Section 6.

12 Optimize

Contingency Plan Assessment

for EHR and HIE
Use this tool to identify and document all existing backup functions, emergency mode
operations, and disaster recovery plans in existence, and to plan for enhancements as
health information technologies (HIT) systems are adopted.
Time needed: 16 hours
Suggested other tools: Section 1.4 EHR Technology and Readiness Inventory, Section 1.5 HIE
Technology Readiness Inventory

Introduction
Disaster recovery refers to the ability to recover data after a disaster or other
interruption of service. You can use the contingency plan assessment to assess your
current contingency plans and to prepare for enhancements as more mission critical
clinical information systems are adopted and replace paper-based systems.
How to Use
1. The person responsible for contingency planning should complete this form, in
conjunction with the (HIT) steering committee. The HIT steering committee needs
to be involved in determining the criticality of IT resources, data, and applications.
Some home health agencies may utilize companies that specialize in emergency
mode operations/disaster recovery planning to develop, test, and maintain such
plans for the physical facility, such as for fire safety. These plans should be
enhanced with backup and business continuity/disaster recovery plans for
disruption to HIT.
2. If you do not have physical facility contingency plans, it is critical to assess
your HIT contingency planning needs.
3. If your agency will have its servers hosted offsite, you may just need business
continuity plans for reverting to paper and manual processes in the event of system
downtime, loss or failure of an input device, lack of connectivity, or power outage.
If your agency will manage its own data center, a more robust plan for backup and
disaster recovery is needed in addition to business continuity planning.
4. Complete each of the sections of this tool in sequence, reflecting the current
situation at your home health agency.
5. As your data criticality changes with electronic health records (EHR) and
participation in a health information exchange organization (HIO), evaluate your
changing needs. For example, you may currently back up once a day and have an
employee take the backup to the banks safe deposit vault. Once you move to an
EHR, you will need fully redundant servers, network capability, and simultaneous
backup. These can be acquired through an information systems host, application
service provider, or software as a service vendor (see Section 1.9 Financial
Assessment, Financing Resources, and Acquisition Models), but there may still be
additional costs for other forms of redundancy, such as for

Section 6 OptimizeContingency Plan Assessment for EHR and HIE- 1

telecommunications/connectivity, input devices, and power. Be sure these

requirements are brought forward as you work on your total cost of ownership and
return on investment planning (see Section 2.11 Business Case: Total Cost of
Ownership and Return on Investment for EHR and HIE.)

Criticality Analysis
Use the following definitions to describe Criticality Level:

For IT Resources:
o Remote and fully redundant (with automatic failover and sustainable
power)
o Local and fully redundant (with automatic failover and sustainable power)
o Redundant (without automatic failover)
o Backup only (with specified lag time during which data may be lost)
For Applications:
o Mission critical (impacts patients)
o Critical (impacts productivity)
o Important (manual workarounds suffice)
o Deferrable (minimal impact)
For Data:
o Private/Sensitive (disclosure adversely impacts patients)
o Confidential (wrongful disclosure has potential to harm individuals or the
organization)
o Proprietary (disclosure of business/practice secrets may result in loss of
competitive advantage)
o Public (no harm through disclosure)
Current State
Description
Criticality
Planned State
Planned
Level
Criticality Level
Remediation
IT Resources
Production server(s)
Test server(s)
Back up server(s)
Exchange server(s)
Other:
Input devices
Printers
Scanners
Other:
Telecommunications
devices
Telecommunications
media
Telecommunications
provider (e.g., telephone
company for Trunk Line)

Section 6 OptimizeContingency Plan Assessment for EHR and HIE- 1

Internet service provider

Other:
Power
HVAC
Fire prevention &
suppression
Other:
Applications
Data (e.g., client
protected health
information, facility
budget, human resource
information/salary and
benefits data)
Other:
Copyright 2014, Margret\A Consulting, LLC. Used with permission of author.

Data Backup Plan

Record the following backup information, as applicable, for data, application software,
operating systems, and hardware (use additional rows as needed):

Frequency may be continual, on schedule (specify schedule), or periodic.

Method may be full, incremental, or partial/differential (other terms may apply,
such as image for a server).
Media are the devices on which the backups are stored and may include a
storage area network, network attached storage, RAID, external disk drive,
internal disk drive, or other device.
File Naming refers to the versioning process to ensure effective and efficient
retrieval.
Media Rotation refers to the process used to reuse media, if applicable.
Location refers to where the backups are stored (both temporarily and
permanently).
Transport refers to how the backups get moved to their permanent storage
locations (e.g., electronic transmission, bonded courier company, staff member
private automobile).
SLA is presence of a service level agreement if backup is performed by and/or
transported and stored by a third party.
Recovery refers to the method by which the asset would be restored/replaced.
Testing refers to whether there is a routine or ad hoc testing schedule.
Organizations may wish to record testing dates and results.
Frequency

Method

Media

File
Naming

Data

Application

Section 6 OptimizeContingency Plan Assessment for EHR and HIE- 1

Media
Rotation

Location Transport

SLA

Recovery

Testing

Software

Operating
Systems

Hardware

Copyright 2014, Margret\A Consulting, LLC. Used with permission of author.

Emergency Mode Operation and Disaster Recovery Plan

The following is an outline of the contents of an emergency mode operation/disaster
recovery plan. Use this to check the documentation and processes that exist in your
organization and identify those that are missing.
Plan Components
Introduction

Organization

Operations

Notification and Activation

Recovery Operations

Return to Normal
Operations
Appendices

Description

Purpose
Applicability
Scope/Assumptions
Development
Maintenance
Testing
Record of Changes
References/Requirements
Steering Committee
Management Team
Support Teams
IT Resources Description and Architecture
Application Description and Architecture
Data Description and Architecture
Damage Assessment
Response

Deployment of Teams

Notification to Alternative Site

Procurement of Resources
Dissemination of Public Information
Recovery Procedures

Emergency Phase

Backup Phase

Recovery Phase
Concurrent Processing
Plan Deactivation
Personnel Contact List
Vendor Contact List
Notification List

Section 6 OptimizeContingency Plan Assessment for EHR and HIE- 1

Present?

Equipment and Specifications

Service Level Agreements or Memoranda of Understanding
Information Technology Standard Operating Procedures
Criticality Analysis
Related Plans

Related Contingency Plans for Patient Care

Emergency Management Plan

Occupant Evaluation Plan

Continuity of Operations Plan

Copyright 2014, Margret\A Consulting, LLC. Used with permission of author.

Copyright 2013

Section 6 OptimizeContingency Plan Assessment for EHR and HIE- 1

Updated 11-20-13

Section 6 OptimizeContingency Plan Assessment for EHR and HIE- 1