iPhone & Cloud: Disaster Preparedness In Hand

For the paperless, cloud-connected medical office, backup Internet access is essential.

David Voran, Contributor

November 15, 2013

5 Min Read
Clinic back in business, thanks to a wireless hotspot. Photo: David Voran

Just as the afternoon clinic session began, all of our clinic phones and Internet connectivity froze, stopping us in our tracks. Our clinic has been virtually paperless for several years and fully reliant on the Internet and phones to connect with data servers and call center.

Trouble is, we couldn’t remember the last time we had gone down. Yeah, there was that day several years ago when the main power supply to the town was cut but that left the whole town dark. No disaster: everybody had a day off. This time, everything was working except the phones and computers. Power was on and scheduled patients were coming in the door. We were left with no way to let scheduled patients know we’re in crisis mode and give them the opportunity to reschedule. Now this was a disaster!

Spasmodically we all whipped out our mobile phones and began finding out:

  1. What caused the outage?

  2. How long was it going to last?

  3. What were we to do?

Within a minute we pieced together the following:

  1. The backhoe we could see out the window at a nearby construction site had severed the fiber optic cable that fed most of our town,

  2. Local telecom provider had no idea how long connectivity would be down, and

  3. We were to initiate downtime procedures.

Downtime procedures? The manual said to revert to paper visit forms and scripts to process patients. We would then check in and backfill data in by scanning these into the chart when the system was restored. We were fortunately able to find the stack of paper visit notes and script pads gathering dust way in the back of our stock room.

These in hand, we re-entered exam rooms feeling naked, vulnerable, and fraudulent. These blank forms didn’t contain any of the information needed to make clinical decisions: no patient histories, allergies, problems, medications, overdue health maintenance, and a host of other things on which we were so reliant. In fact, so much information was missing we all shuddered with the realization we’d have to double the time for each visit in order to work with the patient to recall as much as we could. To top it off, we’d all but forgotten how to handle a patient visit using paper. Not unlike trying to remember how to properly fill out a paper check.

I had to pull out my cell phone less than a minute into the first paper visit in order to answer the patient’s question about a medication he was taking. As the visit progressed, it was embarrassing not to be able to answer many of the patient’s questions. I couldn’t remember anything about him from the last visit six months ago. I kept staring stupidly at the empty paper visit note and the frozen computer screen. Laughing in frustration, I let the patient know my dilemma. He joined in the laughter as he couldn’t remember either, and he was the patient!

We finally got through most of the visit and settled on a medication and referral. I picked up the pen and nervously started to spell out a prescription on the foreign looking paper script pad beside the iPhone that we’d used several times during the visit. Hmmm. The iPhone!

“Do you mind if I try something?” I asked the patient.

“My time, your dime, doc,” he said, more than a bit amused at my discomfort as well as curious about what I was going to do.

It took only a couple of seconds to turn on the personal hotspot, and in less than a minute had the HP9300t all-in-one standard exam room device as well as my laptop back on the web and connected to our remote hosted EMR. I quickly logged in, selected the script, and sent it to the pharmacy that was fortunately about 30 blocks away. The only thing I couldn’t do was to give him the visit summary, as all of our printers are hard wired to the network (which, of course, was dark).

Coming out of the room, I showed the other providers how to turn on their personal hotspots. For some, this was the first time they’d ever used this functionality. Soon, we had all of the exam room devices as well as the other 12 all-in-one desktops up and humming on the backs of 5 smartphones.

The only problem was the reception area devices were all fixed desk units without wireless cards. We were able to find a couple of laptops with wireless cards for them. So before each of us finished with that first patient of the afternoon, we were back live while many of the nearby business were stymied, waiting for phone and Internet service to be restored.

Lessons learned:

  1. Smartphones with personal hotspot capabilities should be an integral part of any disaster preparedness plan.

  2. All computing devices should have wireless capabilities to leverage these emergency hotspots.

  3. Keep the data and application servers in the cloud, protected from local backhoes.

The other thing we discovered was that those phones with AT&T plans could receive and send voice calls without cutting off the access points other computers were using while those on Verizon plans had to reconnect after that phone was used for a voice session.

With data in the cloud and iPhones in hand, we only suffered a brief delay and avoided a true disaster, as it took the remainder of the afternoon before service was restored.

Remote Patient Monitoring: Don't let all those Fitbits fool you. Though remote monitoring technology is sound, it's still far from widespread clinical adoption. Read the new InformationWeek Healthcare Digital Issue.

About the Author(s)

David Voran


David Voran, M.D., Assistant Professor and Informatics Director of Community and Family Medicine at Truman Medical Center and Medical Director of the Innovation Clinic at Platte City for Heartland Health and is a Collaborative Physician for CVS's Minute Clinics in the Kansas City Area. Prior to joining Truman Medical Center and Heartland Health Dr. Voran was a Physician Executive for Cerner Corporation (2003-2006), the CMIO for Health Midwest (1997-2003) and the Executive Director of Information Technology at the University of Kansas Medical Center (1994-1997). Over the last 6 years Dr. Voran has piloted various workflows and technologies with emphasis on putting as much technology in the primary care physician's exam room as possible. He is a strong believer patient directed care and has aggressively using the patient portal and promoting point of care imaging and believes that until the patient is the primary user of the EMR medicine will not fully realize the power of the clinical information systems in which they are now investing.Dr. Voran received his bachelor's degree in anthropology from the Wichita State University in 1974. He earned his medical degree from the University of Kansas School of Medicine in 1988 and post graduate degree from University of Kansas – Family Practice in 1991. He is Board Certified in Family Practice and is an active member of the American Academy of Family Practice and was a member of the Academy's ad hoc Committee on Electronic Medical Record. Dr. Voran is active in a number of professional organizations and is a past president for the Heart of Americachapter of HIMSS and is a Medical Director for CVS Minute Clinics in the Kansas City area.

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