - telephone call and census sheet
-  Admissions - telephone call and census sheet
-  Switchboard - telephone call and census sheet
-  Pharmacy - copy of Physicians Order sheet

b.  Implement couriers as necessary
3.  Laboratory
a.  Current test results are held (paper) until system is backup - any critical values are called.
b.  New patients are processed with requisitions and patient numbers and tests performed and held as above.
c.  If downtime prevents printout of 7:00 a.m. inpatient specimen collection list, orders will be requested from SCU and Med Surg.

d.  Outpatient requisition will be used for in-house patients (ED, OR, SCU, and  Med Surg) orders.
e.  Critical order:  STATS, SCU, Med Surg, OPs 
f.  Special requests are honored.
g.  Current staff on duty are responsible.
h.  Manager or designee assesses the need for extra staff and / or overtime.  i.e.  clerk may be sent home to come back when the system is up.
i.  Instrument printout / other results may be charted as rough drafts.
4.  Radiology
a.  Revert to manual (existing file system) backup of x-ray numbers
b.  Use outpatient orders (requisition form) to perform tests
c.  Critical order:  STATS, SCU, Med Surg, OPs, special d.  Use word processing on PC or typewriter for reports
5.  Cardiopulmonary
a.  Outpatient requisitions used for orders to perform test
b.  Inpatients (stats) called followed by outpatient requisition
c.  Outpatients will be done by requisition and STAT results will be called
d.  Manual log will be kept for procedures to be charged
6.  Physical Therapy
a.  Orders would be called to Physical Therapy and logged in an appointment book, followed by an outpatient requisition
b.  Charges would be logged on paper to be input when the system comes back up.
7.  Pharmacy
a.  Assessment of CPSI failures:
 -  Upon first notification of a CPSI failure, it will be necessary for the Pharmacy Department to ascertain from Information Services the extent of the failure and estimated downtime.
b.  If the CPSI failure is estimated to be of four hours duration or less, the Department of Pharmacy Director Recovery Plan will not be enacted.  At this point, the Pharmacy Department will deliver as need medications and  controlled substances to the nursing units on a patient by patient basis when needed until the CPSI system is recovered and then continue with the work day form the point at which time CPSI failed.  It is expected that no additional staffing requirements would be needed; however, late work and / or overtime may be required to complete the days work.
c.  A CPSI failure of estimated duration of more than four hours but less than nineteen hours and begins after a patient cassette cart fill list is generated, the Pharmacy Department Recovery Plan will not be enacted.
d.  A CPSI failure of estimated duration of more than four hours but less than nineteen hours and begins before a patient cassette cart fill list is generated, the Pharmacy Department Disaster Recovery Plan will be enacted as outlined under Pharmacy Procedures in the Event of a CPSI Failure.
e.  CPSI failure of estimated duration of more than nineteen hours will require the implementation of the Disaster Recovery Plan as outlined under Pharmacy Procedures in the Event of CPSI Failure.
f.  Pharmacy Procedures in the Event of a CPSI Failure:
-  When Information Services determines that CPSI failure will be of a duration of more than nineteen hours or the failure is estimated to have a duration of more than four hours but less than nineteen hours and occurs before a patient cassette cart fill list is generated not only will CPSI pharmacy functions be interrupted, but also the Pyxis 2000 Medstation function will be interrupted as well.  A this time the Pyxis system will be shut down by Pharmacy to prevent the loss of charges and activities because of a lack of communication with CPSI.  When Pyxis is shut down, Pharmacy will supply prn medications to the patient cassette drawers.  A limited supply of controlled substance on used carts and in SCU.  The ED will be supplied with a limited number or narcotics and controlled substances for lock up in a secure medication cupboard.
-  If the failure occurs before a patient cassette cart fill list is generated, it will be necessary to accumulate data from multiple sources in order to compile a patient by patient current medication profile.
1)  Recover the most current copy of the patient cassette cart fill list from Pharmacy archives where they are stored for a minimum of thirty days.  This will serve as a basis for compiling  a patient by patient current medication profile,
2)  Obtain a list of current patients from Med Surg Ward Secretary,
3)  Using 5x7 ruled index cards and using one card per patient, compile patient profile cards including the following items:
  Patient name (last name first, first name, middle initial)
  History number
  Age (date of birth)
  Allergies
  Medications (item master number, drug name, strength,signs, first dose date and time) number for twenty-four hour patient cassette cart fill
  Room number
These cards will have the following format:

Card Per Patient

4)  These cards will be verified with MARs and the Ward Secretarys Kardex.  Any discrepancies will be resolved using the patients chart.
5)  The Pharmacy Medication Profile cards will be updated using a copy of the Physician Order sheets 6)  Once the patient profile cards have been set up, the twenty-four hour cart fill will take place.  For charging and billing 
purposes, a list will be maintained that will include patient name, history #, item master number, medication name and strength, and quantity dispensed, and date.  Each time a medication leaves the Pharmacy, it will be added to the list.        

