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In the world of healthcare, Electronic Health Records (EHRs) have become indispensable tools, revolutionizing the way patient information is documented, managed, and shared. MEDITECH, one of the leading providers of EHR systems, has played a significant role in this transformation. However, despite their reliability, EHR systems are not immune to downtime, which can occur due to various reasons such as technical glitches, ransomware attacks, maintenance activities or even natural disasters.
Downtime in an EHR system can significantly disrupt healthcare operations, impacting patient care and safety, workflow efficiency, and overall productivity. Therefore, it's crucial for healthcare organizations to have robust preparedness plans in place to mitigate the impact of such events. In a recent blog I wrote on Emergency Preparedness, I shared strategies for ensuring smooth operations during a downtime. By developing comprehensive policies and procedures, investing in staff training, implementing redundant systems, and fostering a culture of preparedness, healthcare organizations can navigate EHR downtime with confidence and resilience. Remember, preparedness is not just about preventing downtime but also about effectively managing it when it occurs.
Insights from the MEDITECH Community 
I recently had the opportunity to hear from several of our MEDITECH clients during the February 21 MUSE Downtime Process and Workflows Jam Session. (Requires MUSEweb account to access.) What a wonderful opportunity for these folks to come together, share their experiences, learn from each other, and explore efficient ways to continue operations during a MEDITECH downtime event. I want to highlight some key takeaways from both the MUSE Jam session, several conversations with our downtime client user groups, other news from non-MEDITECH hospitals experiences that should help prove to you how important being prepared is for your organization.
What is the longest planned or unplanned downtime your site has experienced in the last 5 years?
This question was asked on the JAM session and I was astonished with the outcome.
- Less than 4 hours = 12%
- Between 4 and 8 hours = 39%
- Between 8 and 12 hours = 17%
- More than 12 hours = 32%
I worked at a hospital many years ago where we unfortunately experienced a two-week EHR downtime due to what I will call a technical glitch. We thought we were prepared, but in reality we identified many gaps in our processes. Continuum of care is vital while your technical and clinical teams determine next steps for resolution and recovery efforts. Our clinicians didn't have the data they needed to do their job to safely care for their patients! Shortly after the dust settled, we attended the annual MUSE conference, spoke to other hospitals and vendors to understand the solutions others were using. We quickly stood up a downtime solution that allowed us to distribute clinical data from our MEDITECH standard and custom reporting tools, built a solution to capture registration information electronically, created downtime forms to capture documentation, etc. Unfortunately we did this after the downtime event. Learn from others and please do not wait to experience a lengthy downtime to realize you should have been more prepared.
Every Minute Matters
In my local community, there is a non-MEDITECH hospital that was under a ransomware attack. We learned that their hospital patients waited over eight hours to be served lunch due to insufficient dietary data. They didn't have the patients’ dietary orders available after their EHR went down. I am proud to say our team here at Acmeware, that develops and supports Downtime Defender, was already in the process of releasing a dietary report for our clients.
Mission critical data becomes obsolete after a few hours. Medications change, new orders are delivered, vitals change, and so on. The moment the data are no longer at your staff’s fingertips, they will start to define their own processes and document new data, which can be counter-productive after the downtime is over.
Understanding the different stages of an EHR downtime, based on overall duration, is crucial in preparing your organization:
- Initial 4-12 hours = focus on the ability to view and capture data
- More than 12 hours = your disaster plan should go into effect
- Systems back online = recovery process begins, including data re-entry and post-downtime assessment
Most importantly catch up on sleep because I guarantee your IT, Clinical Informatics, front line staff that assisted with other job duties for hours on end and leaders will need it.
Who owns the downtime processes within your facility?
The first thing to consider is creating a governance committee that comprises of ALL of your departments and leaders. Downtime processes are not an IT responsibility, but a collaborative effort for all to participate. It is common for your root policy to be owned by IT of course, but then additional departmental downtime procedures and policies are created as guidance from the root policy.
Are you testing your downtime processes and procedures? 
During the MEDITECH JAM session it was noted that 59% do NOT hold routine or at least annual downtime tabletop or other downtime simulation exercises. One of my colleague’s family member’s just entered their nursing career working as a floor nurse. He posed this question to her: Do you know how and what to document in the event the EHR went down? Crickets.
We have to adapt to our upcoming tech-savvy generation entering the workforce and educate them, end of story. State organizations and the Joint Commission have started to help facilitate tabletop exercises. I was proud when a client of ours on the MUSE JAM session spoke about their tabletop exercise processes. They indicated that representation from all departments is key. They came up with a scenario that included damage to their building and spoke about how practicing for this scenario helps to identify gaps in their processes.
What is your recovery process?
This varies from client to client when I ask them this question. Manual or automated re-entry of registration data and scanning clinical documentation is typically done only after a four hour downtime or longer, otherwise they manually re-enter data. There is an uptick in vendors attempting to provide solid and accurate solutions yet at a high cost. Wouldn't it be nice to have an "EASY" button? Not all hospitals have the flexibility to put forth a huge investment in a solution they might use only a few times before there is newer technology consider. I always ask my clients to weigh the cost along with the problem they are trying to solve. Sure, we want to automate as much as possible, keep in mind someone will still need to validate the automation process is successful to mitigate any risk.
Summary
In the unpredictable landscape of healthcare IT, downtime in MEDITECH EHR systems can pose significant challenges for hospitals and healthcare entities. However, with meticulous planning, clear communication, and robust recovery strategies, institutions can navigate these challenges with confidence, ensuring continuity of care and safeguarding patient safety. By viewing downtime as an opportunity to test and refine emergency response capabilities, healthcare organizations can emerge stronger and more resilient in the face of adversity.