“Give me six hours to chop down a tree, and I will spend the first four sharpening the axe.” Abraham Lincoln
What is EHR Downtime?
EHR downtime, defined by the National Library of Medicine, is when a hospital's Electronic Health Records system goes down completely or is partially unavailable. These periods are incredibly disruptive to the flow of information and pose considerable threats to the safety of patients. Unfortunately, in our experience, most hospitals are not adequately prepared to handle and continue operations as usual whenever downtime occurs.
As the current landscape of the hospital EHR system continues to innovate, it has become more apparent that the expectation of hospital downtime has become more frequent. As a result, the information stored within the hospital MEDITECH Electronic Health Record (EHR) has also increased as these systems have continued to innovate and grow. Therefore, in addition to storing more data within the hospital EHR, the reliance on uninterrupted access to that data has increased.
Hospital clinicians and staff have increasingly relied on these systems to provide the highest quality patient care.
When downtime events occur, planning and preparing is time well spent. We have seen that the planning responsibilities fall on the hospital executive team or are left to the C-Suite to develop a plan. Hospitals that are genuinely prepared to have uninterrupted access to their data have included a wide range of experts within the hospital. To successfully plan for downtime preparedness, we see that all areas of clinicians and physicians are consulted during the process.
During these processes, IPeople takes a consultative approach to help the hospital consider what data is critically necessary and what workflows would be nice. At times we begin to build out a multi-year plan to create a solution that will ensure that the highest quality care is maintained even during downtime.
What happens when the Electronic Health Record system becomes unavailable?
How critical can the experience be when the Electronic Health Record system becomes unavailable? Any moment when necessary clinical data cannot be accessed, the hospital is in jeopardy. How can life-saving data stored within the hospital EHR continue to be accessible to clinical staff? Access to patient history, allergies, and unique indicators could prove to be life-saving if a patient presents to your ED and is unresponsive. What may seem to be the most basic patient information is now critical in the event that no data is accessible.
Understanding how critical information can be when access is limited or unavailable gives a new lens to view what data is needed during downtime. This is the first step in planning for rest, which data is essential to continue care and not break clinical workflow to ensure patients have the highest quality care.
Secondly, what used to be a question of if the EHR goes down has become a question of when. How readily accessible is your downtime data? How often is that data that you are relying on during a downtime updated? One of the problems with paper printouts is how quickly that printout becomes outdated. Since reliance on real-time data has become paramount, the risk of outdated information cannot be part of a downtime plan.
Whether the outage is planned as you prepare to take on new priority packs or updates or unplanned, which can be anywhere from a brief outage or catastrophic, these outages will always disrupt your data accessibility and have an unknown element regarding the disruption timeframe.
Even in the event of a planned disruption, clinicians can experience a disruption in their workflow. Unplanned downtime can create even more disruption to clinician workflow. Is your hospital prepared to respond and pivot if the downtime moves from 8 to 10 to 16 hours? Does your data access preparedness plan allow you to increase times for printed MARs or to look back historically at patient data?
These are all critical cases to consider when determining your plan as to how your hospital will have the ability to ensure urgent life-saving care. The time to prepare for continued access to critical patient data and prevent disruptions to clinical workflow is now. But, unfortunately, when downtime happens, it is too late.
In the twenty years that IPeople has served the MEDITECH hospital community and provided solutions to data accessibility needs, we have learned some crucial lessons when planning for times when your EHR is wholly or partially down.
A recent study on understanding the scope of downtime said, “During an unexpected downtime, healthcare workers are rapidly forced to use rarely-practiced, paper-based methods for healthcare delivery. Sometimes, patient safety is compromised, or data is exposed to parties seeking profit.”
We have observed that the preparation for downtime readiness still seems to be in its infancy. The stories we have heard have been quite creative, detailing how hard hospitals work to ensure that nothing is missed during downtime. Our hearts go out to the teams that take many additional steps to ensure that patient care is not compromised.
Yet, even when a hospital has taken steps to prepare, we see 3 or 4 solutions relied upon to provide data access to the clinical staff. Many times during the IPeople Offline Suite demo, we hear executives express that the IPeople solution will not only cover the data access of all 3 or 4 solutions but also give greater access and more reliability.
