Downtime Challenges: Keep the Focus on Patient Safety

Melissa Forinash, BSN, MBA, FHIMSS, Program AdminiRebecca Freeman, BSN, PhD, CNIO, Manager of NursinHIMSS Clinical Informatics Insights

The evolution of enterprise EHRs is changing the perspective of clinicians towards downtimes. While EHRs were still emerging, most staff was less reliant on them and more comfortable with paper processes – downtimes were a welcome return to the familiarity of paper. Today, we have quite a different scene – EHRs are more fully integrated into operational workflows and many newer clinicians have never documented on paper. This reality, coupled with an increasing reliance on electronic access to general information, policies and procedures, and tools to aid in clinical practice, means that downtimes represent an entirely new and different challenge. It’s no longer enough to keep the EHR application functional; there is a new definition of “mission critical” when planning downtime management.

The navigation of downtimes often requires that leaders revisit multiple aspects of governance associated with information technology and clinical documentation, as well as focus on patient safety and quality concerns.

Common issues are:

  • How do we plan and communicate downtimes? Should there be standing downtime windows? How do we balance key stakeholders’ interests to determine the best offline window?
  • With the move to all-electronic systems, form build is frequently initiated in an electronic format. What should key forms (Flowsheets, Order Sets, etc.) look like? How do we design/store/print them?
  • When downtimes are over, what is the minimum data set for back-entry? Who enters the data (i.e., clinical staff vs. clerical staff)? What is the timeline for back-entry? How do we audit the back-documentation?
  • How do we train and determine competency for staff on paper documentation? How do we train staff on downtime policies and procedures?
  • Where can staff go for historical data during extended downtimes? Do we have backup or read-only EHR versions available? “Downtime” computers with local data stores?
  • How often are simulated downtimes practiced? How is simulated performance graded?

The most critical requirement for downtime management is the alignment of hospital and information technology leadership. These entities must work together to create a support process, key performance indicators, and governance structures that serve the needs of clinicians as well as technical staff. Every downtime needs a critical review/debrief from leaders and stakeholders to guarantee the most efficient and effective process. Above all, downtimes can only have minimal impact on bedside clinicians and the continuous patient record with careful planning and revision through teamwork, careful planning and practice!

About the Contributors

Rebecca Freeman worked in IT for more than 15 years before attending nursing school. She is currently the Chief Nursing Information Officer and Manager of Nursing Informatics for the Medical University of South Carolina. Rebecca received a BS in Psychology from the College of Charleston and her BSN and PhD in Nursing from the Medical University of South Carolina. A certified Project Management Professional, Rebecca’s academic and operational focus is on interdisciplinary collaboration, the evolution of clinical informatics and project management of clinical systems.

Melissa Forinash has worked in healthcare IT for 30 years in a variety of roles and functions. She currently is the Program Administrator for the Epic Enterprise implementation at MUSC Health in Charleston, SC. Melissa received her BS in Nursing from Old Dominion University and her Master’s in Business Administration from The Citadel. She is board-certified in Nursing Informatics and is a HIMSS Fellow.