Keeping Patient Care on Track: A Guide to Handling EMR Downtime

Ensuring Continuity of Care Through Robust Downtime Procedures

Healthcare organizations should have detailed downtime plans outlining communication protocols, clinical workflow, and staff training to ensure patient care continues safely when the EMR system is down. Robust downtime policies and regular training help maintain continuity of care and minimize disruption during inevitable EMR outages.

Electronic medical records (EMRs) have become an invaluable tool for healthcare providers over the last decade. By storing patient medical information digitally, EMRs make this data more readily accessible and shareable between members of the care team. However, as most medical practices have experienced, EMR systems can and do experience outages or downtime events. 

These disruptions can severely impact clinic workflow and patient care if the practice is not adequately prepared. Having clear policies and procedures for EMR downtime is crucial for maintaining patient safety and continuity of care when the system is unavailable.

In this blog post, we will discuss the importance of developing comprehensive EMR downtime plans, including communication protocols, staff training, and alternative documentation methods. We will also explore lessons learned from real-world downtime experiences and how healthcare organizations can continuously improve their readiness to handle these inevitable events.

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What is EMR Downtime?

EMR downtime refers to any period when the electronic system is unavailable or inaccessible to users. This could occur due to power outages, natural disasters, ransomware attacks, or technical failures of the EMR software or hardware. Downtime events may be planned or unplanned:

• Planned downtime occurs when the EMR vendor schedules system upgrades or maintenance that requires taking the platform offline temporarily. These events are usually communicated well in advance.
• Unplanned downtime occurs unexpectedly, such as during a sudden server crash or ransomware attack. Medical practices likely have little to no warning before these incidents.

Depending on the cause and duration, EMR outages can severely obstruct clinic operations and patient care coordination. According to a 2018 survey by Black Book Market Research, 87% of hospitals reported at least one EMR-related disruption in patient services per day. Without robust continuity plans, even short-term EMR downtime can lead to delayed diagnoses, medication errors, redundant testing, and poor patient experience.

Preparing for the Inevitable: Developing an EMR Downtime Plan

Given the near certainty of both planned and unplanned EMR outages, having a clearly defined downtime plan is essential for every medical practice. An effective EMR downtime plan allows providers to maintain continuity of operations and prioritize patient safety above all else. Key elements include:

Communication protocols	The downtime plan should outline communication strategies to keep both internal staff and external partners updated. Define key contacts who will lead communications about system status.
Alternative documentation procedures	The plan should specify acceptable downtime documentation methods such as paper charts or forms. Include policies for later reconciling this data back into the EMR once available.
Clinical and medication procedures	Provide staff clear guidance for writing orders, administering medications, routing lab results, and facilitating referrals during an outage.
Resource allocation	Assign responsibility for accessing alternate systems with patient data. Maintain backup resources like paper charts and drug references accessible to staff.
Training	Conduct regular training to ensure all staff understand the downtime plan and their individual roles and responsibilities during an outage. Practice mock downtime scenarios.

In 2016, the Office of the National Coordinator (ONC) for Health Information Technology issued guidance recommending medical practices outline these elements in their EMR contingency plans. Having robust policies and adequate training to support patient care during outages is vital to ensuring medical practices meet their legal responsibilities for patient safety in the event of disasters or emergencies.

Communication is Key: Keeping Everyone Informed During Downtime

When EMR systems go down unexpectedly, clear communication across the entire organization is vital. The downtime plan should designate points of contact responsible for disseminating status updates to both internal and external stakeholders.

Internal communication

When an unplanned outage occurs, the EMR administrator or assigned manager should immediately inform staff of the event and expected resolution timeline. Provide instructions per the downtime plan, such as reverting to paper documentation temporarily. Regular status updates should be given to avoid misinformation and confusion.

Patient communication

Staff should notify patients about the system's outage and how it may impact their visit. This helps manage expectations and avoid frustration. Signage at check-in and information sheets can provide transparency about the EMR downtime.

External partner communication

Practices should also reach out proactively to hospitals, specialists, labs, pharmacies, and other facilities that receive data and orders from their EMR. This allows external teams to accommodate delays in data or records availability.

Designating communication protocols and responsible personnel ahead of any major EMR outage helps deliver timely and accurate information to those who need it. Strong communication and transparency with patients also demonstrates the practice's commitment to mitigating disruption to their care.

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Maintaining Patient Care During Downtime

When the EMR system becomes unavailable, medical practices must have alternative methods in place to safely treat patients and avoid disruption in care. While rudimentary, temporary reversion to paper documentation is necessary.

Staff should follow the practice's defined procedures for accessing paper charts with up-to-date patient information, writing orders or prescriptions, taking notes, and recording diagnostic test orders or results. Convenient access to forms, templates, prescription pads, and clinical references enables smoother transition away from digital workflows when required.

To account for lack of digital access, clinical staff should take extra precautions when administering medications, reporting lab results, and coordinating care:

• Verify medications and dosages with paper references or pharmacy contacts
• Contact labs directly to retrieve urgent diagnostic results
• Route paper referral requests through administration for follow-up communication

These stopgap measures allow medical teams to deliver safe, minimally disrupted care during temporary downtime. Practices should ensure HIPAA and patient safety protocols are maintained throughout.

Learning from EMR Outages: Continuity Planning and Process Improvements

Once IT staff resolve the cause of an EMR outage, it's critical for healthcare organizations to focus on recovering normal operations and analyzing the incident to make improvements for the future. Key steps include:

1. Data Reconciliation: Paper records and documentation created during an EMR downtime must be accurately and completely captured back into the system once it is restored. This preserves continuity of the patient record and ensures no data is lost.
2. Downtime Debrief: Conduct an analysis of what worked well and where there were gaps during the EMR outage response. Review communication protocols, clinical workflows, downtime procedures, and staff readiness. Identify strengths to maintain as well as areas for improvement.
3. Continuity Plan Updates: Use insights gained from each real-world incident to improve the organization's continuity plans. Update downtime procedures, communication templates, training approaches, backup systems, and disaster recovery plans.
4. Ongoing Readiness Evaluation: Proactively analyze recovery efforts from any data loss incidents, communication breakdowns, or patient care disruptions that occur. Identify how clinical protocols, staff training, or coordination with external partners can be enhanced to minimize impact during the next inevitable EMR outage.
5. Process Improvements: Look for opportunities to implement technology improvements, system redundancies, or procedures that will reduce the frequency or duration of EMR outages. Preventing outages is ideal, but improved continuity plans can reduce their impact.

By continually reviewing response efforts and identifying areas for growth after each EMR disruption, healthcare organizations can optimize their continuity planning and readiness. This allows them to maintain quality patient care and normal operations during even the most challenging technical outages.

Conclusion

EMR outages large and small are an inevitability in modern healthcare. But having comprehensive policies and procedures focused on maintaining patient safety and care continuity can help medical practices minimize disruption. 

By investing time in planning, training, and analyzing real-world incidents, organizations can continuously improve their resilience when EMR systems go down. While technology failures are unavoidable, harm to patient care does not have to be.

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