Manet Community Health Center, Inc.
Managing Interruptions to Information Processes
EMR-Downtime Procedures
(EMR failure, T-1 Line failure, Medical Manager Failure)
See other guide for phone system failure
Policy:
It is the policy of the health center to provide guidance to staff when the EMR is not functioning due to any reason. This situation may occur at just one site or may be system wide.
Purpose:
The staff will need emergency preparedness procedures in place so that the health center may continue its prime function of access to patients for medical care.
Procedure:
PLANNED DOWNTIME:
2 DAYS PRIOR TO THE PLANNED DOWNTIME:
1. Gather data for each patient scheduled during the day or hours of downtime. Do not forget the providers like nutrition, Spirometry, DigiScope, nursing and especially laboratory appointments for the scheduled downtime.
a) Print last physician visits, problems, medications, allergies, directives, and labs.
b) The laboratory staff must review those appointments and check the future orders in LabDaq and Centricity. If no orders exist but there is an appointment please search out the ordering provider or the provider of the day to be sure to enter those lab orders in Centricity to be prepared for the downtime. Determine by review of chart and visit reason to place orders (if necessary). Make sure the orders are future dated.
2. Materials: make sure the following are available:
a) Copies of downtime paper encounters-use the forms manual to pull out the correct form for the correct visit type.
b) Know where prescription pads are kept (tamper resistant paper)
c) Note to be aware 2 days before that laboratory tests will be ordered on MCHC paper encounter forms during the downtime and the diagnosis to cover each test must be clearly written on the encounter form.
d) Know where the paper education handouts are kept and blank letters.
1 DAY PRIOR TO THE PLANNED DOWNTIME:
1. Double check that no additional patients are scheduled for that day. Including all those department patients mentioned above-don’t forget the laboratory patients.
2. Have the MA/Nurse (appropriate support person) meet with provider to review the downtime schedule to decipher any additional labs needed to be ordered/documentation to print from the EMR.
3. Create a general OFFFICE VISIT for each patient scheduled by compiling the following:
a) Pre-print encounter form
b) Documentation form that matches the visit type. (e.g., chronic pain visit, chronic disease visit). See blank forms manual for visits on paper.
c) Attach a copy of the patient’s medications that can be used to document medication reconciliation.
d) Attach all patient information to pre-printed paper encounter form and pile in order of the patient’s visits in the front desk area.
DAY OF DOWNTIME-PROCEDURES
1. All documentation will be recorded on the Downtime Paper Encounter forms.
2. Nurses will complete a flow sheet of all triage or prescriptions refills in a chart as noted below. These medications can be updated in Centricity when it is up again.
Patient Name / DOB / Call / Script Written / Script Called-In / Name of Medication3. Laboratory tests will be ordered on MCHC paper encounter forms during the downtime and the diagnosis to cover each test must be clearly written on the encounter form.
a) If LabDaq is up and functioning the lab will enter the orders into LabDaq. In-house test result reports will be sent to the provider on the old paper reports that tests were reported on prior to the EMR. Note that when the EMR comes live these results will flow over to Centricity; however there will be no corresponding electronic order for these tests. It is important to note in terms of an audit trail that these orders must be written in the paper record.
4. Any prescriptions will be written on Tamper resistant Rx Pads with NCR paper.
5. When the system is accessible again, the provider will verify that any medications prescribed or refilled do not interact with allergies and/or medications already prescribed to the patient. If interactions occur, the patient will be notified immediately.
RECOVERY PERIOD
1. Enter patient visit data: (when scanning is available the visits encounters will be scanned into the patient record.) At a minimum each patient chart will be opened, select Update. It is very important to change the clinical date to the date of the actual patient visit and choose the office visit type) Document that the visit was recorded on paper and refer the reader to the paper chart. This can be documented easily with a quick text developed for this purpose- use “.down” to access this quick text.
2. Although rare, if LabDaq and Centricity were both down the orders would be placed in LabDaq when it came back on line. The same process must remain in place as described above in “DAY OF DOWNTIME PROCEDURES” item number 2a.
3. All new medications, problems, allergies noted during the visit when the EMR was not available will be updated. The medications will be updated using the copies created when the Rx was written on NPR paper. The provider will determine who will add the salient data.
