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© 2017 Journal of the Practice of Cardiovascular Sciences |
Published by Wolters Kluwer - Medknow 1
Editorial
Innovation
“Innovation is a great idea, executed brilliantly, and
communicated in a way that is both intuitive and fully
celebrates the magic of the initial concept”
–Pete Foley
This issue celebrates innovations. Dr. Padma’s Telestroke paper
shows how a simple Whatsapp network links doctors and
radiologists to create a STROKE network and provide fast
stroke
care all over a state in India. The HRIDAY CARD is another
such innovation. A unique combination of patient education,
doctor checklists for heart failure and patient sickness response
systems and monitoring charts combined in a single card and
already being used in many hospitals in Delhi. HOME-N is
a very simple but effective nurse lead heart failure program
designed to use all available resources, including the HRIDAY
card, smartphone-based apps, and simple telephone calls to
improve the outcomes of acute heart failure.
In our curriculum section, we take up a case of acute heart
failure
and discuss the management from myocarditis to assist device
implantation. The statistical section discusses the intricacies of
the Bland–Altman plot and the history section takes us back to
the glamour of the discovery of the various stents.
Our readers have sent us a book review of a very interesting
book “SAPIENS,” which seems to overturn many of our beliefs
and is a must read. Dr. Sarvesh presents his experience with
the AIIMS experience with Heart Ware HVAD devices which
should be useful to anyone implanting similar devices.
Entering our 3rd year of publication, we are gradually
increasing our readership and circulation. Our mandate is
education. We invite everyone to send articles on themes
which provide learning experiences to others. Original articles
and cases, journal clubs and bedside cases, and simple journal
clubs, etc., are welcome. Encourage your students to write and
send their articles and thesis work. If the content and ideas
are good, we will help them with the language and structure
if needed.
“Write. Rewrite. When not writing or rewriting, read. I know
of no shortcuts.”
Larry L. King, WD
Sandeep Seth, Shyamal K. Goswami1
Department of Cardiology, AIIMS, 1School of Life Sciences,
Jawahar Lal Nehru University, New Delhi, India
Address for correspondence: Dr. Sandeep Seth,
Department of Cardiology, AIIMS, New Delhi, India.
E‑mail: [email protected]
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DOI:
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How to cite this article: Seth S, Goswami SK. Innovation. J
Pract
Cardiovasc Sci 2017;3:1.
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Running head: LOOP INC. DISASTER RECOVERY PLAN1
LOOP INC. DISASTER RECOVERY PLAN 10
Loop Inc. Disaster Recovery Plan
Manogna Telikapalli
BA63570 G2 Disaster Recovery
Professor Gulsebnem (Sheb) Bishop
Loop Inc. Disaster Recovery PlanExecutive Summary
Loop Inc. as an e-commerce company that offers different forms
of online services, the company needs to have a strong disaster
recovery plan. The company has specialized in selling software,
applications, and other electronic software products via its e-
commerce platform. This business and others such as offering
cloud storage services raise to allow the company to transact a
lot of data. This paper will highlight on the company’s Disaster
Recovery Plan and ways the company can recover its
Information Technology function after a disaster. Disasters are
both unpredictable and inevitable which raises the need for a
disaster recovery plan in place. The guidelines in this plan can
be applied to Loop Inc. entirely or on the company’s subsystem
within the enterprise.
Loop Inc.’s disaster recovery plan involves or focuses on the
amount of downtime which will be measured in days. The
recovery plan highlights the different possible causes of
disasters by assessing human, natural, or mechanical as the key
sources of disasters. The recovery plan also focuses on the
effects of disasters and developing guidelines on how to recover
from them. The disaster recovery plan identifies and classifies
key risks or threats that may lead to disasters for the company.
The recovery plan also defines the processes and resources that
facilitate or support business continuity during a disaster. The
plan also defines the reconstitution mechanism of getting the
business back to normal operations and ways of getting through
the after-effects of the disaster.
Table of Contents
Loop Inc. Disaster Recovery Plan2
Executive Summary2
Identification of Disaster Risks4
Risk Classification4
Risk Assessment6
Effects of Disasters7
Disaster Recovery Mechanisms9
Disaster Recovery Phases11
Recommendations14
References15
Identification of Disaster Risks
Loop Inc., just like most other online companies faces both
direct and indirect risks to its business. The identification of
disaster risks is guided by the essential function of the business.
These functions set ground for assessing and mitigating the
risks. Essential functions to the company are those whose
interruption would greatly interpose the flow of business and
may result in financial losses (Reason, 2016). Online presence
and functionality is the key function of the business. The
company relies on its online presence to offer services to its
clients. There are other risks but online presence should be
given more priority. Risk evaluation was based on a number of
attributes as shown below.
Figure 1 Risk Attributes
Online functionality faces numerous risks such as network
failure, power outages, and physical or electronic damage to
supporting equipment and facilities. The magnitude of risks in
the company is dependent on the affected component and effect
to the company’s core functions. The effects of disasters that
affect the entire business, for example, server failure are
different from those disasters that affect specific sections of the
business.Risk Classification
The evaluation process allowed for the categorization of risks
into different classes to help the company accurately prioritize
them. Loop Inc.’s risks can be classified as data systems risks,
external risks, facility risks, departmental risks, and desk-level
risks.
i. Data systems risks
Data systems risks are associated with shared infrastructure
usage, for example, software applications, file servers, and
networks. The failure of this shared infrastructure can impact
different departments of the business. The analysis of these
risks has helped in the identification of all specific points of
failure within Loop Inc.’s data system’s architecture (Sadgrove,
2016). Inappropriate operation processes can also result in data
systems risks
The company may face a lengthy and expensive recovery
process from such kind of failures because there may need to
update or replace software, equipment, or personnel.
