HIMSS16: Curbing errors during EHR downtime

When downtime comes to your healthcare facility, the likelihood of EHR mistakes goes up, says Joseph H. Schneider, MD, Senior Vice President and Chief Health Information Officer with Indiana University Health.

Schneider, who presented the session entitled “Convening to Develop Best Practices on Reducing Errors during Downtime” as part of the Health IT Safety Symposium at HIMSS16, spoke with Clinical Innovation + Technology about the risks of downtime for EHRs, how facilities can prevent errors and what steps are needed to develop national downtime standards.

Can you give an overview of your presentation at HIMSS16?

Downtime and downtime recovery are complex processes that are left up to individual organizations to determine what is done, when, and by whom. While the ONC SAFER Guides cover some of the issues in downtime, they don't have the specificity of standards, and so each system handles this differently. There is good evidence that even the basic SAFER guidelines are not being met in many cases.

Why do errors occur during downtime of EHRs?

Downtime results in an abrupt change of workflow for clinicians and the downtime workflow is not a usual one, so it is easy to make mistakes. The alerts and other clinical decision support tools that work in EMRs are also not available, so the guardrails against making mistakes that EMRs can provide are also missing. Finally, the downtime data recovery process is often incompletely done, so information can be missing, resulting in the possibility of error

What types of errors may occur?

Duplicate testing, missed testing, duplicate medications, missed medications, delays in treatment, delays in discharge, even possible morbidity and mortality (although none have been reported yet).

What steps can be taken to prevent these errors?

Prepare for downtime by having standardized procedures; drill adequately using simulation so that all clinicians, including physicians, have a basic familiarity of what to do during a downtime and recovery; have a communication process for keeping clinicians and staff informed; and do what the SAFER Guides say.

Any final thoughts on this topic?

Patient Safety Organizations and other safety collaboratives are the perfect place to develop national standards for downtime and to collect the incidence of this problem. We need to find ways to focus on this as a national issue. Also, there are many examples of high-reliability organizations nationwide. We need to start thinking about our EMRs in the fashion and taking steps to accomplish this.