What Goes Up Must Come Down: Electronic Medical Record Downtime and the Value of Effective Communication

What Goes Up Must Come Down: Electronic Medical Record Downtime and the Value of Effective Communication

Ransomware has dominated recent news cycles, and all types of organizations are at risk of an attack. From major fuel lines to healthcare entities, ransomware attacks affect victims in a variety of industries and can wreak havoc on our everyday lives in many ways. While today's cybercrime threats are vast, they are not the only area of concern when it comes to electronic data. The Atlantic hurricane season, which runs from June through November, can cause significant power outages and interfere with electronic medical records (EMR) systems. 

Electronic health record downtimes are any period where all or part of an organization's computer systems are unavailable, either for planned or unexpected events. Events internal or external to the organization's information technology infrastructure can cause system failures. These events include loss of internet connectivity, natural disasters, or human error. As one author in the Journal of AHIMA writes, "what goes up must come down." While we may not have the ability to control when or if it even happens, we can still do our best to be prepared to respond to cyber threats, outages, or any event that affects EMR functionality. 

Whether planned or unplanned, where does your organization stand when it comes to preparing for EMR downtime? There are a number of valuable resources out there to help answer this critical question, such as the SAFER Guide from The Office of the National Coordinator for Health Information Technology.

We've all heard the scouting mottos from our childhood that talk about being prepared, and we strive to continue that awareness into adulthood. Preparation for EMR downtime can ease stress and reduce the potential chaos resulting from an unanticipated EMR event. It does not matter if downtime is planned or unplanned, brief or long, partial or complete; preparation and communication are crucial and the common thread between all types of proper EMR downtime. 

The "Before" Communication

Periodic communication before downtime is critical. A template can help standardize the information communicated to end-users. In this templated communication, consider addressing the following questions:

  • Why will the system be down?
  • Which systems will be affected?
  • What changes are being made to the system, and what can end-users expect?
  • Who will be affected by the downtime?
  • When will the downtime begin?
  • What is the anticipated length of time the system will be unavailable?
  • In each department, what will and will not be affected?

For planned downtime, communication can be periodic and at set intervals, such as one to two weeks before, three days before, one day before, and one hour before. 

Staff at the departmental level will need to be informed with status updates for the resources necessary for doing their jobs and providing safe patient care. Are there alternate methods of communication if telephone systems and email servers are down? Does each affected department have a "DowntimeToolkit" that includes what staff needs to do their jobs? These are all questions that will need to be answered and communicated appropriately.

The "During" Communication

The following should be addressed and communicated appropriately during downtime:

  • All staff should be informed of the status of the downtime event and the anticipated recovery time.
  • Leadership, nurse informaticists or other experienced resources should be available to assist staff with documentation and other contingency plans.
  • IT staff should keep leadership informed of the downtime status.
  • Additional resources should be available for unanticipated prolonged downtime.

The "After" Communication

After downtime, the following steps should be taken:

  • Debrief or analyze the downtime response.
  • Review any events that resulted from the downtime, such as canceled procedures, delayed diagnostic testing and results, and medication order or administration errors.
  • Seek input or representation from all levels of staff.
  • Address what worked well and what can be improved.
  • Thoroughly document the analysis.
  • Share the review with all clinical staff as well as senior leadership.
  • Develop an action plan with accountability.

Acceptable Methods of Communication

The following are examples of effective communication strategies for relaying downtime information:

  • Email
  • Newsletters
  • Intranet sites
  • Technology solutions such as emergency mass text platforms
  • Flyers posted near computers and other high-visibility staff areas
  • Online calendars
  • Pop-up notifications when the staff logs into the system 
  • Updates during daily safety huddles (organization-wide and local departmental huddles)

Questions?

Planned or unplanned, having a plan for EMR downtime is critical to the safety of your organization, staff and patients. Talk to a trusted RCM&D advisor for more on EMR downtime and what you can do to prepare your organization. 

Valuable Resources

The Office of the National Coordinator for Health Information Technology "SAFER Guide"

AHIMA "Plan B: A Practical Approach to Downtime Planning in Medical Practices"

AMC/PSO "Patient Safety Guidelines For Electronic Health Record Downtime"

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