Monday, February 13, 2012

Tips from a road warrior (20): Have a backup for your back-up!

As travel is often unpredictable, it is important to have a back-up plan, and even a back-up back-up plan in case the first back-up does not work out. I have had several cancelations late at night, or arrived after midnight in a deserted airport where all connecting flights have departed. I have been fortunate to never have to overnight at an airport, although I have come close. If your back-up plan for being stuck at the airport is getting a hotel booked by the carrier, here is some advice; don’t.
First you have to wait in line for at least a half hour to get a voucher, then wait another half hour for a bus that has to be chartered, then stand in another half hour line to check in with a night clerk at the hotel. When you finally arrive in your hotel room at about 2 a.m., you realize that the airline has booked you on the first flight out, which leaves at 6 am. You might have 2 hours of sleep. A better back-up is to call your travel agent right away, get a room, and a cab so you’ll be taken care of in half an hour.
I have observed a couple of incidents where hospitals did not have a back-up of their back-up. I have heard first-hand stories of IT professionals who after Katrina had to go into the hospitals when the flood water receded to find the back-up in storage cabinets. A perfect example where an additional back-up somewhere in the cloud would have helped. There are also some files that typically were not backed up or had been forgotten that would have proven invaluable had there been a back-up.
As and example, radiologists often go to great length to specify how they want their images to come up on screen. They specify their preferences with regard to their window/width and level settings, and how to configure their work lists. Not backing up this information will create a lot of additional work and aggravation in case the data is lost or corrupted. Another data set that might get overlooked are “deleted” images. When discussing this with one particular PACS administrator, he mentioned that in several instances, after he was told to delete a case, he was asked to undelete it. As a result he developed a back-up plan. He basically created a special library for these deleted images, similar to the “trashcan” you find on your computer desktop and made sure he never deleted that.
Audit trails are another important set of files that should not be deleted. These files have been required by HIPAA regulations and need to be accessible in case there is a question of whether certain patient information and/or images were accessed by healthcare practitioners. Teaching files are also important to make sure that they are kept safely. In many cases, PACS systems are not geared towards creating and maintaining teaching files, as these are studies that need to be indexed based on diagnosis and/or diseases. Additional keywords need to be added that can be used to search and categorize, which is something that is clearly addressed with the IHE teaching file profile but is not widely supported. This results in institutions maintaining their own separate teaching file repositories, which become important pieces of intellectual property that can be costly to recreate should it be destroyed by unforeseen events and the back-up fails.
One last item that is often overlooked is the calibration records of the diagnostic monitors. I have talked with a PACS administrator who was asked to provide the detailed record of a particular monitor, which was used to make a diagnosis more than two years prior as the diagnosis was disputed in court as part of a malpractice suit.
In conclusion, back-ups are part of our daily lives, and just as we make sure we have alternate plans in place when traveling, we need to have back-up plans in place when the unexpected occurs. Make sure you have a back-up plan, and a plan for when the back-up does not work, and consider back-ups for areas that you might otherwise overlook.