These change lists will be maintained in the Pharmacy until CPSI is again operational; at that time Pharmacy and / or billing will enter the charges.
7)  Whenever a CPSI failure occurs that is estimated to be more than four hours, the Pharmacist and staff must be notified and put on stand by and called in when necessary.
8.  Dietary
a.  Census sheets to be sent to Dietary for patients diets
9.  Materials Management
a.  Hold all requisitions until system is back up
b.  Manually check stock items for reordering
c.  Type Purchase Orders on typewriter
d.  Keep daily edits and hard copy of Purchase Orders
10. Time Clocks
a.  Manually log time in books by time clocks
11. Medical Records
a.  Refer to hard copy of Master Patient Index for Medical Record numbers and for pulling patient charts
b.  Use PC or typewriter to transcribe reports.  Critical order:
-  Patient transfers
-  Progress notes
-  Operative procedures
-  History and Physicals
-  Emergency room reports
-  All others
12. Payroll
a.  Manual process of using previous records to average 
13. Accounts Payable
a.  Manual process match invoices to receiving reports and Purchase Orders
b.  Use list for vendors and General Ledger numbers
c.  Hold until system is back up or manually type checks and hold backup
14. Accounting 
a.  Keep source documents and edit lists to recreate any transactions
C.  Resumption of Service
1.  Registration will notify either Director of Business Office or Information System Coordinator of the next available numbers.
2.  Director of the Business Office or Information System Coordinator or computer call person will change the next available number in the AHIS tables.
3.  After receiving notification they can automatically assign new numbers the registrars will manually input all registrations and will start with live registrations assigning new numbers from the CPSI system.
4.  Input information from saved Disaster Recover form 
a.  Critical order for input of information
-  Inpatients
-  ASU
-  Emergency Room
-  Outpatients
5.  Nursing Departments
a.  Med Surg would have three Ward Secretaries
-  Order entry to Pharmacy
-  Order entry all other Ancillary departments
-  Maintain duties of the work station and continue with all new orders
b.  The ED would reenter lab orders
c.  Keep all Physician Orders, if patients are discharged retain inpatient charts on the nursing floor.
6.  Laboratory
a.  Retrieve orders from MRH order entry departments along with registration numbers
b.  Retrieve registration numbers for outpatient and enter orders
c.  Enter results
d.  Print and chart results
e.  Assess need for additional staff
f.  Documents, requisitions and test results are available in department
7.  Radiology
a.  Retrieve generic orders from Millinocket Regional Hospital order entry system
b.  Enter test completed and charges from order entry and Physician Orders
c.  Enter transcription
d.  Assess need for additional staff
e.  Revert to manual card files
8.  Cardiopulmonary
a.  Input charges from Physicians Orders and log
9a.  Input charges from charge ticket or log
10. Health Information
a.  Enter transcription from a Dictaphone
11. Billing
a.  Done by edit lists from last update
12. Purchasing
ab.  Purchase orders
13. Accounts Payable / Payroll
a.  Accounts payable would be input from held invoices.  Typed checks would be input with backup
b.  Catch up - enter all employees time, deduct checks previously paid and pay difference
c.  Recovery from source documents and edits
14. Fiscal Services
a.  Recovery from source documents and edits
15. All backup documentation must be kept for three days.  Occasionally Information Systems Coordinator may instruct departments to retain backup material longer.


IV.  CATASTROPHIC FAILURE OR DAMAGE TO FACILITY

A.  Coordinator of Information Systems and Millinocket Regional Hospital Administration on call are to be notified immediately.
1.  Information Systems Coordinator or alternate will assess the situation immediately upon arrival and notify Millinocket Regional Hospital Administration as to status.
2.  Information Systems Coordinator or alternate will notify all other personnel of affected departments as soon as possible.
3.  Upon notification of complete destruction or major failure of computer room:
a.  Information Systems Coordinator or alternate will contact the CPSI Customer Support and report the situation.
b.  A command center to answer questions will be set up in the Accounts Payable office
c.  Direction will be taken from CPSI Customer Support
d.  Manual processing as above will go into effect
4.  Recovery from backup
a.  Users will be notified when the system is back up
b.  Directions of backup start time will be communicated over the CPSU Bulletin Board
c.  Recovery procedures as above policies
d.  Data entry will be from the time of backup
5.  Multiple days closing
a.  Registration will do the Census Report with room and board charges after all inpatients for a day are entered
b.  Switchboard will perform daily system closing after each days registrations and charges have been entered.