When you were considering the purchase of your electronic health record system (EHR), the company’s sales representative probably pointed proudly to the system’s reliability and minimal “downtime.” This is the amount of time when the system fails for any reason.
Most companies describe their EHR reliability as 99.99 percent. So what do you do when the 1/100 of a percent occurs and the EHR goes down—whether in the middle of the day or at 2:00 a.m.? Can you still conduct patient visits, document tests, and perform all of the necessary activities required to run your practice?
“Orthopaedic practices rely on their EHR systems for documenting just about all things patient-related. I am not sure what we might do in my practice if the system went down,” admitted Richard M. Dell, MD, a member of the AAOS Practice Management Committee who practices at Kaiser Permanente in Downey, Calif.
Have a plan
Experts recommend that every medical practice have a plan to follow if the EHR stops working and patient activities grind to a halt. The plan should be based on previously established policies and procedures that define who is responsible for each of the various actions needed to continue patient activities and get the system up and working. The plan guides both physicians and staff with clear instructions. If the practice has a disaster plan, it could be used as a guide in developing an EHR down-time plan.
The plan might include the following elements:
- noting the beginning of the downtime as well as its end time
- members of the EHR down-time team
- responsibility for contacting the EHR vendor
- responsibility for distribution of back-up paper-based forms
- paper-based forms collection procedures to ensure HIPAA compliance
- conducting a root cause analysis to identify what caused the system to go down
- data entry when the EHR is back in operation
- data recovery, if necessary, because the problem may have started hours before the actual time the system ceased working
“A set of patient documentation forms are necessary for data collection. Paper forms used before EHR implementation should be thoroughly reviewed and updated to ensure consistency in patient data collection,” said Dr. Dell. “It may be necessary to create a print form that looks similar to the EHR interface, essentially creating a form that looks exactly like the screen.”
Dr. Dell found that Kaiser has a downtime procedure that has been used several times during the past 10 years. It includes a backup “read-only” view of the EHR that is used to manage patients while the actual EHR is down. When the EHR is back online, the documentation and orders recorded on paper during the brief downtime are entered into the system.
“I can sense a palpable rise in anxiety when the system is either running very slowly or not running at all. Luckily, this is an infrequent occurrence,” said Dr. Dell.
“Prior to implementation of an EHR, it was not uncommon that portions of the chart (laboratory, radiography, pathology, operative, or other reports) were missing or not yet filed, or that another clinician had the chart and/or images,” he continued. “Today multiple clinicians can review the chart or images at the same time. Those benefits offset the less than 1 percent of the time that the EMR is down or imaging studies aren’t available.”
When an EHR goes down, nerves may fray and overtime may be required for staff. It is very important to give the information technology (IT) staff sufficient time to diagnose and repair the problem before jumping to conclusions about when practice routines can return to normal. In addition, billing staff will need to establish procedures to complete revenue cycle management.
A communication plan for informing payers of the IT problems is important if the outage is not quickly resolved. Practice staff who have never used paper-based forms may need training. Consider conducting a short 15-minute test to determine readiness in the event of an outage. Additional help on EHR contingency planning can be found at the HealthIT.gov web site.
Just remember Murphy’s Law—and the Scout’s Corollary: Anything that can go wrong, will go wrong—be prepared!
Howard Mevis is the AAOS director of electronic media, evaluation programs, course operations, and practice management. He can be reached at firstname.lastname@example.org