Loop Inc.’s data system risks will be evaluated under the
following subcategories:
· Telecommunication systems and network
· Data communication network
· Shared servers
· Data storage or backup systems
· Software applications and bugs
· Viruses
ii. External risks
External risks are those associated with failure outside the
enterprise. These risks are noteworthy because they are not
under the company’s control. External risks for the company
can be natural, human-caused, civil, or supplier related. Natural
disasters are key to this disaster recovery plan and on top of the
list because they damage a large geographic area. Earthquakes
have been noted to be a major risk to Loop Inc. because most of
the company facilities are located in earthquake-prone areas
(Lan & Mojtahedi, 2017). The chances of mitigating these risks
are considerable because meteorological threats can be
forecasted and the company can set-up disaster recovery
facilities. Human-caused risks can include sabotage, acts of
terrorism, crimes, and operations mistakes among others. Civil
risks include labor disputes, local political stability, and
software legal claims among others. Civil risks can either be
internal or external of the company.
iii. Facility risks
Loop Inc. is highly dependent on the wellbeing of its local
facilities. Facility risks analysis allows for the consideration of
power sources, communication facilities, availability of water,
climate control, and ability to avoid or control fire, structural
risks, and physical security among others (Lan & Mojtahedi,
2017). The security of the company’s facilities is a mandatory
measure to protect assets from both employees and outsiders.
iv. Departmental risks
Failures within specific departments can be a risk to the
company. Such risks can include the failure to load given
scripts on the company’s system and missing communication
links within a department among others. Unavailability of
skilled employees can be a risk to the company’s output or
performance.
v. Desk-level risks
Successful operations of Loop Inc. are dependent on most of the
day-to-day personal work of employees. Desk-level risks have
necessitated the analysis and accounting of all processes and
tools that facilitate an employee’s job.Risk Assessment
The risk assessment is based on the completed risk
classification. The risks will all be scored and sorted into
different categories based on the impact and likelihood. Risk
assessment form will form the basis of the score sheet which
will be used in the scoring process. The score sheet includes a
main risk category and its subcategories in form of groups.
Risks are the specific risks in each subcategory or group that
can affect the business. Likelihood, impact, and restoration time
are estimated in a scale from 1 to 10 but the likelihood is
considered as long plan period such as 5 years while the impact
is highly sensitive to time.
Below is an example of the company’s risk assessment form
with all the keys of a score sheet. Projected rough risk analysis
score is arrived at after multiplying the likelihood time, impact
time, and restoration time (Webber & Wallace, 2017). There is a
total risk score of zero when there is a zero value within one of
the two columns. The biggest risk and those that require more
attention are put to the top when the score sheet table is sorted
in a descending order.
Table 1 Risk Assessment Form
Risk Assessment Form
External risks
Date:
Likelihood
Impact
Restoration Time
Score
Grouping
Risk
0 – 10
0 – 10
0 – 10
Natural disasters
Tornado
0
9
10
0
Severe thunderstorm
1
4
2
8
Earthquake
5
9
10
450
Hail
7
2
6
84
Snow or ice
8
5
7
280
Human-caused risks
Poor skills
1
6
10
60
Human error
2
5
7
70
Sabotage
1
8
2
16
Power supply cut
9
9
2
162
Effects of Disasters
The previous sections of this disaster recovery plan will help in
assessing risks and making decisions on where to cover the most
critical risks. In this section, the recovery plan will determine
and list the most probable effects of each disaster. The disaster
recovery process of Loop Inc. will cover these specific effects.
Multiple causes have been noted to produce the same effects
and these effects can, in turn, lead to other effects. This
recovery plan focuses on earthquakes and power supply cut as
some of the main risks due to natural disaster and human-caused
risks (Reason, 2016). An earthquake leads to the failure of
several entities such as office facilities, operations staff, power
system, telephone system, and data systems of the company.
Below is a sample mapping of the cause, effects, and affected
entities in cases of earthquakes or power supply cut.
Table 2 Disaster Affected Entities
Risk (Disaster)
Effects
Affected Entity
Earthquake
Telecom failure
Telephone instruments and network
Desktops destroyed
Desktops and workstations
Office space destroyed
Office space
Power disruption
Power
Operators cannot report to work
Office staff
Data systems destroyed
Data systems
Power supply cut
Data systems powered of
Data systems
Desktops powered off
Desktops/workstations
Power disruption
Power
Telecom failure
Telephone instruments and network
Data network down
Network devices and links
In the above table, it may be noted that several disasters may
affect the same entities and this can help identify the entities
which are most affected. Data systems and power are the main
entities with the highest probability of being affected because
they support most of the company’s entities.
Determining the effects of disasters also requires the company,
through the recovery plan, to set downtime tolerance limits. The
downtime limits will be based on the “Affected Entity” list with
each entity having a set downtime limit (Torabi & Sahebjamnia,
2015). The tolerance limit will be sorted in an ascending order
and those entities with the least tolerance limit will be highly
prioritized for recovery. The cost of downtime has been used as
one of the metrics for evaluating downtime tolerance limits.
Table 3 Risk Tolerance Limits
Risk (Disaster)
Affected Entity
Cost of Downtime
Tolerance Limits
0-5
0 - 10
Earthquake
Telephone instruments and network
4
2
Desktops and workstations
3
3
Office space
3
3
Power
4
1
Office staff
2
4
Data systems
5
1
Power supply cut
Data systems
5
1
Desktops/workstations
3
3
Power
4
1
Telephone instruments and network
4
2
Network devices and links
4
1
The investment required for any recovery plan is based on the
cost of downtime which can be either tangible or intangible
costs. Tangible costs are consequences of the business’s
interruption, productivity, and generating less revenue.
Intangible costs can be identified as lost opportunities when the
company loses reputation and customers approaching
competitors among other factors. The recovery plan identifies
there are several interdependencies from the affected entities.
There are disaster affected entities which will need a detailed
recovery sequence, for example, data system restoration is
dependent on the restoration of power. Disaster Recovery
Mechanisms
After preparing the list of affected entities and assessing their
failure tendency, there is enough laid ground for analyzing
different recovery methods available for each entity. This
analysis helps to identify the best suitable recovery method for
each entity.
i. Data systems
Disaster recovery facilities are key in supporting the effective
data redundancy in the company’s onsite data center. These
facilities will act as offsite data storage and will also have
recovery systems from other entities such as power cuts,
network outages, storage, connectivity to paths and devices. To
increase redundancy and prevent the need for a disaster
recovery, technologies such as the redundant array of
independent disks (RAID) and mirroring will be used in the
software layer (Chang, 2015). One way of providing fast
recovery from any hardware or software error is having on-site
data center redundancy because there will not be a need for
disaster recovery.
The company’s business needs will determine the nature of each
disaster recovery mechanism. Loop Inc. will have several
duplications of its data center to ensure the company’s business
processes are not affected by any site loss. The company can
also build its own data center specifically for disaster recovery
purposes with the basic and necessary required hardware to
keep the business running. Loop Inc. can eventually opt for a
colocation facility where the company can access data center
services on a rental basis.
ii. Major incident process
The major incident process will have an objective of efficient
resolution of incidents which have a key impact on the
company’s critical business processes. The process ensures
there are quality and quantity of communication in cases of
major incidents. The process also ensures there are sufficient
resources for the resolution of any major incident (Torabi &
Sahebjamnia, 2015). The major incident process will offer a
systematic incident review to prevent similar incidents from
reoccurring. To ensure these objectives are realized, Loop Inc.
will its customized “Major Incident Handling Plan Model” and
it will be anchored on communication.
