When your EHR is no longer available to retrieve the data that allows your clinicians to provide the best and safest care for your patients, what do you do? We have become so dependent at having data at our fingertips that when it stops working or we have to wait for it, we grow impatient, it creates chaos, and we find other avenues to retrieve the data. Quality of care and safety for our patients is the number one priority in healthcare.

One step towards this priority is to ensure mission-critical information necessary for continuity of care and business operations remains available during downtime events. Every hospital should have a downtime solution.

Be Ready for an Unanticipated EHR Downtime Event

One of the most common conversations I have had in my healthcare IT career is about evaluating what went wrong or was lacking during a downtime event and making sure it is available for next time. Unfortunately, figuring this out after the fact is common practice for most organizations and the time when we discover our most basic needs. It causes us to stop and refocus on the important matters for the quality and safety of our patients. Even if your primary expertise is information technology, we are all in this together. I challenge you to lead your organization in an effort to ensure you are prepared to take care of your patients when your EHR is unavailable.

Let's get down to what you need to know about different categories of downtime: planned and unplanned.

Planned: There will always be planned downtime to do server maintenance or EHR upgrades. These are a must to avoid unfortunate technological events. Think of it as getting routine maintenance on your car: if you stop getting your oil changed, your engine will eventually stop working. These routine planned events typically last 2-5 hours and most sites will schedule these monthly or bi-monthly.

Unplanned: Unplanned events can be caused by extreme weather, power outages, software failures or viruses, malicious malware attacks, wireless and network connectivity issues. Not being prepared for either could be catastrophic for your clinicians and ultimately result in harm or adverse outcomes for your patients.

Having the necessary clinical data to continue patient care, like the last administered medication, is absolutely essential to avoid these circumstances and reducing risk will make care delivery predictable. Downtime events can last several hours to days, or even longer in extreme cases. Being prepared for both a short-term EHR downtime and a longer period which may result in activating your disaster operational procedures will allow your doors to stay open to care for your community.

Planning Phases

Phase one: The SAFER Guide measure will help guide your organization to actively prepare for either a planned or unplanned EHR downtime event.

Phase two: Establish a committee to lay the groundwork and make decisions. Ensure all departments are represented and kept in the loop. This is the committee that will put together your policies and procedures, make decisions on your communication methods, planned events, what technology and processes to use.

Phase three: Select a response team. This response team is responsible for gathering information during an event, assessing the risk, planning next steps so the appropriate communication can be distributed to the appropriate staff.

Phase four: Back up important data and distribute it electronically. First and foremost are clinical records and results for inpatients and outpatients: things like the medication administration record (MAR) from pharmacy; patient problem lists and allergies; clinical procedures recently ordered and resulted; clinical and physician documentation and notes.

Also consider the need for basic reports like the current inpatient census by location, patient demographic facesheets, scheduled outpatient visits and surgeries. Don't forget about ambulatory patient encounters, patient info from ED, and so on. Other helpful data during a downtime event can include employee contact and work schedule information, business office information, and financial account summary information from BAR.

Phase five: Provide documentation. Do you have policies and procedures in place and distributed throughout the organization? Be sure to provide checklists, basic resource information containing links, access information, how to contact the command center, etc.

Phase six: Educate your staff and test the plan. Most organizations only test their downtime processes and procedures during a planned event, typically when doing server maintenance or an EHR update. I would encourage everyone to consider doing these types of planned events periodically on different shifts. Another testing drill that has been successful are tabletop exercises. CMS recognizes the benefits of these exercises and provides a tabletop exercise template.

In Summary

If you are interested in learning more about how we can help you with your downtime planning, a downtime solution, or your reporting needs, please contact us.