With Electronic Health Records (EHR) downtime an increasingly common occurrence, health providers need to have robust paper-based processes in place to continue to provide healthcare during outages. Hospitals also need to think about how to quickly and efficiently return to business as usual - converting paper forms back into EHR data, seamlessly and without delay.
In today's digital age, where electronic health records (EHR) are integral to the operations of hospitals, the importance of maintaining well-documented paper processes cannot be overstated. Despite the efficiency and accessibility that EHR systems offer, they are not immune to downtimes or cyberattacks. Such incidents can cripple a hospital's ability to function effectively, emphasising the need for robust backup processes.
The increasing threat of EHR outages
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Recent incidents |
EHR systems, like all complex digital platforms, are susceptible to various forms of disruptions.
In recent years, the healthcare sector has witnessed a significant increase in cyber threats, with ransomware attacks leading the charge. These attacks not only threaten patient privacy but also disrupt the delivery of critical care services.
Not all threats are from bad actors, however; the recent Crowdstrike outage and worrying trends in extreme weather events and concerns over the reliability of our power supplies all emphasise the need for hospitals to be able to function during systems outages.
The Role of Paper Processes
In the event of EHR system downtime, well-documented paper processes serve as a critical fallback mechanism. They ensure continuity of care by providing healthcare professionals with the necessary information to make informed decisions and maintain patient care without interruptions.
Implementing Effective Paper Processes
“Downtime represents a risky time for patients because patient information and critical EHR functionality are unavailable. Many institutions have used EHRs for years, with health professionals less likely to be familiar or comfortable with paper-based processes, resulting in an increased risk of errors during downtimes.” 1
To implement effective paper processes, hospitals must ensure that these processes are comprehensive and regularly updated. This involves:
Documenting Critical Information
- Recent, essential patient information, including medical histories, medication lists, and emergency contacts, should be readily available on a backup system such as Cerner 724 Downtime Viewer or Epic Downtime Designated Computers(BCA PC).
- As far as possible, the format and content of your paper forms should mirror the digital version that hospital staff are already trained on
- Document your paper and digital processes in the same repository, link them to the same data model, and govern them in the same way to ensure consistency
Training Staff
- Regular drills and training sessions should be conducted to ensure that all healthcare providers are proficient in switching to and from paper records.
- Consider using scheduled EHR downtime (for upgrades etc.) to train and test your capability to run your paper-based processes
Regular Audits
- Conduct regular audits to ensure that the paper processes are up to date and in line with current practices and regulations.
Use technology to speed up the recovery phase
Consider arming your uptime team with Optical Character Recognition (OCR) and automation capabilities to update your patients’ EHR with all relevant data. The increased speed and error reduction due to lack of rekeying can allow your uptime team to focus on edge cases and the most urgent needs.
Conclusion
Reliance on digital technologies in healthcare is a double-edged sword. While they offer significant improvements in efficiency and patient care, they also introduce vulnerabilities.
Well-documented paper processes are not just a regulatory requirement or a backup plan; they are a fundamental aspect of a resilient healthcare system. Hospitals must recognise the importance of these processes and invest in their development and maintenance to ensure patient safety and service continuity, no matter the circumstances.
1 What Goes Up, Must Come Down: A State-of-the-Art Electronic Health Record Downtime and Uptime Procedure in a Metropolitan Health Setting. Appl Clin Inform. 2023 May; 14(3): 513–520.
