HIM 560 Module 6 Downtime Short Paper Example

When the Screens Go Dark: Downtime and Disaster Recovery at Pelican Shoals Health

[Student Name]

Southern New Hampshire University

HIM 560: HIM Informatics and Technology Infrastructure

Downtime Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

When the Screens Go Dark: Downtime and Disaster Recovery at Pelican Shoals Health

Pelican Shoals Health has lost its electronic record three times in five years: once for six hours after an upgrade failed, once for most of a day when a clinic circuit was cut and once for two days after a hurricane pushed water into the basement server room. Each time, staff improvised. This paper proposes a plan so that the next outage, whatever its cause, is handled by procedure rather than invention, and so that recovery restores both the systems and a complete record.

Why Downtime Is a Safety Issue

Downtime is often treated as an IT problem, but its consequences land on patients. Larsen et al. (2018) examined patient safety event reports that involved record downtime and found that outages disrupted laboratory results, medication processes and other steps in care, sometimes delaying treatment. At Pelican Shoals, the two-day storm outage produced a medication given twice because the paper medication record and the last printed list disagreed. Sittig et al. (2014) surveyed experts about contingency planning for electronic records and identified widely endorsed practices, including read-only copies of key data, tested paper procedures and regular drills, and found that many organizations had not fully adopted them. The hospital has the paper forms but none of the other practices.

Recovery Tiers and Targets

Systems differ in how urgently they are needed, so restoration should be staged. The NIST contingency planning guide recommends a business impact analysis to decide how quickly each system must be restored and how much data loss is tolerable (Swanson et al., 2010). Table 1 applies that approach.

Table 1. Recovery Tiers for Pelican Shoals Health Systems

Note. Prepared by the author from interviews with clinical, health information and IT leaders.

The First Hour of an Unplanned Outage

When the record fails without warning, the house supervisor declares downtime after confirming with IT, and a recorded message goes to every unit. Each unit opens its downtime workstation, a computer with a local, read-only copy of current patients' medication lists, allergies, problem lists and recent results, refreshed every fifteen minutes and powered by the emergency circuit. Nurses print what they need and switch to paper forms that mirror the electronic screens. Laboratory results are phoned to units and logged. The pharmacy verifies every new order against the last printed medication list, which would have prevented the duplicate dose after the storm. The health information department opens a downtime log so every paper document created can be tracked.

The Rural Clinics

The four clinics face different risks. Their record is hosted by its vendor, so a hospital server failure does not affect them, but each depends on a single leased circuit, and a cut line leaves a clinic without its schedule, notes or prescribing. Each clinic will keep a laptop with a cellular hotspot that can reach the vendor's hosted record over an encrypted connection, which would have kept last year's clinic open electronically. Front-desk staff will print the next day's schedule every evening, and clinicians will have paper visit forms and a documented process for prescribing during a technology failure, including calls to the patient's pharmacy. When the circuit returns, clinic staff enter paper visits the same day, and the health information department audits a sample within a week.

The Storm Plan

Hurricanes give warning, and the plan uses it. Seventy-two hours before expected landfall, IT confirms that backups have copied to the off-site location and tests the recovery site. At forty-eight hours, units print census reports and refresh downtime workstations, and the clinics schedule closures. At twenty-four hours, a ride-out team of IT, health information and clinical informatics staff moves into the hospital with supplies for several days. If the record is hosted off site as the hosting discussion recommended, the main risk becomes connectivity, so the plan adds a cellular backup link and a satellite terminal for the emergency department and pharmacy.

Communication

Every past outage at Pelican Shoals was made worse by confusion about what was happening and when it would end. The plan names the house supervisor as the single source of updates to units, with messages every hour through overhead pages, text alerts and runners if phones fail. IT sends the supervisor a status estimate every thirty minutes, even when the estimate is unknown. The clinics receive the same updates by text. Physicians outside the hospital are told how to call in orders. When systems return, the supervisor declares recovery and tells units which functions are available first, since the tiered restoration means some systems will come back hours before others.

Recovery and Back-Entry

Restoring the servers is not the end of recovery. Every paper order, result, medication administration and note created during downtime must enter the record, or the legal record will contain a gap. Health information staff will sort paper documents by patient using the downtime log. Clinicians will enter critical items, such as medication administrations and allergies, within four hours of restoration. Remaining documents will be scanned and indexed within forty-eight hours. A reconciliation report will compare the downtime log with documents received, and any missing item will be followed up with the unit. After every unplanned outage longer than an hour, a short review will record what worked and what failed.

Drills and Review

Procedures that exist only on paper tend to fail when they are first used. Each unit will hold a thirty-minute paper drill twice a year, and the whole hospital will conduct one scheduled downtime drill before each hurricane season, with the recovery site restored and verified. Results, including how long units took to switch to paper and how many documents were missing at reconciliation, will be reported to the governance committee.

Conclusion

Pelican Shoals Health cannot prevent every outage, but it can decide in advance how quickly each system must return, what staff do in the first hour, how a storm is met and how paper returns to the record. A tested plan turns downtime from an emergency into a procedure.

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

Sittig, D. F., Gonzalez, D., & Singh, H. (2014). Contingency planning for electronic health record-based care continuity: A survey of recommended practices. International Journal of Medical Informatics, 83(11), 797-804. https://doi.org/10.1016/j.ijmedinf.2014.07.007

Swanson, M., Bowen, P., Phillips, A. W., Gallup, D., & Lynes, D. (2010). Contingency planning guide for federal information systems (NIST Special Publication 800-34, Rev. 1). National Institute of Standards and Technology. https://doi.org/10.6028/NIST.SP.800-34r1