Let's Get Prepared: Implementing an EHR Downtime Preparedness Plan  

Healthcare organizations today are very complex operations that have increasingly become dependent on the use of technology and computerization. Electronic health record (EHR) use is widespread and patient’s health data is accessible through many phases of a patient’s care. There are many advantages associated with having an EHR, which include effective communication and improved patient safety as well as an efficient way to share information between departments and disciplines. However, no system can always run seamlessly, and there will be occasional disruptions in the EHR. This is referred to as an EHR downtime that poses many challenges for clinicians as they try to care for patients without the use of the computer and data available. A downtime event in healthcare is when a machine or a system being used is not functioning correctly or is unavailable to users. Downtimes can be a disruption to all systems or a just a portion of the EHR system and can be classified as either planned or unplanned.

The purpose of this quality improvement project was to have nurses more competent in downtime processes and procedures. This project assessed the impact of training staff on all the tools available to them during a downtime and how to navigate them. This initiative was implemented at an acute care community hospital located in southeast Texas that is a part of a large health system and academic medical center. This project focused on providing education and training of downtime processes with emphasis on tools available during an EHR downtime event. Participants included nurses from two medical surgical units, A-East and B-South, within the organization. Inclusion criteria was any registered nurse working in either department. The project included a pre-survey, roving in-service training, a downtime quick guide overview, distribution of a badge buddy, and a post-survey.

Data from the pre-survey showed that nurses were not fully knowledgeable about downtime processes, procedures, and tools available. 53 nurses participated. Only 5.7% of nurses stated that they had ever participated in downtime education or drills during their time at the organization. 32.1% knew where to locate their departments’ downtime laptop which houses the patient reports generated from the EHR, and only 26.4% knew how to access patient information from the downtime laptop. 24.5% knew where to locate their downtime patient care flowsheets and MD order sheets, respectively, and 30.2% did not know what to do with the paper forms once the EHR is restored from downtime. Nurses, however, were knowledgeable on how to call the IT help desk (90.6%) to report a downtime.

Following training and the distribution of the badge buddy, post-survey results were overwhelmingly favorable with 100% of nurses responding that they knew all 14 of the preparedness knowledge statements. The data provided very strong evidence that education will improve downtime preparedness. This project was simple to implement as was relatively low cost. It can be replicated at other organizations as part of a greater downtime education initiative that would include education to providers and other members of the healthcare delivery team.