We can be encouraged that more hospitals are beginning to take the necessary steps to maintain critical clinical data access and ensure that downtime cannot disrupt clinical workflow. Ultimately and most importantly, in taking these steps to secure critical clinical data, life-saving care can be guaranteed to remain constant.
There has been a realization that these disruptions can potentially risk patient safety and add to clinician stress. With the frequency of EHR disruptions and the critical nature of the data being disrupted, a complete downtime contingency plan is necessary. In addition, continued reports outline the rise in clinician stress.
Downtime disruptions do not need to add to the tensions that clinicians balance daily. Patient safety is paramount. No one would willingly jeopardize patient safety, but we regularly have conversations where a downtime solution “checks the box.” The importance of critical access to clinical data cannot be stressed enough. The solution deployed to give data confidence during a disruption cannot be left on the budget-cutting room floor. At the heart of this contingency plan must be a way to ensure continued access to your MEDITECH EHR critical patient data.
Unfortunately, the risk of experiencing downtime is continuing to grow. What key areas of focus can every hospital prepare for to ensure that critical areas of patient care are not compromised during a downtime event?
6 Commonly Overlooked Factors When Preparing For Downtime
1. Start with the ED: rooms and beds.
Ensure that your staff and especially your ED have access to not only patients who are currently in rooms and beds but rooms and beds available in the hospital. The CDS questions required during registration can be incredibly time-consuming, even in the standard electronic workflow. The potential risk exponentially increases when the standard registration workflow is interrupted and paper registration is relied on. Manual entry after the downtime event concludes is required when paper registrations are used. In our experience, this is a crucial area of potential mistakes or lost data. When the admin staff is already stressed from downtime and then faced with a mountain of paperwork, this potentially creates errors in updating data in the EHR.
Additionally, how will the hospital track which beds are open to making a life-saving transfer to continue patient care after they present to the ED? Too often, excel spreadsheets, paper forms, or whiteboards are standard practice during downtime. There is no real-time ability to update rooms and beds without making excessive amounts of phone calls. Time is limited during downtime; additional phone calls to verify available beds do not help workflow.
Furthermore, once that transfer occurs, does the attending physician or clinician have the ability to view patient history or place an order? Executing the bed management becomes only a part of the overall solution needed. The IPeople Downtime Registration solution is read/write capable. When the patient is registered and then transferred, the entirety of critical clinical data is available because Downtime Registration and Offline View work together to give hospitals the ability to maintain care.
Does your hospital have a plan to maintain the ability of clinical staff to admit patients,
transfer current patients to new rooms for life-saving care, or discharge patients during downtime?
2. Critical access to essential patient data.
At the most basic needs of the clinical workflow, we recommend the need to access critical patient data like allergies, particular indicators, and critical patient history. During downtime, data access is disrupted, but patient care does not stop. How will fundamental decisions continue? With necessary access to data limited, even the most essential choices become life-threatening without access to allergies.
Accessible current patient data is not enough. So much of the highest quality patient care is understanding patient history and previous visits. However, accessing the recent stay is insufficient to enable clinicians to maintain proper workflows.
Will the downtime preparedness plan be considered to give access to all data to provide life-saving care? Some of the data is just not enough. The IPeople Offline Views solution will provide hospitals with access to the entire historical patient data since the MEDITECH system was stood up.
3. Access to Reports and Lab data.
Preprinted reports or even accessible pdfs of lab data are better than no access. However, access to one slice of data does not give clinicians the greatest ability to provide continued patient care amid a downtime event.
For example, how will the best decision be made if a new physician begins rounds just as a downtime event occurs and the patients they are about to see only have one report of lab data accessible? Instead, physicians have access to trending lab data, allowing them to provide life-saving decision-making.
Lab data or a single report in a vacuum does not provide the holistic insight needed for physicians and clinicians to provide the care required.
How will your hospital continue to provide clinicians and physicians access to current and historical:
lab data, nursing vitals, or other life-saving tests that have been run?
