Nearly a million residents of the Gulf Coast region hit by Hurricane Katrina late last August were forced to evacuate their homes. In addition to losing shelter, most lost access to medical records and billing data destroyed by the storm and flooding that followed. Healthcare professionals in the region were treating evacuees who in many cases did not know what medications they were taking. Treatment centers in surrounding areas were left to reassemble evacuee medical histories — even as Hurricane Rita hit many of these cities in late September of last year, just one month after Katrina. In addition to these treatment challenges, healthcare providers faced significant reductions in cash flow as they lost access to billing data and systems damaged by the storms. "The public health and medical response to Hurricane Katrina has also called attention to the matter of disaster planning in healthcare facilities, and the potential role of health information technology in expediting the care of displaced persons," according to "Hurricane Katrina: The Public Health and Medical Response," a report issued last year by the Congressional Research Service. The report also noted that "rendering ongoing care to thousands of displaced persons involves restoring lost medical records and reworking the mechanisms that finance their care." Many healthcare administrators have a natural tendency to want their patient data stored under their facility's roof, in order to protect that data and control access. But in reality, having your data on-site could be a huge risk during a hurricane or other disaster. The experiences of a group of Houston emergency room physicians and a physician practice in Mississippi last summer illustrate how best practices in data storage can mitigate the effects of a natural disaster on the healthcare system. The emergency rooms of 12 HCA hospitals in the Houston area treated a large number of Hurricane Katrina evacuees arriving from New Orleans. These hospitals also treated displaced New Orleanians and large numbers of local patients following Hurricane Rita. Gulf Coast Physician Administrators (GCPA) is the billing arm of Greater Houston Emergency Physicians, which provides medical services in HCA's emergency rooms in Houston and Corpus Christi. GCPA had chosen to store its billing data in a remote data center located in the Midwest. The fact that Greater Houston Emergency Physicians' billing data was not stored locally in Houston hospitals meant that access to data was not a factor during the hurricanes. "Throughout the Hurricane Rita disaster, we had uninterrupted connectivity to our practice management system," said Nancy Dumas, administrator for GCPA. "All patient records and reporting remained available to GCPA. Using secure off-site data storage gives us comfort knowing that medical records, patient accounts, and system functionality will not be compromised in times of disaster, such as Hurricane Rita. In addition, if it is necessary to move our offices following a storm, we have connectivity to work from any location utilizing the Internet." By having remote data storage and recovery systems in place, GCPA avoided a cash flow interruption. Without data storage and recovery systems in place, GCPA's ER billing systems likely would have been down for weeks. Many physicians in smaller practices along the Gulf lost nearly all records to the hurricanes. Those who did recover their data took weeks to do so. One practice that did not lose its patient scheduling or billing data during Katrina was Southern Bone & Joint Specialists, a group of 12 orthopedic surgeons located in Hattiesburg, Miss. The group uses practice management software to conduct billing and patient scheduling operations through an application service provider model combined with off-site data centers for storage. Katrina impacted Southern Bone & Joint significantly, forcing the practice to close temporarily due to a power outage. But once the storm had passed, the operation was up and running in a matter of days. As soon as the power was restored, the doctors could access their data, which was never compromised. Both GCPA and Southern Bone & Joint placed their data in capable hands, and both maintained access during or shortly after the hurricanes passed. As those destructive storms proved, on-site storage of paper documents can be disastrous and can necessitate painstaking reassembly of thousands of patient records. Being prepared means storing data off-site in a secure data center with full redundancy. John Gray is the Physician Practice Services Technology Director for DST Health Solutions in Birmingham. John Gray