Problem Statement: This presentation describes the successful implementation of an electronic health record (EHR) downtime and recovery process at a large multifacility Midwest healthcare organization. Following an EHR software upgrade in February 2015, the Clinical Ops Informatics team led by nursing informatics specialists conducted timely and informative multidisciplinary "lessons learned" sessions. It was noted that the just-in-time preparation prior to the upgrade did not leave the healthcare system well prepared for the downtime, even though it was a planned outage. Process gaps identified during lessons learned sessions included (1) lack of clarity of downtime/recovery policy; (2) lack of understanding and preparedness regarding resources necessary for downtime/recovery; (3) communication gaps before, during, and after the planned outage; and (4) data integrity concerns that arose because it took close to 3 days for healthcare system staff to back-enter clinical notes and data into the EHR.
Methods: An extensive review and revision of the Downtime and Recovery Policy were undertaken in 2015 to reflect real-time experiences and correct inconsistencies identified during the upgrade debrief. In collaboration with each site's emergency preparedness committee, tabletop drills were executed. The drills emphasized the need to preplan, included leaders and frontline caregivers, and will be held annually. Planned and unplanned downtime scenarios and recovery steps were included in the drill.
Results: Solutions have been identified to address communication issues across all venues. The downtime and recovery process has been incorporated within the Emergency Preparedness Committee's purview to improve communication and provide leadership. Device agnostic communication software will be implemented. This software incorporates multiple communication modes and has a backup strategy should the healthcare system lose Internet access. For easy transition to and from paper during downtime and again during recovery, three solutions were identified: a downtime/recovery toolkit for an easy transition to paper, a process to flag gaps in the EHR caused by downtime documentation, and streamlined expectations for data back-entry versus scanning documentation.
Significance: Providing increased process standardization, improved communication and preparedness for downtime and recovery have multiple advantages. It has the potential to increase quality of patient care, mitigate the risk of lost resources during transitions to and from downtime and recovery, and to improve employee satisfaction.