If your hospital has deployed an electronic health record (EHR) system, you probably have a contingency plan in the event of a system outage. After all, computing systems go down, and when an EHR system is not working, it affects nearly every aspect of a hospital’s operations, from patient care to admissions to finance to supply chain and more.
Having an effective response plan is critical for mitigating the impact of downtime, and your organization has likely put a tremendous amount of thought and care into its contingency plan. But your plan may have an Achilles’ heel that your organization is completely unaware of—a weakness that could leave your organization as poorly prepared as if you had no contingency plan at all. Where are the holes in your plan? Find them by asking a simple question: What is the longest hypothetical outage you have planned for?
Are you prepared for an EHR outage of an hour? Eight hours? Twenty-four hours? What about 10 days?
We mention 10 days for a good reason. That is the length of an EHR outage that Boulder Community Hospital in Colorado experienced earlier this year. And we are not alone. We have heard and read about similar extended EHR outages at other hospitals, so this was not an isolated experience. It could happen anywhere, and when it does, it can undermine even the best contingency plan. Our plan’s “worst case scenario” for an EHR outage did not anticipate a situation where our entire hospital information system would be down for 10 days. We got through the outage thanks to a tremendous amount of hard work and ingenuity by members of our clinical team, administrative team and technology team, and we learned a lot of lessons and developed new best practices through that experience.
The purpose of this article is to share what we learned, to allow your organization to integrate our lessons learned into your contingency plan to better prepare for a similar technology failure, if (or when) it happens.
How Long Is Long-Term?
One of the biggest lessons we learned through this experience is that our imagination was not pessimistic enough when anticipating what would constitute “long-term” downtime for the EHR system. Most hospitals define a “short” outage as an hour or less, followed by an escalating set of protocols that work their way up to a “long-term” outage of 12 to 18 hours at the most. That approach measures potential outages in hours, but our experience, and the recent experiences of other hospitals, shows that contingency plans should redefine long-term outages to be measured in days or even weeks, in order to adequately prepare for what might happen if your EHR software goes down.
In addition to the extended length of our outage, there were three additional aspects of the situation that are important to discuss: