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Electronic health records (EHRs) can be a boon to clinical care, until the system goes down or the power goes off. Then the clinicians might be flummoxed by how to do things "the old-fashioned way" with paper and pen, or they might not have the resources necessary.
For that reason, risk managers should ensure their hospitals have contingency plans for an EHR failure, says Dean Sittig, PhD, faculty member at the University of Texas Health Science Center at Houston, who specializes in clinical information systems and clinical decision support. He was the lead author of a recent paper that quantified how often EHRs go down and how hospitals are prepared to respond.
The numbers were not good. Sittig and his colleagues surveyed 50 U.S.-based healthcare institutions that were members of a professional organization that focused on collaboration and sharing of best practices related to health information technology (HIT) among its members. All members were large integrated health systems.
Nearly all (96%) institutions reported at least one unplanned downtime (of any length) in the last three years, and 70% had at least one unplanned downtime greater than eight hours in the last three years. Three institutions reported that one or more patients were injured as a result of either a planned or unplanned downtime.
"It was a little shocking to me how many of these organizations had these large downtimes. Most people would say that can’t happen to us," Sittig says. "If you asked them what they would do if the computer were down for eight hours, they would be hard pressed to imagine how they would carry on. The point of our paper is that you have a very good chance of being in that situation."
The survey also revealed that most institutions had only partially implemented comprehensive contingency plans to maintain safe and effective healthcare during unexpected EHRs downtimes. (An abstract of the study is available online at http://tinyurl.com/kfm8z43.)
Risk managers can take the lead in ensuring that contingency plans are in place, possibly acting as a liaison between clinicians and the hospital’s IT department, Sittig suggests. Even highly skilled and motivated IT professionals might not fully understand the ramifications of even a brief EHR failure, he says. Risk managers, especially those with clinical backgrounds, will be able to explain, Sittig says.
IT professionals and clinicians can assume that a brief EHR failure will be easily handled with a temporary return to the pre-EHR work flow, he says. However, they often find that going back is not so easy.
"We were able to afford those nice EHR systems by eliminating the runners we used to employ for taking medication orders to the pharmacy, and we got rid of all the fax machines," Sittig says. "Plus, there will be some employees who never worked under that system and don’t have any idea how to manually accomplish these tasks. In our hospital, at least a third or maybe half of the nurses have never worked in an environment where they didn’t have a computer system."
Sittig suggests these strategies for EHR downtime contingencies:
Have a binder in each room with the forms necessary for ordering medications and recording treatment notes that normally would be handled in the EHR.
Ensure that each unit has at least one computer plugged into the emergency generator supply (usually the red plug) so that it will continue functioning in a power outage.Hospitals often have elaborate plans to keep their servers and the network operational in a power outage, but units still are helpless if they don’t have a computer on the dedicated power supply.
A "read-only" computer terminal in each unit can serve as a backup for all current patient data in the event of an EHR crash. When the EHR goes down, clinicians still can access this computer terminal for patients’ medications, lab values, and treatment notes.
Sittig cautions that the risks from EHR downtimes are easily overlooked.
"In my experience the risk managers are not really worrying about the computer so much because they have to worry about falls, medication errors, and all kinds of things," Sittig says. "But it’s getting to be so that the computer is driving a lot of what we do in healthcare, and if the computer isn’t working, that can open all kinds of potential for patient harm. And one of the things that can happen is the computer doesn’t
work at all. No screen. No data.