4. What about Order Sets and Order History?
Just because the EHR system goes down does not mean that physicians can stop placing orders. However, the physician workflow can be critically impacted during downtime. Order History needs to be readily accessible and not only for acute but ambulatory orders. Viewing Order History is only part of the solution. Once a decision is made, and an order needs to be placed, how will that happen?
Will the physician even have the ability to complete an Order? Does the physician have access to the personalized or approved hospital Order Sets? Do the current downtime procedures require a physician to work based on a preprinted, blank Order Set? This exemplifies how procedures and workflow disruptions can impact patient care.
When considering Order Sets, has preparation been made for how clinicians and physicians
will handle the reflex orders, protocol text, and CDS questions?
Hospital protocol varies on customized physician Order Sets; workflow disruption potentially increases with the inability to stay synced with your custom MEDITECH dictionaries. A critical workflow disruption happens when the required fields are not filled out on an Order Set. This prevents the clinician from placing the Order, requiring the clinician to find all parties necessary to complete the Order and then return to hopefully place the Order. Is the Order quickly recorded with a customized patient bar code?
The IPeople Order Sets within Offline Views will give a pdf that already contains the patient header and necessary information. Additionally, critical components like CDS questions and reflex questions are required to ensure that the Order Set workflow is not disrupted and that, ultimately, patient care is not compromised.
With that one word, all clinicians know just how critical downtime preparation for properly handling medications is. Due to the essential nature of the MAR, some hospitals have a routine to constantly print the MAR just to have a recent paper copy available in the event of unexpected downtime.
How confident is your hospital that the data in your MAR is
up to date and refreshed with the most accurate data?
We have had many conversations with hospitals where clinicians have expressed a lack of confidence in the printed MAR due to the potential of it being outdated and inaccurate. At IPeople, we commit to the accuracy and regular updating of the MAR. In addition, past downtime analytics have shown that the MAR is the most highly accessed view.
Just having the ability to access the MAR is not enough. Especially in the event of extended downtime, administering medication must follow protocol. Therefore, accurate and easily accessible MAR reports are critical to ensure clinical workflow is not significantly impacted.
Does your clinical staff have their workflow impacted by inaccurate data
or the lack of confidence in the data provided?
Do clinicians have the ability to access the MAR in the ways needed?
The IPeople MAR can be customized to see patient detail, floor detail, and specific location or to generate the entire hospital in a few clicks.
How is the accuracy of the MAR ensured?
Are wristbands validated and the MAR signed off on?
Are barcodes present to enable the MAR documentation?
All of these questions go back to the clinical workflow and just how disrupted it can be just with the administration of medication. The administration of medication must follow protocol. The IPeople MAR provides clinicians the ability from one document to validate the medication being administered, check wristbands, and have the patient sign off on administering the medication. The ability to rely on this downtime MAR gives clinicians the confidence to continue the existing workflow.
6. Downtime recovery.
Thankfully downtime does come to an end, hopefully, sooner than later. How efficient is your clinical data entry process following downtime? Typically when hospitals rely on paper during downtime, the expense on the hospital is great as many admin staff are wrapped up in manual data entry. In addition, when the staff is already stressed and exhausted, the manual entry of downtime data can lead to manual mistakes.
We hope it could be limited to a minimal number of data entry errors. Still, unfortunately, we have seen worse-case scenarios where the worst-case situation happens, and the manual data entered after the downtime is lost as the systems sync back up. Therefore, IPeople believes that recovery after a downtime entering the MEDITECH data needed from the downtime should not be a critical strain on the clinician workflow.
The IPeople Downtime Registration solution handles all necessary synchronizations for all admission, transfers, or patient discharge. In addition, the ease of having barcodes to scan in Order Sets or MAR can make the recovery process much more accurate and less stressful.
Proper preparation for any level of downtime is critical to the success of continued high-quality patient care. Therefore, IPeople continues to iterate new ways to give clinical staff ways to avoid disrupting workflow during these unfortunate outages.
Downtimes don’t have to be a dreadful time when you have access to the critical data needed. IPeople is proud to be the leader in downtime workflow management.
If you have not had the opportunity to demo the IPeople Offline Views Suite, schedule a time here. Let IPeople give your clinicians and physicians confidence in their data to ensure the highest quality care continues.