Mercy Medical Center

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Jeff Cash CIO Sr. Vice President Mercy Medical
Center Cedar Rapids, Iowa Floods of 2008
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Mercy Medical Center Cedar RapidsGeneral
Information

• Sisters of Mercy Hospital Established in 1900
• Licensed for 450 Beds
• Supported by approximately 370 Community
  Physicians
• Associated MPS Primary Care Network
• 20 Sites, Approximately 90 Providers
• Most Wired Winner in 2006 and 2008

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Mercy Hospital 2008 Flood
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Mercy Flood Video
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Timeline and Course of Action

• Monday June 2nd
• CIO Leaves for 3 week family vacation in Europe.
  
• 10 Days before the flood..

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Thursday, June 12th Paris France(No Flooding
in Paris)
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Thursday, June 12th Cedar Rapids, MMC (Flooding
in Cedar Rapids)
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1st Rule of Disaster Planning

• Prepare in Advance - Not During the Disaster
• You dont know who will be there when disaster
  strikes
• Approximately 140 Mercy Employees Directly
  Affected
• In our case, we had excellent leadership in place

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Downtown Cedar Rapids Normal View
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Downtown Cedar Rapids Flood View
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Downtown Flood Zone Map With Mercy
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Cedar River Water Levels 2008 Flood

• 2008 Flood Crest 32 Feet
• Previous Flood Crest - 24 Feet
• Flood Stage 12 Feet
• Normal Depth 6 Feet

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Mitigation Efforts

• Sandbagging the facility was an all hands event!
• Hospital Staff
• Community Volunteers
• Vendors
• Hundreds of People with One Goal

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What Happened Cause of Evacuation

• Water Sources
• Flood Waters Surround Hospital Depth up to 5
  feet outside the facility, water breeches
  sandbags and enters facility
• Ground Water Pressure water pressure pushes
  water in through floor and side walls of
  foundation.
• Black Water enters through sewer system plumbing.
• Service Outages
• Loss of electrical power and steam from local
  utility
• Water nears internal electrical distribution
  systems
• Primary Concern Potential loss of full
  electrical power
• Evacuation Coordinated with State EOC
• 176 Patients Evacuated
• All incoming patients diverted

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Mercy Emergency Operations Center

• Utilized EOC structure from previous training
  drills.
• Reorganized leadership structure as necessary
• Established communications with external
  organizations
• Coordinated regular briefings for internal staff
• Maintained on-going event and work assignment log

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How Decisions Were Made

• Disaster Management Organization is key
• Disaster drills helped prepare our organizational
  capabilities
• Every Disaster is Unique
• They dont happen by the book
• Normal Job roles did not apply
• Re-organized to meet the situation not the
  traditional roles.
• Decisions will sometimes need to happen fast and
  furious.
• Centralized oversight (EOC), with localized
  decisions

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Organizational Recovery Goals

• Recovery Timeframes
• Disaster Recovery Teams On-Site in 48 hours
• Re-open Cancer Services 72 Hours
• Fully Restore Services 2 weeks
• Fully Restore Facility 120 Days
• Organizational Commitments
• All employees will remain employed
• Rebuild will be Better than Ever

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Actual Timeline
1 Day
1 Day
2 Days
2 Weeks
3 Months
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Cleanup Begins

• Time is of essence
• Engage professionals with access to resources
• Work with regulatory agencies
• Invited in Department of Inspections
• Ordered long lead items immediately
• Construction Supplies and Equipment
• Work with staff to fill unconventional roles

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Parking Ramp Salvaged Supplies
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Parking Ramp Cleaning Chambers
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Recovery Efforts

• Temporary steam boiler arrives and is installed
• Mobile services arrive
• Cath Lab
• CT
• MRI
• Nuclear Medicine

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Recovery Efforts

• Architects, Vendors, Engineers, and Hospital
  Staff
• Order construction materials and replacement
  equipment
• Organize the demolition and rebuilding efforts
• All ground floor and basement services relocated
• Clinical Services
• Emergency Department, Radiology, Physician
  Offices, Therapies, Cardio Pulmonary, Treatment
  Center
• Support Services
• Lab, Pharmacy, Registration, Central Stores,
  Central Sterile, Maintenance, Environmental
  Services

