AHIMA: EHR downtime event offers opportunity to review, improve procedures

EHR patient

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Providers should not only prepare for possible disruption to their electronic health record systems, but also learn from such an event should it occur, according to a recent perspective article.

An unexpected disruption of an EHR can risk patient safety and result in the loss or inappropriate access of data, according to the authors of the article, published in AHIMA Foundation’s Perspectives in Health Information Management. The authors all work for the National Institutes of Health Clinical Center in Bethesda.

The perspective focuses on an EHR outage at the NIH's Clinical Center. The system, which supports about 3,200 users, went down in 2010 for 33 hours. The issue occurred, according to the article, because of a hardware failure that caused corruption in both the primary and backup databases, causing a sudden loss of access. It was restored only after installing a replacement part. After the restoration, the information collected manually during the downtime had to be entered into the EHR, a labor intensive task which took more than a week to accomplish. 

NIH had regularly tested restoring its data base, but had not tested what would happen upon failure of the remote backup network, the article said. The health system reviewed the event afterward for lessons learned, forming a committee which met for a year and still meets periodically.  \

NIH found that communication during the disruption was good, with the creation of a command center, use of rounds, email and overhead announcements. NIH did revise its downtime policy upon its review and created a downtime toolkit of paper forms. The institute also determined that it needed additional backup systems, adding a read-only system and a “warm” site that was fully redundant but with no direct link to the other databases.

The article authors also recommended that providers have a "99.999-percent system availability target," which translates to nine hours of both planned and unplanned downtime a year. Hospitals and health systems should have in place policies and procedures for IT and clinical staff, regular review of documentation and management of system availability, according to the article. 

“Downtime affects all organizations; however, it is important to maintain technology to reduce system downtime and to maintain a robust IT infrastructure. Maintaining a strong infrastructure, monitoring tools, ensuring a culture of high system availability, conducting frequent reviews of the business continuity documentation, and testing procedures at regularly scheduled intervals are keys to meeting a high target level of system availability,” the authors concluded.