Down Time

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Purpose

The purpose of this standard is to ensure that:

  • All users and IT staff are aware of the procedures to be used during an outage
  • All users and IT staff are aware of the communication plan for downtimes and outages

Requirements

Enterprise EHR Downtime Policy & Procedure

Downtime Communication

  1. Users should check the IT Service Center status line by calling 1-800-681-2060, option 7. The status line will describe the problem, the next update and the estimated time of repair. If the user suspects a problem and it is not listed on the status line, a new ticket should be generated with the IT Service Center.
  2. For any known problems, the analyst on-call will send an e-mail (if available) to the EHR Users e-mail distribution group, which should include all physicians, providers, management, and super-users. A page (if available) will also be sent to the designated EHR group.
  3. In the event of a large scale extended outage in which additional communication is needed, other forms of communication such as conference calls, faxed updates, intranet postings, etc. may be initiated with affiliate administration.
  4. The proper downtime procedure should be followed according to the level of outage.

Levels of Downtime - Enterprise EHR

  1. Enterprise EHR is completely unavailable on all clinic devices due to a server, network or electrical outage. Users should revert to the downtime procedures.
  2. The Enterprise EHR web application is not available due to a Citrix server outage; however, the iPAQs are fully functional. Users should revert to downtime procedures for those functions not available via the iPAQ.
  3. All wireless devices are non-functional due to a wireless access point outage. This may affect an entire clinic or only portions of a clinic. Users should perform all functions via the web application.
  4. Printing/faxing are adversely affected due to a server outage or other technical malfunction. Prescriptions should be generated via phone call or paper pad and documented in Enterprise EHR with an action of “record”. In the event that the issue is limited to specific stores, IT staff will send an e-mail notification with the specific store name.
  5. Interfaces are down or impaired. Follow individual processes as outlined in this document.

Level 1 Outage: Procedure

Enterprise EHR is completely unavailable on all clinic devices due to a server, network or electrical outage. Users should revert to the downtime procedures.

  1. In preparation for a potential outage, all clinics, at the end of a business day, will print the next day’s provider schedules. A master paper schedule will then be maintained during an outage in which GroupCast is unavailable. Triaging of patients will need to occur for any new requests for appointments. (Please refer to GroupCast downtime instructions in the event of a network or electrical outage.)
  2. If there is advanced warning of a potential downtime or if another clinic has connectivity and is able to assist, the Patient Snapshot report should be printed for each scheduled patient.
  3. If a super-bill (charge ticket) cannot be automatically generated, it will be hand-written with the patient’s name, DOB and account #.
  4. If able to, the front office staff will make a copy of the insurance card. The demographics sheet will be completed, either automatically or manually. All paperwork obtained at check-in will be sent back with the patient, and attached to the downtime form. The pertinent patient information at the top of the clinical downtime form will be completed by the front office staff or the clinical staff.
  5. All phone messages will be recorded using the clinic’s previous paper process or telephone message pads and later scanned into the Office Notes folder.
  6. If lab or radiology results are needed, and a paper result is not available, the clinical staff will place a call to the performing lab or radiology site. Outstanding results will be queued in the interface for later import into Enterprise EHR. If a paper result is available, the results will be distributed to the providers on paper and treated like a non-interfaced result for the purposes of adding manual comments, etc. The paper results should not be scanned, as the results will need to be verified and all comments added once the system is available and the results have interfaced.
  7. The nurse or clinical assistant will room the patient and complete the appropriate sections of the downtime form. They will need to review the patient’s current meds, allergies and problems and sign the form. (If the Patient Snapshot report was printed pre-downtime, it can be used as a tool to review and update the key information.)
  8. The physician or provider can complete the downtime form or use Gas-n-Go dictation for acute visit documentation. The preferred method would be the downtime form. Due to limited analog phone lines, the phone dictation system should be reserved for H & P’s or complex visits. (See the iPAQ dictation guide card, available on the Enterprise EHR intranet site, for information regarding how to use the analog phone dictation system.)
  9. During brief periods of downtime, it is highly recommended that the information, including the full note, be entered into Enterprise EHR once available.
  10. Use the former paper order requisitions when generating referrals, lab, rad or procedure orders. A copy of the order should be kept for later entry into Enterprise EHR.
  11. The allergies, problems, medications (including immunizations), vitals, and new prescriptions must be entered into Enterprise EHR by a clinical staff member after the system becomes available.
  12. The downtime form should be scanned (when available) into the Office Notes folder and the paper copy destroyed. If the visit was recreated electronically, it is not necessary to scan the form.
  13. If a refill or prescription is needed, the physician will utilize a script pad or phone in the medication to the pharmacy. If a script pad is used, a copy of the script can be attached to the downtime paperwork. All new scripts should be recorded on the downtime paper form for later entry into Enterprise EHR.
  14. Refill requests sent to a clinical assistant or nurse can be phoned into the pharmacy. A paper log with the patient’s name, DOB, account number, and refills should be maintained, and kept for later entry into Enterprise EHR. The form can be shredded once the information has been entered.
  15. Please refer to your GroupCast policies for other downtime procedures.

