HIMSS Clinical Informatics Insights
The catastrophic impact to patient safety, revenue loss, customer service and trust caused by downtimes is a painful reality in today’s electronic healthcare setting. Analyzing the business impact due to varying levels of system failure ensures effective planning and budgeting in order to deploy meaningful strategies for managing downtimes. Preparedness, mitigation and communication planning requires a partnership between the vendor and client to successfully survive unscheduled downtimes in particular.
Redundancy and disaster recovery are important considerations during electronic healthcare system selection, implementation and maintenance planning. All potential points of failure – internal and external – as well as vendor contingencies must be reviewed to determine technological resiliency. What are the back up plans for data centers, circuits, servers and data retrieval? Is there virtualization capability? Is there a downtime software that end users can access to view the medical chart and how often is the data refreshed? If not, are there downtime reports that can be auto scheduled containing pertinent data to continue caring for patients safely?
System monitoring and maintenance must be a proactive and ongoing process in addition to coordinated testing after downtimes before the system is released for general use. Whether remotely or self-hosted, a single facility or a multi-facility behemoth, a clearly delineated monitoring and support plan that is updated as the system changes will help to minimize risk. Regular hardware, software and infrastructure maintenance, though costly, are crucial to foster optimization. Monitoring is a challenge when there are numerous applications to contend with, which then requires multiple outages for scheduled routine maintenance. Evaluating the benefits of consolidation may be beneficial depending on organizational structure and needs.
Preparedness is crucial to successful downtimes. Annual in-services and simple policy and procedures cannot be underestimated. In some instances, departmental downtime policies and procedures are useful, however, administrative and organizational-wide polices are generally more effective and should be reinforced by downtime drills. Scheduled downtimes provide the ideal opportunities for these rather than waiting until the next major upgrade to instruct users. Users must know their roles and responsibilities pre-downtime and post-system restoration.
This goes hand in hand with having a solid communication plan from the vendor and internally within the organization. Most health care facilities have an approval process for the scheduling and notification process for planned downtimes. For unscheduled outages, this is more challenging. To help mitigate the effects of unscheduled downtimes, identify who makes the decision to go to downtime procedures, push updates out to work stations frequently, utilize call centers or help desk to communicate, have downtime teams round often and establish a command center.
About the Contributors
Geeta Nastasi is the Assistant Director of Applications for IT at New York Hospital Queens, a member of the New York-Presbyterian Healthcare System. She has worked in several culturally diverse settings including Trinidad, London and New York. Ms. Nastasi has more than 25 years of combined clinical and IT expertise with a strong emphasis on leadership, strategy, process and project management.
Ken Ong, MD, MPH, is the Chief Medical Informatics Officer of New York Hospital Queens and a member of the New York-Presbyterian Healthcare System. His professional activities include: Member, Health Information Management and Systems Society Board of Directors (HIMSS); Member, Healthcare Association of New York State's Health Information Strategy Group; Member, Greater New York Hospital Association Health I.T. Steering Committee; past president of the New York State chapter of HIMSS; past president and board member of Medical Informatics New York. He has devoted the last dozen years to clinical informatics in hospitals located in New York.