Friday, June 5, 2015
When your system has an outage and you have to resort to paper
The more we computerize our work, the more difficult it will be to recovery from unanticipated down times. In a hospital situation for example, when your system goes down, every task done on the computer goes into manual “paper” mode. Work is done and forms are used. At some point when the system is back up, you have to deal with the pile of paper that accumulated during the outage. This paper pile could consist of notes, orders, assignments, referrals, medication list, etc. What do you do with this stuff?
Everyone plans to recovery, but the real question will it go as planned? Did everyone follow the downtime documentation procedures accurately? For example, was the account number written on the form? Can barcodes be printed after the outage?
Automated scanning with barcodes for indexing paper can be a life saver, however with an outage there no barcodes, which can be a major hassle from which to recover. Also, what if the accounts are still caught up in the content management system?
If you have an automated workflow for coding diagnoses or approving invoices, is there a paper alternative for this, or do you just go home?
To recover a system by back loading information from paper, it might take a temporary surge of contractors. This unexpected budget hit should be noted as a risk in your outage plan.
Sometimes during an outage, only one system is down, leaving up or downstream systems running. Users could go about their normal routines without knowing for a while. Data entry could get queued up as the integration is broken. So, one process is using paper and another one is still using a computer. When the outage is over, some data might have been corrupted. For example, a patient is registered and is being seen by a nurse. The nurse fills out the patient’s drug allergies on a paper form. The patient goes in for surgery and is recovery. A physician checks the EMR for allergies and sees none. The paper form for allergies is in the chart, but the physician assumes the system is up-to-date…
Chances are good that the downtime procedures cover what should happen and are in compliance with the auditors, however when your system goes down and the paper comes out there are many more chances of mistakes. Of course the answer is a plan for system redundancy, however, this comes at a hefty prices that not every hospital or entity can justify.