HCA 120 Module 6 Downtime and Data Errors Example

When the Screens Go Dark: Record System Downtime and the Errors It Invites

Student Name

Health Care Administration Program, Aspen University

HCA 120: Healthcare Information Systems

Instructor Name

Month Day, Year

When the Screens Go Dark: Record System Downtime and the Errors It Invites

Health care now depends so completely on electronic systems that their failure can stop work. Planned downtime for upgrades is announced in advance, but unplanned outages from hardware failures, network problems or cyberattacks arrive without warning. This paper analyzes a composite four-hour unplanned outage of the electronic health record at the outpatient clinics of a community hospital, describing what failed, how staff responded, what errors occurred and how the organization improved its readiness.

The Outage

At 9:40 on a Tuesday morning, the record system stopped responding in all outpatient clinics after a failure in the hospital's data center. The schedule, patient charts, order entry and electronic prescribing were unavailable. The practice management system, hosted separately, continued to work, so staff could still see the day's schedule and patient demographics. The outage lasted until 1:50 in the afternoon.

Downtime Procedures

The clinics had downtime procedures and a kit, but the last drill had been two years earlier. The table lists the kit's contents and what happened with each.

Working on Paper

Staff checked patients in from the practice management schedule and wrote notes on paper forms. Providers could not see medication lists, allergies or recent results except on the read-only computers, so they asked patients directly and, for complex patients, rescheduled. Several prescriptions were written by hand. Nurses phoned pharmacies to confirm current medications for some patients.

What Went Wrong

Two problems caused near misses. First, without printed labels, laboratory requisitions were handwritten, and one specimen was labeled with the wrong birth date; the laboratory caught the mismatch and redrew the sample. Second, results that arrived during the outage went to the laboratory's printer rather than to the clinics, and an abnormal potassium result was not seen until the next morning. These are the same risks found in national data: in an analysis of patient safety reports related to record downtime, 48.7% involved laboratory orders and results, patient identification and communication were common problems, and 46% of reports indicated that downtime procedures were not followed or not in place (Larsen et al., 2018).

Delays

Downtime also slows care. In a study of downtime events at a hospital, laboratory results were delayed by an average of 62% compared with normal operation, and interviews showed delays often came from procedures not followed and incomplete documentation (Larsen et al., 2019). In the composite clinics, patients waited an average of 40 minutes longer, and 23 visits were rescheduled.

Recovery and Back-Entry

When the system returned, the work was not over. Paper notes, orders and prescriptions had to be entered into the record so it would be complete. Each clinic assigned a medical assistant to enter demographics and orders, and providers scanned or typed their notes. Results received on paper were entered and reviewed. Back-entry took most of two days, and charges for the affected visits were delayed until notes were complete.

Ransomware and Extended Downtime

A four-hour outage is disruptive; a cyberattack can last weeks. A national database of attacks on hospitals, clinics and other care providers counted 43 ransomware incidents in 2016 and 91 in 2021, and in 44.4% of all incidents care itself was disrupted, with system downtime the usual form (Neprash et al., 2022). Downtime plans must therefore cover long outages, not only short ones, including how to schedule, bill and share records for days without the main system.

Lessons

The outage showed that having procedures is not enough; staff must practice them. Supplies must be checked, contact lists kept current, and responsibilities assigned for printing labels, routing results and back-entry. The organization also learned that the separate practice management system was an asset, since it kept schedules and demographics available.

Readiness Plan

The clinics adopted a readiness plan: a downtime drill twice a year in each clinic; monthly checks of kits and read-only computers; a pre-printed label sheet for each day's scheduled patients, generated each morning; a rule that all results received during downtime are phoned to the clinic; and a named back-entry lead in each clinic. The plan also covers extended outages with a paper billing process and a way to share critical records with hospitals.

Staff Experience

Staff described the outage as stressful, especially those who had never worked on paper. Newer employees did not know the paper forms or how to write a prescription request by hand. Drills help not only by testing procedures but by giving staff confidence, and debriefs after each event let them name what did not work.

Communication During the Outage

Communication was uneven during the outage. Clinics learned of it from staff rather than from an alert, and updates on the expected end time came irregularly. The readiness plan now includes an overhead and text alert to all clinic managers within ten minutes of an unplanned outage, hourly updates from the IT service desk and a script for front desk staff explaining delays to patients.

Protecting Data During Downtime

Paper records created during downtime hold protected health information and can easily be misplaced. Each clinic now keeps a locked box for downtime paperwork, and paper is shredded only after back-entry is checked. Printed daily label sheets are also kept secure and destroyed at the end of the day, so the readiness plan does not create a new privacy risk.

Conclusion

The four-hour outage exposed the same weak points found in national data: patient identification, laboratory results and procedures that exist on paper but are not practiced. No patient was harmed, but two near misses showed how close the clinics came. Regular drills, current kits, daily label sheets, routed results and planning for long outages turn downtime from a crisis into a manageable event.

References

Larsen, E., Fong, A., Wernz, C., & Ratwani, R. M. (2018). Implications of electronic health record downtime: An analysis of patient safety event reports. Journal of the American Medical Informatics Association, 25(2), 187-191. https://doi.org/10.1093/jamia/ocx057

Larsen, E., Hoffman, D., Rivera, C., Kleiner, B. M., Wernz, C., & Ratwani, R. M. (2019). Continuing patient care during electronic health record downtime. Applied Clinical Informatics, 10(3), 495-504. https://doi.org/10.1055/s-0039-1692678

Neprash, H. T., McGlave, C. C., Cross, D. A., Virnig, B. A., Puskarich, M. A., Huling, J. D., Rozenshtein, A. Z., & Nikpay, S. S. (2022). Trends in ransomware attacks on US hospitals, clinics, and other health care delivery organizations, 2016-2021. JAMA Health Forum, 3(12), Article e224873. https://doi.org/10.1001/jamahealthforum.2022.4873