Figure 2 Major Incident Workflow
The major incident handling model will need a suitable major
incident team for it to work successfully. The major incident
team will consist of the problem manager, major incident
manager, incident manager, and the service desk manager
among other members. Loop Inc. will need a team that can
accurately and swiftly tackle any incident in question while
maintaining good customer relations. The team will also be
responsible for the root cause analysis after resolving a given
incident. Disaster Recovery Phases
Loop Inc.’s disaster recovery process will happen under the
activation, execution, and reconstitution sequential phases. The
activation phase will involve the assessment and announcements
of the disaster effects (Kerzner & Kerzner, 2017). The
execution phase will involve the execution of the actual
procedures for the company to recover from each disaster. The
company’s business operations are restored on the recovery
facilities or systems. In the last phase, the reconstitution phase,
the execution phase procedures are stopped after the original
system is restored.
i. Activation phase
The activation phase will involve notification procedures,
damage assessment, and disaster recovery activation planning.
Notification procedures will be highly dependent on effective
communication because they are the primary measures taken as
soon as an emergency or disruption has been predicted or
detected. Notification procedures will contain the process to
notify the recovery personnel during working and outside
working hours (Torabi & Sahebjamnia, 2015). A notification
will be sent to the damage assessment team after the disaster
detection for them to assess the real damage and instrument
subsequent actions.
Notifications from one team to another can take place through a
pager, telephone, cell-phone or an e-mail. Loop Inc. has a
notification policy that describes the procedures to be followed
when required personnel cannot be contacted. These policies are
clearly documented in the contingency plan. To document
primary and alternate contact methods, Loop Inc. will use a call
tree as shown below. The call tree has procedures to be
followed in cases when a specific individual cannot be
contacted.
Figure 3 Call Tree Chart
The contact list on the plan will unmistakably identify staff to
be alerted and they will be classified by name, role, and contact
information. In cases where disrupted systems are
interconnected with external organizations, the plan will
provide a point of contact in the given organizations (Richie &
Kliem, 2015).
Damage assessment
Damage assessment will help establish ways the contingency
plan will be executed when the business’s services are
disrupted. The nature and degree of the damage to the system
are assessed quickly as conditions permit. The evaluation
should be done with personal safety as the highest priority and
the damage assessment team should be the first to be notified of
the incident and they will use the damage assessment guidelines
for investigating different types of disasters (Richie & Kliem,
2015). Power outage in the data center facility can have an
assessment on whether power can be restored before the
facilities UPS system runs out of static power. If the power
cannot be restored, a disaster recovery plan can be activated
immediately.
Damage assessment processes will vary with each given
emergency and Loop Inc. can use the following general
procedures.
· Origin of the disruption or disaster.
· The potential for additional emergencies or damages
· The area affected by the disaster.
· Status of the physical infrastructure
· Inventory of the key equipment.
· Functionality status of the important equipment
· Type of damage to equipment
· Items to be replaced.
· Estimated restoration time for normal services.
Activation planning
The disaster recovery plan should only be activated when a
thorough damage assessment has been conducted to avoid
stalling normal business operations as a result of false alarms.
The Disaster Recovery Committee will do a disaster activation
planning depending on the extent of the damage from the
disaster (Cook, 2015). The committee's plan should:
· Plan for communication between teams
· Catalog systems and services that need to be restored
· Catalog instructions for reporting failures to the team
· Showtime estimations for each restoration
ii. Execution Phase
The execution phase is involved in bringing up the disaster
recovery system, for example, temporal manual processing,
operation, and recovery on an alternate system. Sequence
recovery activities should include instructions to coordinate
with other teams in given situations, for example, when items
need to be procured, completion of a key step, and when an
action is not realized within the estimated time frame (Lan &
Mojtahedi, 2017). Listed recovery procedures will provide
detailed processes of restoring the system and its components.
Loop Inc.’s procedures for IT service damage will address
actions such as:
· Acquire access authorization to damaged premises
· Notify users linked with the system
· Procure needed office supplies and a working space
· Secure and load backup media.
· Restore critical application software and operating system
· Restore system data.
· Test system functionality and security controls
· Connect the system back to other external systems of the
network
iii. Reconstitution phase
In this phase, the business’s operations are transferred back to
the original facility. Rebuilding can also be done in cases where
the original facility is unrecoverable (Lan & Mojtahedi, 2017).
This phase may last several days depending on the nature and
severity of the destruction. The Disaster Recovery Committee
will be involved in:
· Constantly monitoring the site or facility’s suitability for
reoccupation
· Verifying the site or facility is free from aftereffects of the
disaster
· Establish and maintain connectivity between internal and
external systems.
· Ensure full functionality by testing the system’s operations
· Shut down the contingency system
· Arrange for operations as staff return to the original or rebuild
the facility.Recommendations
This disaster recovery plan document should be constantly kept
up to date with Loop Inc.’s current organization environment.
To maintain the plan documentation, Loop Inc. should be
involved in the periodic mock drill. The company should also
capture the document’s experience in case of a disaster to help
improve the plan. The disaster recovery plan can also be
maintained by periodic updates which reflect the current
information about the components covered in the DRP.
References
Chang, V. (2015). Towards a Big Data system disaster recovery
in a Private Cloud. Ad Hoc Networks, 35, 65-82.
Cook, J. (2015). A six-stage business continuity and disaster
recovery planning cycle. SAM Advanced Management Journal
80.3, 23.
Kerzner, H. R., & Kerzner, H. (2017). Project management: a
systems approach to planning, scheduling, and controlling. .
John Wiley & Sons.
Lan, B., & Mojtahedi, M. (2017). Critical attributes for
proactive engagement of stakeholders in disaster risk
management. International journal of disaster risk reduction, 21,
35-43.
Reason, J. (2016). Managing the risks of organizational
accidents. Routledge.
Richie, G. D., & Kliem, R. L. (2015). Business continuity
planning: A project management approach. . Auerbach
Publications.
Sadgrove, K. (2016). The complete guide to business risk
management. Routledge.
Torabi, S. A., & Sahebjamnia, N. (2015). Integrated business
continuity and disaster recovery planning: Towards
organizational resilience. European Journal of Operational
Research 242.1, 261-273.