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Flood of 2008Fun Facts
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• Rebuild
• 22 Electricians averaging over 300 hours overtime
  weekly
• Replaced over 800 outlets and 150 lights
• 88 Carpenters working 1500 hours overtime weekly
• Installed 2,400 lineal feet of cabinets and
  countertops
• 2,500 sheets of Sheetrock (80,000 Square Feet)
• 250 five-gallon buckets of drywall compound
  (1,250 Gallons)
• 500 dumpsters taken to the landfill (20,000 cubic
  yards)
• Ran Generators for 355 hours, burned 15,000
  gallons of fuel

• Click to edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

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Flood of 2008Fun Facts
Click to edit Master title style

• Wall Coverings
• 2,000 yards of wallpaper
• 150 gallons of glue
• 550 gallons of paint
• Floor Coverings
• 9,000 sq. ft. ceramic tile
• 3,000 yards of carpeting
• 24,000 sq. ft. vinyl tile floor
• 2,000 sq. yards of vinyl sheet flooring
• 8,000 sq. ft. vinyl wood plank floors
• Over 4 miles of vinyl base installed

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• Second level
• Third level
• Fourth level
• Fifth level

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Rebuild
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Rebuild
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Rebuild
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Rebuild
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Data Center Services TimelineShutdown Due to
Power Concerns

• Friday June 13th
• Early Morning
• Relocated Backup Data Center to Primary Data
  Center
• Morning
• Contacted Qwest and had DMARC relocated
• Began shutdown of all non-essential I.T. systems
• Reroute key phones to Mercy Hospice
• Migrated web site and Physician Portal to
  off-site hosted locations
• Evening
• Finalized shutdown of all IT systems
• Data Network, Phones, Vocera, Internet are the
  exception

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Data Center Services Timeline Startup

• Saturday June 14th
• Direct Generator Electrical Line to Primary Data
  Center
• Begin making plans to restore full IT operations
  and Hospital operations
• Sunday June 15th
• IS Systems Startup Begins
• Monday June 16th
• IS Systems Fully Operational
• 1st Patients Return to Cancer Center

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Information Services - What Worked Well

• Our Employees!
• Vendor Relationships!
• Vital, Cisco, HP, PEC, Qwest, Patient Keeper,
  Vocera, Geonetric.
• Technologies Deployed
• VoIP Network (Cisco)
• Data Network (Cisco)
• Vocera
• In-Building Cellular
• Citrix
• HP Storage and Server Blades
• VM Ware
• PolyServe

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Disaster Recovery (DR) Plan

• Business Continuity Planning
• Helped us focus on architecture and process for
  disaster recovery
• Know your Systems
• Know your Customers
• Know your Priorities
• Know your Vendors
• Critical System Redundancy
• Protect critical systems with redundancy
• Primary and Backup Data Centers
• Multiple Communications Systems voice and data
• Off-Site hosting where necessary Web Site and
  EMR

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DR Systems In-Place

• Network
• Full fiber network redundancy between data
  centers and floors
• Wireless, LAN Switches and In-Building Cellular
  on Generator Power
• Dual Clustered Core Cisco Network Switches
• Dual Clustered Vocera Servers
• Note Vocera mobile communications support during
  staff displacement
• Dual Clustered Cisco Call Manager VoIP Telephony
  Servers
• Note Call Manger Device Support during
  Department Relocations
• Application
• Dual HP EVA SANs Utilizing Business Copy for
  Data Redundancy
• PolyServe for SQL Database and File Services
  Redundancy
• Dual Meditech HIS Platforms

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Lessons Learned What Worked Well

• Advanced planning and emergency response drills
  are essential
• Keep it Simple
• When trying to minimize impact, make changes that
  are simple.
• Dont hesitate to make decisions
• Mistakes will be made, learn from them and focus
  on the big picture
• Leadership structures in place
• Ask for HELP Partner with Experts.
• EXTRODINARY things happen when the entire
  organization is focused on one goal!

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Next Steps and Opportunities

• Internal Organization Review of Disaster Response
• All Hands Meetings for What Worked Well and What
  Didnt
• Future Flood Mitigation
• Earth berm landscaping around facility for water
  barrier
• Sewer system disconnect
• Electrical distribution systems additional
  water protection

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Questions and Answers