what-happens-when-these-webbased-ehr-systems-or-networks-go-down_641_658204_0_14085916_500For many years, I’ve been writing about the potential damage that EHR down time can have on an organization. I’ve also been writing a number of things to try and help organizations battle against EHR downtime. For example, here’s a few of the articles I’ve written: Cost of EHR Down Time, Reasons Your EHR Will Go Down, and SaaS EHR Down Time vs. In House EHR Down Time. The reality is that EHR down time is going to happen and as more organizations adopt EHR it’s going to happen more frequently.

The past week I’ve gotten a number of people emailing me about the pain it’s been having their EHR down. Here’s one message I got from a doctor:

Today, the whole system ground to a halt and froze screens for 10 to 15 seconds at a time, which made it impossible to get our documentation done on time when trying to see 15 to 20 patients each in a day. Both myself and my colleague weren’t able to finish any of our work. My colleague called the system “unbearable” today. Hence, we get to spend the weekend working to catch up.

I guess it could be worse. We could be paying for it.

Another doctor on the same system wrote:

I have had nothing but trouble with my EHR the last two days. I can’t enter new notes. Their Help Desk takes 10 minutes to get respond on line. Not happy at all.

The former doctor had a similar complaint about the EHR helpdesk, but described the help desk’s response as “denying any problems exist even though it’s obvious when the problems do exist.”

Sometimes it’s not even the EHR vendor’s fault that the EHR is down, but it still illustrates the pain of not being able to access your EHR. HIStalk broke the news of the Epic EHR downtime (caused by a network issue) that occurred at Martin Health System in Florida. Here’s the CIO’s response to HIStalk’s inquiry:

Martin Health System had a hardware failure that has resulted in our network being down. The failure occurred the evening of Jan. 22 and we are continuing to work on rectifying the situation. Epic is among the systems being impacted by this hardware failure, however, it was not the genesis of the problem. We are continuing operations as scheduled, while strictly monitoring any potential patient safety concerns or issues that would require appropriate care determinations to be made. Our patient care teams are following downtime procedures and protocols to ensure patient safety and proper documentation is provided.

HIStalk offered more insight on the downtime a few days later:

From Scooper: “Re: Martin Hospital. You scooped the main media on their EHR crash.” I just happened to have a reader with a friend who was admitted at the time and he passed the information along to me. CIO Ed Collins was nice to provide a response. The contact said it was chaos in the hospital, with confused employees assigning random numbers to patients, runners delivering paper copies of everything, medication errors occurring, and unhappy family members threatening to sue everything that moved (all unverified, of course.) The hospital says the problem was hardware, not Epic, and claims (as hospitals always do) that patient care wasn’t impacted. Of course patient care was impacted – the $80 million system that runs everything went down hard. It would be interesting for Joint Commission or state regulators to show up during one of these hospital outages anywhere in the country to provide an impartial view of how well the downtime process works. All that aside, downtime happens and the key is preparing for it, just like Interstate Highway construction and lane-closing accidents. It’s not a reason to drive a horse and buggy.

It amazes me that it took them from Wednesday night until Friday morning to recover from the downtime. That seems like a failure of downtime procedures. I do find all of this EHR downtime really interesting in light of the recent video interview I did with Jason Mendenhall discussing healthcare in the cloud and data centers. They guarantee 100% uptime for power and connectivity. However, even in a 100% uptime data center, that doesn’t mean the application software might not have its own issues. Although, it does remove some points of failure.

HIStalk is right that EHR downtime happens. The key really is being prepared for when it does happen with proper downtime procedures. Although, that doesn’t mean healthcare and EHR vendors can’t do more than we’re doing now to make it happen less often.

My issue isn’t with EHR downtime, but with preventable EHR downtime. Plus, let’s own up to when it happens and learn from the experience. I know how hard it is on a call with EHR support to explain when a software is “down.” Sure, the server might be up and running, but end users know when something isn’t running smoothly in their EHR. Trying to convince low level EHR support people that it’s indeed an issue is a real challenge. It’s so much easier to point fingers than to try and fix the problem.

Posted on January 28, 2014 I Written By John Lynn


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