Response model is the best Rx
In a contingency exercise, New York's Office of Mental Health devised a way for pharmacists such as Geraldine Gates to access data in the event of a system failure.
By Claire E. House
It's Dec. 29, and New York State Office of Mental Health officials have just been informed that the agency's pharmaceutical management system will likely fail in less than three days.
So what do they do now? In the case of this OMH scenario, the answer is simple: fall back on a standard incident response model.
As state and local governments enter the home stretch of readiness work, they are in the thick of contingency planning'also known as business continuity planning'and consequence management for year 2000 systems failures. Planning guides sit posted on year 2000 Web pages, and most states are requiring agencies to submit plans to a central authority.
In New York, year 2000 contingency planning managers from each agency meet monthly with state technology and emergency management officials to share ideas and track progress. In May, OMH walked through a tabletop contingency exercise for its Pharmakon medication management system.
'We selected a system that in fact won't fail, but if it did would have significant implications for operation of our state psychiatric centers,' said Peter Brown, OMH deputy commissioner for administration and contingency planning. He said the centers serve 6,000 people.Crucial data
Pharmakon taps a VSAM database on an IBM 9021 Model 831 mainframe running MVS. The pharmacy of each of the 28 state-run psychiatric centers links via T1 lines to the mainframe at OMH offices in Albany, OMH chief information officer Michael Mittleman said. Center staff members use PCs to access the system, which holds drug inventory data, drug interaction data, patient histories and patient profiles'including information about allergies and drug regimens.
'It's very important when you're working with a population that has serious mental illness and is dependent upon these medications for assuring their symptoms are in remission as far as possible and not generating additional health issues,' Brown said.
In the Dec. 29 scenario, Brown declared the impending systems failure an emergency and initiated the Incident Command System incident management model, adopted by New York and other states as the official act-fast plan.
ICS was developed in the 1970s by the Firefighting Resources of California Organized for Potential Emergencies, according to a 1998 Federal Emergency Management Agency study. The group of municipal, county, state and federal fire authorities devised the model as a way to coordinate efforts in fighting wildfires.
An ICS plan assigns at least five positions of responsibility: command, planning, operations, logistics and finance. Brown added safety, labor relations and counsel to the list.
OMH has tiers of staff members listed to fulfill each function, so if one person is not available, the next person on the list can be called upon, Brown said.
'If there were a hurricane and we were suddenly faced with a physical disaster, we'd bring in the same group,' he said. 'Depending on the problem, we might emphasize one area over another, but it would be the same people.'
Brown assembled officers for each responsibility to walk through the exercise. The group analyzed the problem and determined that it would have to set up a manual process for getting Pharmakon data to and from the centers.
They discussed the issues that would likely come up and broke the plan down into officer responsibilities:
' Command'To establish command and oversee response
' Planning'To evaluate the problem, plan the manual process, plan for system fixes, monitor activity and consider future ramifications
' Operations'To carry out response activities by working with staff at the ground level for actions such as printing out all records for reference in time and teaching a manual record-keeping process
' Logistics'To make vehicles available to transport additional staff to facilities and move the records back and forth from OMH to the facilities, and to make beds and food available for staff members who would need to stay overnight
' Financial'To assess funding needs for costs such as overtime pay and to track spending
' Safety'To ensure that actions do not jeopardize staff or patient safety
' Labor relations'To inform unions and management about the need for additional staff and provide labor issue information
' Counsel'To ensure that actions don't have legal implications.
The exercise ended with Brown telling the officers to get started and fictionally meet again in 90 minutes to discuss progress. He also stressed the importance of documenting all actions so the group could conduct a follow-up evaluation.
For more information on ICS, check out the FEMA study at www.fema.gov/emi/is195lst.htm
. For more specific year 2000 emergency planning, see FEMA's Contingency and Consequence Management Planning for Year 2000 Conversion guide at www.fema.gov/y2k/ccmp_fl.pdf
. Incident command system principles
stress command, control and coordination
- Common terminology for all responders
- Modular organization to let structure expand or contract as needed
- Integrated communications plan
- Unity of command so each person reports to only one other
- Unified command structure for common objectives and strategies
- Consolidated action plans describing response goals, objectives and activities
- Manageable span of control, limiting resources under a supervisor's control to five
- Designated incident facilities
- Comprehensive resource management that provides accountability and ensures personnel safety