While electronic health record downtimes are infrequent, they have a tremendous impact on critical information flow and clinician efficiency, which introduces challenges to maintain patient safety. In an increasingly digital age, healthcare organizations face the potential for electronic health record (EHR) downtimes not only from internal technology failures, but also escalating cyber-attacks. Evidence shows this phenomenon is likely to persist, if not increase. “Overall, 166 US hospitals experienced a total of 701 days of downtime in 43 events between 2012 and 2018. Almost half (48.8%) of the published downtime events involved some form of cyber-attacks” (Larsen et al., 2020).

Mayo Clinic had struggled to initiate and maintain consistent engagement by staff in downtime readiness preparation, including the completion of downtime readiness practice drills. Evidence shows that defined downtime procedures, continuing staff education and engagement and end-user practice of downtime processes is critical.

The downtime oversight subcommittee previously outlined expected downtime processes, created initial tools, and contributed to the development of the business continuity manual. However, these items were general and lacked specificity for unique department needs rendering them less useful for end users. Early downtime drill participation was poor; reporting lacked detail and clinical staff reported an inadequate understanding of downtime tools and processes. In addition, there was inconsistent leadership engagement, ownership, and accountability to ensure departments were downtime prepared.

Clinical systems site coordinating subcommittees recognized that addressing these challenges was increasingly critical to ensure safe patient care delivery in the event of an EHR downtime. In partnership with the subcommittees, several clinical and nursing informatics interventions were initiated to enhance, stabilize, and maintain EHR downtime tools, processes, and department preparedness. Strategies implemented included accurate identification of departments to perform drills; identifying and excluding areas that didn’t use the EHR and identifying newly created departments due to ongoing campus expansion allowing for accurate reporting; improved reporting of participation data to be shared with site and department leadership; notable increase in ownership and accountability by leadership due to more accurate reporting of participation; increased ownership and accountability by leadership due to more accurate reporting of participation; downtime champions programs created; upskilled designated members of every unit to become downtime champions, ensuring they have a deeper knowledge of EHR downtime processes and tools and empowering them to help their units to be more prepared.

The downtime champion programs have been implemented at varied levels of maturity across sites. Steady improvement in downtime readiness has been demonstrated by improved drill participation; improved BCA computer log-ins; and ongoing requests for BCA report refinements, demonstrating continued engagement with these tools.

These informatics-driven efforts increased end user knowledge of the various downtime tools and enhanced downtime readiness, as measured by increased participation in downtime practice drills. The improved education and enhanced metrics reporting, along with heightened leadership and end user engagement, have demonstrated a significant and sustained impact on downtime preparedness within the organization.

Clare Hogwood MHA, RN

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