UNPLANNED DOWNTIME:
SINGLE SITE INVOLVED: (Usually due to a local inoperableT1 line and not the T1 line connecting the North Quincy site to the remote sites.)
1. Each site evaluates their communication systems and EMR system every morning-to be completed by a front desk personnel.
2. When a site determines that their telephone lines and/or computer system are not functioning, the front desk person will immediately notify the Director of Information Technology and the Administrator on-call. If the phone system is down –please use the land lines that are available to you (red phones). Call another site to determine if their systems are down. If systems are intact in another site request their assistance to notify appropriate people and support in other functions as listed below.
3. Once notified the Director of IT becomes the “incident commander” of the situation. The Director of IT will provide guidance to the sites as the level of the problem becomes clear.
4. The unaffected site will assist the affected site by printing out the day’s schedule and faxing it to the affected site. If feasible, the encounter forms can also be printed out and faxed to the affected site. In addition, the unaffected site will begin to print the medication lists, problem lists, allergies of the patients being seen in the morning or at the time of the incident and forward until all patients scheduled have these documents printed. Enlist the support of Medical Assistants and nurses at the unaffected sites for this support function.
5. The answering service must be notified. All calls should be directed to the unaffected site as described in your telephone failure procedures.
6. All patient care and triage notes must be hand written in the event of a computer failure. These notes can be placed in the paper record now and later when the EMR is up again a note directing the reader of the record to the paper record will be added using the same date as the patient visit. See below “recovery.” Materials needed:
a) Tamper resistant Rx Pads
b) Copies of “downtime” patient visit forms that match the type of visit that is scheduled
c) Patient education, handouts, and letters.
7. All labs must be ordered on paper using the present encounter form. When encounter forms are no longer used other directions will be forthcoming.
8. If LabDaq is also down the lab will function in the same way that it did before we went electronic. A downtime procedure will be written separately in this case for the lab.
9. All prescriptions will be written on tamper resistant prescription pads with NCR paper so that the new prescriptions can be added to the EMR system when it becomes functional. (Prescriptions can be called into pharmacies but it will be better to write them on NCR paper.)
IF ALL SITES ARE INVOLVED: (This will mean that the EMR system has gone down at the server in BMC or that the T1 lines at North Quincy are down so information cannot travel out of NQ to all other sites.)
1. If all sites are experiencing a failure, communications between sites using the red phones should be kept to a minimum.
2. Steps 2, 3, 5, 6, 7, and 8 (if LabDaq is also down) and 9 remain the same.
3. The answering service must be notified stating that all phones are down and request them to fax messages to the sites or hold messages that are not urgent until systems are back up. All patients with emergencies should be instructed to go to the nearest ER.
4. The Director of IT will notify the sites when all systems are back on line.
RECOVERY PERIOD
1. Enter patient visit data: (when scanning is available the visits encounters will be scanned into the patient record.) At a minimum each patient chart will be opened, select Update. It is very important to change the clinical date on the right to the date of the actual patient visit and choose the office visit type) Document that the visit was recorded on paper and refer the reader to the paper chart. This can be done quickly and efficiently using .down quick text.
2. All new medications, problems, allergies noted during the visit when the EMR was not available will be updated. The medications will be updated using the copies created when the Rx was written on NPR paper. The provider will determine who will add the salient data. Providers are responsible to orchestrate the notations in the EMR directing the future reader of the medical record to the paper record for the documentation of the visit on the day when the EMR was down. In the future we will be able to scan the note in the EMR but as of the writing of this procedure this is not yet possible. Materials needed:
3. Note that when the EMR is live lab results will flow over to Centricity, however there will be no corresponding electronic order for these tests. It is important to note in terms of an audit trail that these orders must be written in the paper record at the original documentation of the visit.
4. If LabDaq was down, see laboratory downtime procedures for this case.
5. The Director of Information Technology will keep a log of all episodes of downtime including the sites affected, time down, major problems if any, solutions to those problems.
Notes for the Front Desk: If Medical Manager is down, remember to copy every insurance card as the patient comes in. Write necessary information on a blank encounter form
Note: If providers have their tokens with them, it would only help if the problem for being down was determined to be between BMC and NQ not if our T1 lines were down between sites.
Managing Interruptions to Electronic Information: Filed EMR Guide Manual
December 11, 2008 (KC) Updated 7-20-09 (JML and GB)