Webber, L., & Wallace, M. (2017). he disaster recovery
handbook: A step-by-step plan to ensure business continuity and
protect vital operations, facilities, and assets. Amacom.
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LEADERSHIP PAGE
From the American College of
Innovation
Building the Best Possible Tools for
the Best Possible Care
Shalom Jacobovitz, Chief Executive Officer, American College
of Cardiology
A
few weeks ago, the American College of Car-
diology (ACC) launched its revamped web-
site: ACC.org. Over the last year, a team
of College staff and member volunteers spent count-
less hours interviewing members about their online
needs; meeting with website developers about how
to leverage best practices and new technologies in
light of the many new online channels available;
and, last but certainly not least, building the actual
site with all of these things in mind.
The end result is a site that provides easier and
more personalized access to clinical practice guide-
lines, the latest published research, educational and
practice management tools, and other trusted con-
tent that the cardiovascular community has come to
expect from the College. Given the explosive growth
in the use of multiple mobile platforms to access in-
formation, the new ACC.org and related tools, such
as e-mail news digests, are also optimized for use
across various mobile devices.
I am proud of the new site and all of the work from
members and staff that went into making it a suc-
cessful reality. Its launch is a huge step forward in
positioning the College as an unbiased and reliable
hub for the cardiovascular community to come to-
gether to provide the best patient care. It also pro-
vides a platform for us to be innovative and to
showcase our advances, and it moves us toward our
goal of reducing member burdens and increasing
member value during a time of frequent and un-
precedented change in health care.
According to Meg Wheatley, author and manage-
ment consultant, “Innovation is fostered by infor-
mation gathered from new connections; from insights
gained by journeys into other disciplines or places;
Cardiology, Washington, DC.
from active, collegial networks and fluid, open
boundaries” (1). The process that went into the
development and launch of the new ACC.org em-
bodies this definition. We learned from past mistakes,
gathered information from across our member and
staff networks, looked beyond our own walls for in-
dustry best practices, and developed a site that helps
to meet the needs of members today, while also
leaving some fluidity to meet the inevitable changing
future digital landscape.
The insights and connections gained throughout
the website development process are already being
leveraged across other ACC projects, both big and
small, aimed at ensuring the best possible tools
for the best possible care. The College’s recently
launched Guideline Clinical App is 1 example. As part
of our efforts to modernize the guideline process and
make guidelines more usable at the point of care, the
mobile app provides easy access to guideline recom-
mendations; “10 Points” summaries; and tools such
as risk scores, calculators, and algorithms. The app
can also be customized by using the bookmark, note-
taking, and shareable PDF features. This is 1 of several
cross-college efforts to better align mobile tools and
educational resources with the release of clinical
guidelines—a key element of our strategy to trans-
form cardiovascular care.
The College is also thinking outside of the box in
terms of how to best leverage its clinical data assets to
inform research or measure the effect of new treat-
ments, drugs, or devices. For example, 2 new
PINNACLE registry studies recently provided unique
and timely insights into the potential effects of the
new ACC/American Heart Association cholesterol
guidelines, as well as proposed changes to hyper-
tension management (2,3). Similarly, the ACC and the
Society of Thoracic Surgeons are blazing trails in the
United States when it comes to understanding
http://ACC.org
http://ACC.org
http://ACC.org
http://crossmark.crossref.org/dialog/?doi=10.1016/j.jacc.2014.1
2.005&domain=pdf
http://dx.doi.org/10.1016/j.jacc.2014.12.005
J A C C V O L . 6 5 , N O . 4 , 2 0 1 5 Jacobovitz
F E B R U A R Y 3 , 2 0 1 5 : 3 9 6 – 7 Leadership Page
397
transcatheter aortic valve replacement. In addition,
the College is looking at ways to use data to inform
the development of clinical quality tools, such as risk
calculators and shared decision-making resources
that can be used at the point of care, whether at a
physical location like a cardiovascular practice or a
digital one online.
On an even greater scale, the ACC is excited about
data aggregation opportunities with payers, health
systems, international health organizations, and/or
other partners that would allow for even greater un-
derstanding of the effects of treatments on patient
outcomes. Our relationship with Symphony Health
Solution
s, a provider of high-value data, analytics,
and technology solutions for life science manufac-
turers, payers, and providers, is a prime example of
how an integrated health care database can support
research aimed at advancing scientific understanding
of cardiovascular care.
We are also exploring how the College, through its
suite of hospital and outpatient data registries, can
help members and patients take advantage of new
technological capabilities like remote monitoring. For
example, can we offer a way for patients to easily
track their medication, exercise, and/or vital signs
like blood pressure that can then be easily down-
loaded by their physician as part of a remote moni-
toring session? Or, are there opportunities to work
with industry to track and measure outcomes in pa-
tients implanted with devices or sensors to manage
their heart disease? All of these new ideas will also
require working with payers around billing of ser-
vices, as well as working with lawmakers and other
stakeholders to incorporate new practices in the
overall treatment paradigm.
Jeff Bezos, chief executive officer and founder of
Amazon, once said that “every new thing creates two
new questions and two new opportunities” (4). As we
move ahead into the new year, my challenge to ACC
leaders, staff, and members is to take these words
to heart. We have created several new things—a new
online home for the College being one of them—so let
us ask and answer the new questions and hold tight
to the new opportunities that come in their wake.
REPRINT REQUESTS AND CORRESPONDENCE:
Shalom Jacobovitz, American College of Cardiology,
2400 N Street NW, Washington, DC 20037.
R E F E R E N C E S
1. Wheatley MJ. Leadership and the New Science:
Discovering Order ina Chaotic World. 2ndedition.San
Francisco, CA: Berrett-Koehler Publishers, Inc., 1999.
2. Maddox TM, Borden WB, Tang F, et al. Impli-
cations of the 2013 ACC/AHA Cholesterol Guide-
lines for Adults in Contemporary Cardiovascular
Practice: insights from the NCDR PINNACLE reg-
istry. J Am Coll Cardiol 2014;64:2183–92.
3. Borden WB, Maddox TM, Tang F, et al. Impact
of the 2014 Expert Panel Recommendations for
Management of High Blood Pressure on Contem-
porary Cardiovascular Practice: insights from the
NCDR PINNACLE registry. J Am Coll Cardiol 2014;
64:2196–203.
