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October 30, 2019

Amid blackouts, California hospitals face wrenching choices: Power their EHRs? Refrigerate vaccines? Keep the lights on?

Daily Briefing

    As wildfires continue to rage in California, utility plants are taking precautionary measures and scheduling planned power outages that are forcing many medical providers to make difficult decisions, revealing shortcomings in U.S. hospitals' emergency response.

    Make sure your IT disaster plan includes these key elements

    California wildfires leave health care clinics without power

    Firefighters in California are battling several active wildfires, including the Kincade Fire, which has burned more than 74,000 acres in Northern California since Oct. 23, and the Getty Fire, which has burned more than 600 acres in Los Angeles County. The wildfires have displaced tens of thousands of residents, and more than 25 million people are under red flag warnings, which places them at an increased risk of fire danger.

    To reduce the risk of new fires, utility companies have been scheduling planned power outages—and they're expected to continue doing so going forward.

    But the planned blackouts, which can vary in length, are proving to be particularly problematic for health care providers in the state. Today, nearly every aspect of medical care relies on electricity. ORs and ICUs require electricity to power life-saving medical devices, drugs are stored in electronically locked dispensing units or refrigerators, patient medical records are stored in EHRs, and lights are needed to ensure providers and patients can see.

    And while health care facilities that provide critical care are required to have generators and an emergency plan in place to receive federal funding from Medicare and Medicaid, Grete Porteous, an anesthesiologist and emergency medicine specialist at Virginia Mason Medical Center in Seattle, pointed out that "[j]ust because you have generators doesn't mean they'll work, or work for long enough,".

    The other problem with relying on generators, The Verge reports, is they can only power a limited amount of equipment at once. They also take a while to kick in, which can put patients who are dependent on machines at risk.

    How providers are responding

    When its utility company shut down part of its power grid, Winters Healthcare, a community clinic in Winters, California, faced the difficult decision of choosing what to power with the limited amount of electricity available.

    Winters opted to run just enough lights so that staff and patients could see and closed its dental clinic for the duration of the outage, Christopher Kelsch, an executive at Winters, said. The clinic also chose to keep patients' EHRs online and send vaccines stored in a refrigerator onsite to its sister clinic that wasn't expecting a planned power outage.

    While the clinic does have an emergency plan for more short-term, weather-related blackouts, officials do not know how long this planned blackout will last. "They said we could be down 24 to 48 hours, and it might be five days. It's hard to know what to do," Kelsch said.

    John Muir Health, a network of hospitals and health clinics near San Francisco, California, also was affected by the scheduled outages. According to The Verge, the health system rushed to transport vaccines and medications to facilities that were not expected to lose power, and contact patients to reschedule appointments.

    A new emergency response

    While the recent slate of planned power outages sent many providers scrambling, the changing California climate and increased risk of wildfires suggests the latest round is unlikely to be the last, The Verge.

    As a result, some health care facilities are trying to adapt their emergency response plans to better enable them to withstand longer power outages.

    For instance, a few years ago, Virginia Mason took a hard look at its facility. "We looked at every piece of medical equipment, and asked if it had a battery, and how long did it last," Chris Johnson, the hospital's former emergency management program manager, said. "A ton of work went into doing that, to make sure we were prepared to handle any power failure," including support from hospital leadership to conduct the evaluation, according to Johnson.

    Similarly, in the wake of last week's outages, both John Muir Health and Winters Healthcare said they are re-examining their own response plans. "It's not that anything will happen this weekend, but we want to be prepared for this to happen again. We know this could be the new normal," Kelsch said  (Owens, "Vitals," Axios, 10/29; Wetsman, The Verge, 10/28; CBS News, 10/29; CNN Wire/KTLA, 10/29).

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