IT Downtime – A Cultural Shift
According to Dr. Weed, the four main goals of electronic health record include immediate access to patient data, access to data from multiple care episodes, standardized data organization and help hospitals plan and organize capacity and patient flow. There is an ongoing realization of benefits of Electronic Health Records (EHR) as well as other associated issues such as unplanned downtime. Conventional Information Technology (IT) departments have multiple back-up options to ensure workflow and data safety during downtime. However, EHRs are yet to achieve that level of downtime safety. There have been many reported incidents of EHR downtime, which has gained attention due to inconveniences caused in the workflow. This study outlines the measures taken at University Health Network, a large academic research hospital at Toronto, Canada. 
The research group formed an organization wide IT downtime committee that included representatives from nursing, physicians, laboratory, pharmacy, radiology, facilities, switchboard, IT and administration. They conducted tabletop exercises. More importantly, the EHR downtime is not considered as an IT problem alone; instead, it is considered as both IT and Clinical team problem.
The tabletop downtime exercises emphasized that communication is extremely critical to function during EHR downtime. Further, it emphasized that personnel need to be trained or practice how to effectively communicate during IT downtime. They included an escalation matrix so that as soon as a physician notices trouble with EHR they can escalate the matter and communicate the severity of problems at different levels so that action is taken on time. Paper work was the main source of documentation during downtime. Finally the authors propose plans to fill the gap in EHRs of patients once the hospital recovers from downtime. First they proposed a centralized plan where a team was deployed to fill data into computers. Soon, however, it was realized that centralization of such plan took quite an effort and financially was not very cheap. Then they proposed a de-centralized plan where each department could fill in data at their convenience, which raised concerns about quality. Finally, depending on the needs, to some departments recovery team was deployed and for others it was not.
Orchestrating workflow during IT downtime is an organizational effort and must be a shared responsibility of both IT and Clinical teams. Centralized accountability is necessary to ensure a standardized protocol and coordinated efforts throughout the organization and to foster continuous learning to bridge the gap. Finally, IT downtime preparedness is a continuous planning, practicing, responding, recovering and debriefing process. Downtime knowledge needs to be embedded in staff training and practiced and verified regularly.
It is another study where paper records are considered as ultimate back up plan to continue work during EHR downtime. The downtime protocol proposed in this article is similar to the HELP system downtime protocol in some aspects. One interesting proposal here is that the downtime is not just viewed as IT issue instead it is considered organizational. Also the institution pays emphasis to update patient data to EHR after downtime recovery, which in my opinion is necessary as more practices rely on EHR.
- Caesar, 2015. IT Downtime – A Cultural Shift. http://www.ncbi.nlm.nih.gov/pubmed/26168390