Level 2 Outage: Procedure

A full scale Citrix outage is unlikely; however, if multiple servers are down, it may result in a slowness which forces some users to initiate downtime procedures. The steps below pertain only to those clinics with access to iPAQ devices.

The Enterprise EHR web application is not available due to a Citrix server outage; however, the iPAQs are fully functional. Users should revert to downtime procedures for those functions not available via the iPAQ. Follow procedure #1 as outlined above, with the following exceptions:

  1. The physician/provider can review the allergies, medications, problems, and documents via the iPAQ.
  2. The physician can add new problems, allergies, and medications via the iPAQ; new immunizations or administered medications should be documented on the downtime form for later entry into Enterprise EHR.
  3. The physician could document the visit by using the iPAQ dictation functionality, including the clinical staff’s information indicated on the form.
  4. New prescriptions and/or refill requests can be generated via the iPAQ if the outage is related to Citrix only; however, the user will not be able to monitor the print/fax queue.

Level 3 Outage: Procedure

All wireless devices are non-functional due to a wireless access point outage. This may affect an entire clinic or only portions of a clinic. Users should perform all functions via the web application on a wired device.

  1. All functionality is available using the web application via the desktop. Wireless tablet PC’s, laptops and iPAQs are not functional.
  2. For users with wireless tablets or laptops, they will need to be plugged into the nearest network jack/port or docked in a wired docking station.
  3. Desktop dictation or structured notes should be used instead of iPAQ dictation.

Level 4 Outage: Procedure

Printing/faxing are adversely affected due to a server outage or other technical malfunction. Prescriptions should be generated via phone call or paper pad and documented in Enterprise EHR.

  1. All modules and devices are functional with the exception of the ability to print or fax a document or prescription.
  2. Prescriptions should be documented per usual procedures with an action type of ‘record’. The prescription should then be phoned into the pharmacy. (Schedule I and II drugs may need to be written on a script pad or held until printing functionality is restored.)
  3. Any prescriptions that were previously marked as ‘retail’ that did not fax prior to or during the downtime will process once the server is functional.
  4. In the event that there is a faxing issue limited to a specific store, IT staff will send an e-mail notification with the specific store name and preferred method of alternate communication.

Level 5 Outage: Procedure

Practice Management System/Results/Transcription interfaces are down or impaired. Follow individual processes as outlined in this document.

Practice Management System:

Established patient in organization: If Enterprise EHR is not receiving transactions from the PM, the patient’s arrival status will not be updated. Follow clinic back-up procedures for notifying staff of a patient’s arrival. In addition, the provider schedules on the iPAQ and web application will not be up to date.

Because the patient is accessible via searching for their name, it is still appropriate to document in Enterprise EHR. When starting a note, the patient appointment may not be available. Please create a new encounter, dated appropriately, to attach to the new note.

New patient in organization: The patient name or account will not be accessible in Enterprise EHR. In this instance, utilize the paper downtime form and follow guidelines as outlined in a Level 1 Downtime.

Results:

  1. If the results interface is down, new lab and radiology results will not be sent to Enterprise EHR.
  2. Please call the respective lab or radiology location for results if they are necessary for the patient encounter and a printed report is not available.
  3. Lab and radiology results will queue in the interface and arrive in Enterprise EHR once the outage is resolved.
  4. If a paper result is available, the results will be distributed to the providers on paper and treated like a non-interfaced result for the purposes of adding manual comments, etc. The paper results should not be scanned, as the results will need to be verified and all comments added once the system is available and the results have interfaced.

Transcription:

  1. If the transcription interface is unable to send documents to and from Enterprise EHR, the dictations will queue in the interface and process once the outage is resolved. Documents will not be available for review or signature until the outage is resolved.
  2. It is highly recommended that no further dictation markers be processed during a known transcription interface outage. The use of a complete structured note would be the preferred method of documentation.
  3. Dictations can continue to be processed for later completion by the transcriptionist. If the downtime extends beyond 48 hours, additional communication will be sent to the clinic.

Downtime Form