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Dollars & Sense

By failing to prepare for EHR downtime events, you are planning to fail.

I have written extensively regarding financial benefits related to properly planning for EHR & Network downtime events.

We’ve discussed how EMR downtimes and the use of paper registration forms prolong registration processes by 20 minutes. These delays at the onset of engagement can adversely alter how customers perceive your business, which ultimately degrade quality scores and the bottom line.

We’ve examined the work required to recover from downtime events, specifically the time needed to interpret paper-based registration forms before rekeying into the EHR and the subsequent hours required to correct bad or misinterpreted data.It should come as no shock that poor data quality at registration also slows down billing processes and increases AR days.

We haven’t discussed in detail the clinical impacts of downtime events.  I fear some of you may see downtime mitigation services as a tool for financials with a measureable return on investment and not a solution that has direct impact to the health and wellness of your patients.

If this is your first introduction to the impact of EHR downtimes on healthcare, I recommend “Implications of electronic health record downtime: an analysis of patient safety event reports” published by the Journal of Informatics in Healthcare and Biomedicine (JAMIA).  In this report researchers highlight the serious safety hazards created when downtimes hinder patient identification and information availability.  The authors advocate for development of comprehensive downtime procedures that address safety concerns as well as more consistent adherence to existing procedures.

In one hospital 76 incidents in three years were directly related to downtime.  Most were in the lab, accounting for half of the incidents, followed by medication administration incidents.

Lack of patient identification and an inability to access patient data contributed most to these incidents. What was not counted was the number of lab redraws due to an inability to access the latest patient information before the EHR flat-lined.

Not surprisingly, a lack of formalized EHR downtime procedures has encouraged hospital employees to create their own solutions, a fact that may keep many risk management professionals up at night.

The findings by JAMIA are corroborated by the Pennsylvania Patient Safety Authority, who states Health IT glitches, incorrect CPOE use, EHR documentation issues and the use of paper workflows are among the top technology problems that contribute to medication prescription, dosing, and administrative mistakes that cause patients harm.

Strikingly, and I quote “According to an analysis of the event descriptions, the most common cause of omissions was that the system did not work as expected or was unavailable due to downtime,” the report says.  Eight percent of omissions are attributable to health IT downtime or access issues. “

Let’s not lose focus that EHR’s hold the promise of better care, but without proper downtime planning these tools can actually hurt patients when not available.  Downtime preparations need to include solutions like dbtech’s Downtime Solutions, where access to timely patient information and tools to collect registration data digitally not only saves money, but positively impacts the quality of care at your hospital.

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