4. BrainyQuote.com. Jeff Bezos quotes. Available
at: http://www.brainyquote.com/quotes/quotes/j/
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http://refhub.elsevier.com/S0735-1097(14)07295-7/sref3
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© 2017 Journal of the Practice of Cardiovascular Sciences Pu.docx

  • 1. © 2017 Journal of the Practice of Cardiovascular Sciences | Published by Wolters Kluwer - Medknow 1 Editorial Innovation “Innovation is a great idea, executed brilliantly, and communicated in a way that is both intuitive and fully celebrates the magic of the initial concept” –Pete Foley This issue celebrates innovations. Dr. Padma’s Telestroke paper shows how a simple Whatsapp network links doctors and radiologists to create a STROKE network and provide fast stroke care all over a state in India. The HRIDAY CARD is another such innovation. A unique combination of patient education, doctor checklists for heart failure and patient sickness response systems and monitoring charts combined in a single card and already being used in many hospitals in Delhi. HOME-N is a very simple but effective nurse lead heart failure program designed to use all available resources, including the HRIDAY card, smartphone-based apps, and simple telephone calls to improve the outcomes of acute heart failure. In our curriculum section, we take up a case of acute heart failure and discuss the management from myocarditis to assist device implantation. The statistical section discusses the intricacies of the Bland–Altman plot and the history section takes us back to the glamour of the discovery of the various stents.
  • 2. Our readers have sent us a book review of a very interesting book “SAPIENS,” which seems to overturn many of our beliefs and is a must read. Dr. Sarvesh presents his experience with the AIIMS experience with Heart Ware HVAD devices which should be useful to anyone implanting similar devices. Entering our 3rd year of publication, we are gradually increasing our readership and circulation. Our mandate is education. We invite everyone to send articles on themes which provide learning experiences to others. Original articles and cases, journal clubs and bedside cases, and simple journal clubs, etc., are welcome. Encourage your students to write and send their articles and thesis work. If the content and ideas are good, we will help them with the language and structure if needed. “Write. Rewrite. When not writing or rewriting, read. I know of no shortcuts.” Larry L. King, WD Sandeep Seth, Shyamal K. Goswami1 Department of Cardiology, AIIMS, 1School of Life Sciences, Jawahar Lal Nehru University, New Delhi, India Address for correspondence: Dr. Sandeep Seth, Department of Cardiology, AIIMS, New Delhi, India. E‑mail: [email protected] Access this article online Quick Response Code: Website:
  • 3. www.j-pcs.org DOI: 10.4103/jpcs.jpcs_20_17 How to cite this article: Seth S, Goswami SK. Innovation. J Pract Cardiovasc Sci 2017;3:1. This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. [Downloaded free from http://www.j-pcs.org on Friday, October 12, 2018, IP: 73.251.46.201] Running head: LOOP INC. DISASTER RECOVERY PLAN1 LOOP INC. DISASTER RECOVERY PLAN 10
  • 4. Loop Inc. Disaster Recovery Plan Manogna Telikapalli BA63570 G2 Disaster Recovery Professor Gulsebnem (Sheb) Bishop Loop Inc. Disaster Recovery PlanExecutive Summary Loop Inc. as an e-commerce company that offers different forms of online services, the company needs to have a strong disaster recovery plan. The company has specialized in selling software, applications, and other electronic software products via its e- commerce platform. This business and others such as offering cloud storage services raise to allow the company to transact a lot of data. This paper will highlight on the company’s Disaster Recovery Plan and ways the company can recover its Information Technology function after a disaster. Disasters are both unpredictable and inevitable which raises the need for a disaster recovery plan in place. The guidelines in this plan can be applied to Loop Inc. entirely or on the company’s subsystem within the enterprise. Loop Inc.’s disaster recovery plan involves or focuses on the amount of downtime which will be measured in days. The recovery plan highlights the different possible causes of disasters by assessing human, natural, or mechanical as the key sources of disasters. The recovery plan also focuses on the effects of disasters and developing guidelines on how to recover from them. The disaster recovery plan identifies and classifies key risks or threats that may lead to disasters for the company. The recovery plan also defines the processes and resources that facilitate or support business continuity during a disaster. The plan also defines the reconstitution mechanism of getting the business back to normal operations and ways of getting through the after-effects of the disaster.
  • 5. Table of Contents Loop Inc. Disaster Recovery Plan2 Executive Summary2 Identification of Disaster Risks4 Risk Classification4 Risk Assessment6 Effects of Disasters7 Disaster Recovery Mechanisms9 Disaster Recovery Phases11 Recommendations14 References15 Identification of Disaster Risks Loop Inc., just like most other online companies faces both direct and indirect risks to its business. The identification of disaster risks is guided by the essential function of the business. These functions set ground for assessing and mitigating the risks. Essential functions to the company are those whose interruption would greatly interpose the flow of business and may result in financial losses (Reason, 2016). Online presence and functionality is the key function of the business. The company relies on its online presence to offer services to its clients. There are other risks but online presence should be given more priority. Risk evaluation was based on a number of attributes as shown below. Figure 1 Risk Attributes Online functionality faces numerous risks such as network failure, power outages, and physical or electronic damage to supporting equipment and facilities. The magnitude of risks in the company is dependent on the affected component and effect to the company’s core functions. The effects of disasters that affect the entire business, for example, server failure are different from those disasters that affect specific sections of the business.Risk Classification
  • 6. The evaluation process allowed for the categorization of risks into different classes to help the company accurately prioritize them. Loop Inc.’s risks can be classified as data systems risks, external risks, facility risks, departmental risks, and desk-level risks. i. Data systems risks Data systems risks are associated with shared infrastructure usage, for example, software applications, file servers, and networks. The failure of this shared infrastructure can impact different departments of the business. The analysis of these risks has helped in the identification of all specific points of failure within Loop Inc.’s data system’s architecture (Sadgrove, 2016). Inappropriate operation processes can also result in data systems risks The company may face a lengthy and expensive recovery process from such kind of failures because there may need to update or replace software, equipment, or personnel. Loop Inc.’s data system risks will be evaluated under the following subcategories: · Telecommunication systems and network · Data communication network · Shared servers · Data storage or backup systems · Software applications and bugs · Viruses ii. External risks External risks are those associated with failure outside the enterprise. These risks are noteworthy because they are not under the company’s control. External risks for the company can be natural, human-caused, civil, or supplier related. Natural disasters are key to this disaster recovery plan and on top of the list because they damage a large geographic area. Earthquakes have been noted to be a major risk to Loop Inc. because most of the company facilities are located in earthquake-prone areas (Lan & Mojtahedi, 2017). The chances of mitigating these risks are considerable because meteorological threats can be
