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CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(03): 513-520
DOI: 10.1055/s-0043-1768995
State of the Art Paper

What Goes Up, Must Come Down: A State-of-the-Art Electronic Health Record Downtime and Uptime Procedure in a Metropolitan Health Setting

Rachael Lyon
1   Digital Health and Innovation, Sydney Local Health District, NSW Health, Sydney, NSW, Australia
,
Aaron Jones
1   Digital Health and Innovation, Sydney Local Health District, NSW Health, Sydney, NSW, Australia
3   Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
,
Rosemary Burke
1   Digital Health and Innovation, Sydney Local Health District, NSW Health, Sydney, NSW, Australia
2   Department of Pharmacy, Sydney Local Health District, NSW Health, Sydney, NSW, Australia
,
Melissa T. Baysari
3   Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
› Author Affiliations Funding None.
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Abstract

Background Electronic health records (EHRs) are used at most hospitals around the world, and downtime events are inevitable and common. Downtime represents a risky time for patients because patient information and critical EHR functionality are unavailable. Many institutions have used EHRs for years, with health professionals less likely to be familiar or comfortable with paper-based processes, resulting in an increased risk of errors during downtimes. There is currently limited guidance available on how to develop and operationalize downtime procedure at a local level. In this paper, we fill this gap by describing our state-of-the-art downtime and uptime procedure and its evaluation.

Method A district-wide downtime and uptime procedure was revised and standardized based on lessons learned from other health care organizations. The procedure outlines downtime and uptime preparations including downtime drills, downtime viewer auditing, and downtime education; downtime response including activating downtime and tracking patient changes; and uptime recovery including medication reconciliation and uptime documentation.

Implementation We implemented our new procedure across the district during an 8-hour planned downtime. A district downtime planning committee was formed, and a virtual command center was established to coordinate the downtime and uptime events. During downtime and uptime, onsite support was provided by the district's health informatics teams and clinicians. Data recovery was completed safely and efficiently with the revised uptime process. Following the event, we gathered staff feedback and reflections on implementing the procedure which highlighted its success but also revealed some areas for further improvement.

Conclusion In this paper, we describe a state-of-the-art EHR downtime and uptime procedure and lessons learned from its implementation. The implementation was successful with staff well prepared and information reconciled efficiently ensuring safe continuity of care. It was only through extensive planning, significant commitment, and engagement of all stakeholders that this outcome was possible.

Keywords

electronic health records - downtime - hardware/software failure

Protection of Human and Animal Subjects

This work constituted a quality improvement project, and ethics approval was not required.


Supplementary Material



Publication History

Received: 31 January 2023

Accepted: 19 March 2023

Article published online:
05 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Larsen EP, Rao AH, Sasangohar F. Understanding the scope of downtime threats: a scoping review of downtime-focused literature and news media. Health Informatics J 2020; 26 (04) 2660-2672
    CrossrefPubMedGoogle Scholar
  • 2 Myers RB, Jones SL, Sittig DF. Review of reported clinical information system adverse events in US Food and Drug Administration Databases. Appl Clin Inform 2011; 2 (01) 63-74
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Australian Commission on Safety and Quality in Health Care. The NSQHS Standards. Accessed 8 December, 2022 at: https://www.safetyandquality.gov.au/standards/nsqhs-standards. Published 2022
    PubMed
  • 4 Larsen E, Hoffman D, Rivera C, Kleiner BM, Wernz C, Ratwani RM. Continuing patient care during electronic health record downtime. Appl Clin Inform 2019; 10 (03) 495-504
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Wretborn J, Ekelund U, Wilhelms DB. Emergency department workload and crowding during a major electronic health record breakdown. Front Public Health 2019; 7: 267
    CrossrefPubMedGoogle Scholar
  • 6 Larsen E, Fong A, Wernz C, Ratwani RM. Implications of electronic health record downtime: an analysis of patient safety event reports. J Am Med Inform Assoc 2018; 25 (02) 187-191
    CrossrefPubMedGoogle Scholar
  • 7 Sittig DF, Gonzalez D, Singh H. Contingency planning for electronic health record-based care continuity: a survey of recommended practices. Int J Med Inform 2014; 83 (11) 797-804
    CrossrefPubMedGoogle Scholar
  • 8 Singh H, Ash JS, Sittig DF. Safety Assurance Factors for Electronic Health Record Resilience (SAFER): study protocol. BMC Med Inform Decis Mak 2013; 13: 46
    CrossrefPubMedGoogle Scholar
  • 9 The Office of the National Coordinator for Health Information Technology. Safety Assurance Factors for EHR Resilience (SAFER) Guide: Contingency Planning USA2016
    PubMed
  • 10 Dave K, Boorman RJ, Walker RM. Management of a critical downtime event involving integrated electronic health record. Collegian 2020; 27 (05) 542-552
    CrossrefPubMedGoogle Scholar
  • 11 NSW Government. NSW State Emergency Management Plan. 2018
    PubMed