  • 7. forecasted and the company can set-up disaster recovery facilities. Human-caused risks can include sabotage, acts of terrorism, crimes, and operations mistakes among others. Civil risks include labor disputes, local political stability, and software legal claims among others. Civil risks can either be internal or external of the company. iii. Facility risks Loop Inc. is highly dependent on the wellbeing of its local facilities. Facility risks analysis allows for the consideration of power sources, communication facilities, availability of water, climate control, and ability to avoid or control fire, structural risks, and physical security among others (Lan & Mojtahedi, 2017). The security of the company’s facilities is a mandatory measure to protect assets from both employees and outsiders. iv. Departmental risks Failures within specific departments can be a risk to the company. Such risks can include the failure to load given scripts on the company’s system and missing communication links within a department among others. Unavailability of skilled employees can be a risk to the company’s output or performance. v. Desk-level risks Successful operations of Loop Inc. are dependent on most of the day-to-day personal work of employees. Desk-level risks have necessitated the analysis and accounting of all processes and tools that facilitate an employee’s job.Risk Assessment The risk assessment is based on the completed risk classification. The risks will all be scored and sorted into different categories based on the impact and likelihood. Risk assessment form will form the basis of the score sheet which will be used in the scoring process. The score sheet includes a main risk category and its subcategories in form of groups. Risks are the specific risks in each subcategory or group that can affect the business. Likelihood, impact, and restoration time are estimated in a scale from 1 to 10 but the likelihood is considered as long plan period such as 5 years while the impact
  • 8. is highly sensitive to time. Below is an example of the company’s risk assessment form with all the keys of a score sheet. Projected rough risk analysis score is arrived at after multiplying the likelihood time, impact time, and restoration time (Webber & Wallace, 2017). There is a total risk score of zero when there is a zero value within one of the two columns. The biggest risk and those that require more attention are put to the top when the score sheet table is sorted in a descending order. Table 1 Risk Assessment Form Risk Assessment Form External risks Date: Likelihood Impact Restoration Time Score Grouping Risk 0 – 10 0 – 10 0 – 10 Natural disasters Tornado 0 9 10
  • 9. 0 Severe thunderstorm 1 4 2 8 Earthquake 5 9 10 450 Hail 7 2 6 84 Snow or ice 8 5 7 280 Human-caused risks Poor skills 1 6 10 60 Human error 2 5
  • 10. 7 70 Sabotage 1 8 2 16 Power supply cut 9 9 2 162 Effects of Disasters The previous sections of this disaster recovery plan will help in assessing risks and making decisions on where to cover the most critical risks. In this section, the recovery plan will determine and list the most probable effects of each disaster. The disaster recovery process of Loop Inc. will cover these specific effects. Multiple causes have been noted to produce the same effects and these effects can, in turn, lead to other effects. This recovery plan focuses on earthquakes and power supply cut as some of the main risks due to natural disaster and human-caused risks (Reason, 2016). An earthquake leads to the failure of several entities such as office facilities, operations staff, power system, telephone system, and data systems of the company. Below is a sample mapping of the cause, effects, and affected entities in cases of earthquakes or power supply cut. Table 2 Disaster Affected Entities Risk (Disaster) Effects Affected Entity Earthquake Telecom failure Telephone instruments and network
  • 11. Desktops destroyed Desktops and workstations Office space destroyed Office space Power disruption Power Operators cannot report to work Office staff Data systems destroyed Data systems Power supply cut Data systems powered of Data systems Desktops powered off Desktops/workstations Power disruption Power Telecom failure Telephone instruments and network Data network down Network devices and links In the above table, it may be noted that several disasters may affect the same entities and this can help identify the entities which are most affected. Data systems and power are the main entities with the highest probability of being affected because they support most of the company’s entities.
  • 12. Determining the effects of disasters also requires the company, through the recovery plan, to set downtime tolerance limits. The downtime limits will be based on the “Affected Entity” list with each entity having a set downtime limit (Torabi & Sahebjamnia, 2015). The tolerance limit will be sorted in an ascending order and those entities with the least tolerance limit will be highly prioritized for recovery. The cost of downtime has been used as one of the metrics for evaluating downtime tolerance limits. Table 3 Risk Tolerance Limits Risk (Disaster) Affected Entity Cost of Downtime Tolerance Limits 0-5 0 - 10 Earthquake Telephone instruments and network 4 2 Desktops and workstations 3 3 Office space 3 3 Power 4 1 Office staff 2 4
  • 13. Data systems 5 1 Power supply cut Data systems 5 1 Desktops/workstations 3 3 Power 4 1 Telephone instruments and network 4 2 Network devices and links 4 1 The investment required for any recovery plan is based on the cost of downtime which can be either tangible or intangible costs. Tangible costs are consequences of the business’s interruption, productivity, and generating less revenue. Intangible costs can be identified as lost opportunities when the company loses reputation and customers approaching competitors among other factors. The recovery plan identifies there are several interdependencies from the affected entities. There are disaster affected entities which will need a detailed recovery sequence, for example, data system restoration is dependent on the restoration of power. Disaster Recovery Mechanisms
  • 14. After preparing the list of affected entities and assessing their failure tendency, there is enough laid ground for analyzing different recovery methods available for each entity. This analysis helps to identify the best suitable recovery method for each entity. i. Data systems Disaster recovery facilities are key in supporting the effective data redundancy in the company’s onsite data center. These facilities will act as offsite data storage and will also have recovery systems from other entities such as power cuts, network outages, storage, connectivity to paths and devices. To increase redundancy and prevent the need for a disaster recovery, technologies such as the redundant array of independent disks (RAID) and mirroring will be used in the software layer (Chang, 2015). One way of providing fast recovery from any hardware or software error is having on-site data center redundancy because there will not be a need for disaster recovery. The company’s business needs will determine the nature of each disaster recovery mechanism. Loop Inc. will have several duplications of its data center to ensure the company’s business processes are not affected by any site loss. The company can also build its own data center specifically for disaster recovery purposes with the basic and necessary required hardware to keep the business running. Loop Inc. can eventually opt for a colocation facility where the company can access data center services on a rental basis. ii. Major incident process The major incident process will have an objective of efficient resolution of incidents which have a key impact on the company’s critical business processes. The process ensures there are quality and quantity of communication in cases of major incidents. The process also ensures there are sufficient resources for the resolution of any major incident (Torabi & Sahebjamnia, 2015). The major incident process will offer a systematic incident review to prevent similar incidents from
  • 15. reoccurring. To ensure these objectives are realized, Loop Inc. will its customized “Major Incident Handling Plan Model” and it will be anchored on communication. Figure 2 Major Incident Workflow The major incident handling model will need a suitable major incident team for it to work successfully. The major incident team will consist of the problem manager, major incident manager, incident manager, and the service desk manager among other members. Loop Inc. will need a team that can accurately and swiftly tackle any incident in question while maintaining good customer relations. The team will also be responsible for the root cause analysis after resolving a given incident. Disaster Recovery Phases Loop Inc.’s disaster recovery process will happen under the activation, execution, and reconstitution sequential phases. The activation phase will involve the assessment and announcements of the disaster effects (Kerzner & Kerzner, 2017). The execution phase will involve the execution of the actual procedures for the company to recover from each disaster. The company’s business operations are restored on the recovery facilities or systems. In the last phase, the reconstitution phase, the execution phase procedures are stopped after the original system is restored. i. Activation phase The activation phase will involve notification procedures, damage assessment, and disaster recovery activation planning. Notification procedures will be highly dependent on effective communication because they are the primary measures taken as soon as an emergency or disruption has been predicted or detected. Notification procedures will contain the process to notify the recovery personnel during working and outside working hours (Torabi & Sahebjamnia, 2015). A notification will be sent to the damage assessment team after the disaster detection for them to assess the real damage and instrument subsequent actions.
  • 16. Notifications from one team to another can take place through a pager, telephone, cell-phone or an e-mail. Loop Inc. has a notification policy that describes the procedures to be followed when required personnel cannot be contacted. These policies are clearly documented in the contingency plan. To document primary and alternate contact methods, Loop Inc. will use a call tree as shown below. The call tree has procedures to be followed in cases when a specific individual cannot be contacted. Figure 3 Call Tree Chart The contact list on the plan will unmistakably identify staff to be alerted and they will be classified by name, role, and contact information. In cases where disrupted systems are interconnected with external organizations, the plan will provide a point of contact in the given organizations (Richie & Kliem, 2015). Damage assessment Damage assessment will help establish ways the contingency plan will be executed when the business’s services are disrupted. The nature and degree of the damage to the system are assessed quickly as conditions permit. The evaluation should be done with personal safety as the highest priority and the damage assessment team should be the first to be notified of the incident and they will use the damage assessment guidelines for investigating different types of disasters (Richie & Kliem, 2015). Power outage in the data center facility can have an assessment on whether power can be restored before the facilities UPS system runs out of static power. If the power cannot be restored, a disaster recovery plan can be activated immediately. Damage assessment processes will vary with each given emergency and Loop Inc. can use the following general procedures. · Origin of the disruption or disaster.
  • 17. · The potential for additional emergencies or damages · The area affected by the disaster. · Status of the physical infrastructure · Inventory of the key equipment. · Functionality status of the important equipment · Type of damage to equipment · Items to be replaced. · Estimated restoration time for normal services. Activation planning The disaster recovery plan should only be activated when a thorough damage assessment has been conducted to avoid stalling normal business operations as a result of false alarms. The Disaster Recovery Committee will do a disaster activation planning depending on the extent of the damage from the disaster (Cook, 2015). The committee's plan should: · Plan for communication between teams · Catalog systems and services that need to be restored · Catalog instructions for reporting failures to the team · Showtime estimations for each restoration ii. Execution Phase The execution phase is involved in bringing up the disaster recovery system, for example, temporal manual processing, operation, and recovery on an alternate system. Sequence recovery activities should include instructions to coordinate with other teams in given situations, for example, when items need to be procured, completion of a key step, and when an action is not realized within the estimated time frame (Lan & Mojtahedi, 2017). Listed recovery procedures will provide detailed processes of restoring the system and its components. Loop Inc.’s procedures for IT service damage will address actions such as: · Acquire access authorization to damaged premises · Notify users linked with the system · Procure needed office supplies and a working space · Secure and load backup media. · Restore critical application software and operating system
  • 18. · Restore system data. · Test system functionality and security controls · Connect the system back to other external systems of the network iii. Reconstitution phase In this phase, the business’s operations are transferred back to the original facility. Rebuilding can also be done in cases where the original facility is unrecoverable (Lan & Mojtahedi, 2017). This phase may last several days depending on the nature and severity of the destruction. The Disaster Recovery Committee will be involved in: · Constantly monitoring the site or facility’s suitability for reoccupation · Verifying the site or facility is free from aftereffects of the disaster · Establish and maintain connectivity between internal and external systems. · Ensure full functionality by testing the system’s operations · Shut down the contingency system · Arrange for operations as staff return to the original or rebuild the facility.Recommendations This disaster recovery plan document should be constantly kept up to date with Loop Inc.’s current organization environment. To maintain the plan documentation, Loop Inc. should be involved in the periodic mock drill. The company should also capture the document’s experience in case of a disaster to help improve the plan. The disaster recovery plan can also be maintained by periodic updates which reflect the current information about the components covered in the DRP. References Chang, V. (2015). Towards a Big Data system disaster recovery in a Private Cloud. Ad Hoc Networks, 35, 65-82. Cook, J. (2015). A six-stage business continuity and disaster recovery planning cycle. SAM Advanced Management Journal 80.3, 23.
  • 19. Kerzner, H. R., & Kerzner, H. (2017). Project management: a systems approach to planning, scheduling, and controlling. . John Wiley & Sons. Lan, B., & Mojtahedi, M. (2017). Critical attributes for proactive engagement of stakeholders in disaster risk management. International journal of disaster risk reduction, 21, 35-43. Reason, J. (2016). Managing the risks of organizational accidents. Routledge. Richie, G. D., & Kliem, R. L. (2015). Business continuity planning: A project management approach. . Auerbach Publications. Sadgrove, K. (2016). The complete guide to business risk management. Routledge. Torabi, S. A., & Sahebjamnia, N. (2015). Integrated business continuity and disaster recovery planning: Towards organizational resilience. European Journal of Operational Research 242.1, 261-273. Webber, L., & Wallace, M. (2017). he disaster recovery handbook: A step-by-step plan to ensure business continuity and protect vital operations, facilities, and assets. Amacom. J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y V O L . 6 5 , N O . 4 , 2 0 1 5 ª 2 0 1 5 B Y T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y F O U N D A T I O N I S S N 0 7 3 5 - 1 0 9 7 / $ 3 6 . 0 0 P U B L I S H E D B Y E L S E V I E R I N C . h t t p : / / d x . d o i . o r g / 1 0 . 1 0 1 6 / j . j a c c . 2 0 1 4 . 1 2 . 0 0 5 LEADERSHIP PAGE
  • 20. From the American College of Innovation Building the Best Possible Tools for the Best Possible Care Shalom Jacobovitz, Chief Executive Officer, American College of Cardiology A few weeks ago, the American College of Car- diology (ACC) launched its revamped web- site: ACC.org. Over the last year, a team of College staff and member volunteers spent count- less hours interviewing members about their online needs; meeting with website developers about how to leverage best practices and new technologies in light of the many new online channels available; and, last but certainly not least, building the actual site with all of these things in mind. The end result is a site that provides easier and more personalized access to clinical practice guide- lines, the latest published research, educational and practice management tools, and other trusted con- tent that the cardiovascular community has come to expect from the College. Given the explosive growth in the use of multiple mobile platforms to access in- formation, the new ACC.org and related tools, such as e-mail news digests, are also optimized for use across various mobile devices. I am proud of the new site and all of the work from members and staff that went into making it a suc- cessful reality. Its launch is a huge step forward in positioning the College as an unbiased and reliable
  • 21. hub for the cardiovascular community to come to- gether to provide the best patient care. It also pro- vides a platform for us to be innovative and to showcase our advances, and it moves us toward our goal of reducing member burdens and increasing member value during a time of frequent and un- precedented change in health care. According to Meg Wheatley, author and manage- ment consultant, “Innovation is fostered by infor- mation gathered from new connections; from insights gained by journeys into other disciplines or places; Cardiology, Washington, DC. from active, collegial networks and fluid, open boundaries” (1). The process that went into the development and launch of the new ACC.org em- bodies this definition. We learned from past mistakes, gathered information from across our member and staff networks, looked beyond our own walls for in- dustry best practices, and developed a site that helps to meet the needs of members today, while also leaving some fluidity to meet the inevitable changing future digital landscape. The insights and connections gained throughout the website development process are already being leveraged across other ACC projects, both big and small, aimed at ensuring the best possible tools for the best possible care. The College’s recently launched Guideline Clinical App is 1 example. As part of our efforts to modernize the guideline process and make guidelines more usable at the point of care, the mobile app provides easy access to guideline recom- mendations; “10 Points” summaries; and tools such as risk scores, calculators, and algorithms. The app can also be customized by using the bookmark, note-
  • 22. taking, and shareable PDF features. This is 1 of several cross-college efforts to better align mobile tools and educational resources with the release of clinical guidelines—a key element of our strategy to trans- form cardiovascular care. The College is also thinking outside of the box in terms of how to best leverage its clinical data assets to inform research or measure the effect of new treat- ments, drugs, or devices. For example, 2 new PINNACLE registry studies recently provided unique and timely insights into the potential effects of the new ACC/American Heart Association cholesterol guidelines, as well as proposed changes to hyper- tension management (2,3). Similarly, the ACC and the Society of Thoracic Surgeons are blazing trails in the United States when it comes to understanding http://ACC.org http://ACC.org http://ACC.org http://crossmark.crossref.org/dialog/?doi=10.1016/j.jacc.2014.1 2.005&domain=pdf http://dx.doi.org/10.1016/j.jacc.2014.12.005 J A C C V O L . 6 5 , N O . 4 , 2 0 1 5 Jacobovitz F E B R U A R Y 3 , 2 0 1 5 : 3 9 6 – 7 Leadership Page 397 transcatheter aortic valve replacement. In addition, the College is looking at ways to use data to inform the development of clinical quality tools, such as risk calculators and shared decision-making resources that can be used at the point of care, whether at a physical location like a cardiovascular practice or a
  • 23. digital one online. On an even greater scale, the ACC is excited about data aggregation opportunities with payers, health systems, international health organizations, and/or other partners that would allow for even greater un- derstanding of the effects of treatments on patient outcomes. Our relationship with Symphony Health Solution s, a provider of high-value data, analytics, and technology solutions for life science manufac- turers, payers, and providers, is a prime example of how an integrated health care database can support research aimed at advancing scientific understanding of cardiovascular care. We are also exploring how the College, through its suite of hospital and outpatient data registries, can help members and patients take advantage of new technological capabilities like remote monitoring. For example, can we offer a way for patients to easily track their medication, exercise, and/or vital signs like blood pressure that can then be easily down- loaded by their physician as part of a remote moni-
  • 24. toring session? Or, are there opportunities to work with industry to track and measure outcomes in pa- tients implanted with devices or sensors to manage their heart disease? All of these new ideas will also require working with payers around billing of ser- vices, as well as working with lawmakers and other stakeholders to incorporate new practices in the overall treatment paradigm. Jeff Bezos, chief executive officer and founder of Amazon, once said that “every new thing creates two new questions and two new opportunities” (4). As we move ahead into the new year, my challenge to ACC leaders, staff, and members is to take these words to heart. We have created several new things—a new online home for the College being one of them—so let us ask and answer the new questions and hold tight to the new opportunities that come in their wake. REPRINT REQUESTS AND CORRESPONDENCE: Shalom Jacobovitz, American College of Cardiology, 2400 N Street NW, Washington, DC 20037. R E F E R E N C E S 1. Wheatley MJ. Leadership and the New Science:
  • 25. Discovering Order ina Chaotic World. 2ndedition.San Francisco, CA: Berrett-Koehler Publishers, Inc., 1999. 2. Maddox TM, Borden WB, Tang F, et al. Impli- cations of the 2013 ACC/AHA Cholesterol Guide- lines for Adults in Contemporary Cardiovascular Practice: insights from the NCDR PINNACLE reg- istry. J Am Coll Cardiol 2014;64:2183–92. 3. Borden WB, Maddox TM, Tang F, et al. Impact of the 2014 Expert Panel Recommendations for Management of High Blood Pressure on Contem- porary Cardiovascular Practice: insights from the NCDR PINNACLE registry. J Am Coll Cardiol 2014; 64:2196–203. 4. BrainyQuote.com. Jeff Bezos quotes. Available at: http://www.brainyquote.com/quotes/quotes/j/ jeffbezos412272.html. Accessed December 1, 2014. http://refhub.elsevier.com/S0735-1097(14)07295-7/sref1 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref1 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref1 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref2
  • 26. http://refhub.elsevier.com/S0735-1097(14)07295-7/sref2 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref2 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref2 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref2 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref3 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref3 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref3 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref3 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref3 http://refhub.elsevier.com/S0735-1097(14)07295-7/sref3 http://www.brainyquote.com/quotes/quotes/j/jeffbezos412272.ht ml http://www.brainyquote.com/quotes/quotes/j/jeffbezos412272.ht ml Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. InnovationReferences