Despite every hospital and health system’s efforts to deliver high-quality, efficient care and keep business operations running smoothly at all times, healthcare information system (HCIS) downtimes inevitably occur. Sometimes these are planned (routine maintenance, updating of systems, or switching from one EHR to another) and sometimes they are unplanned (power outages, natural disasters, system malfunctions, or cyberattacks). The most frequent downtime occurrences are local rather than global – for example, power or internet outages that affect only one particular unit or offsite location, or even just one floor of a hospital.
Regardless how isolated or widespread a downtime may be, if a health system isn’t equipped with the right plan and the right technology to carry on operations when downtimes occur, the costs – both for patient outcomes and overall business – can be substantial. Following are the key impacts of downtimes that are often overlooked by hospital leaders.
Patient safety – If your HCIS is not up and running, physicians, nurses, and other care providers may not have access to the most up-to-date information they need to make real-time treatment decisions. Current medications, allergies, and most recent lab results may not be accessible, which could lead to incorrect and potentially dangerous treatment decisions. For many patients in ER departments or those who have been admitted, even the smallest delay in care can make a big difference in terms of outcomes (and consequently, in long-term healthcare costs). For example, one study published in the Journal of the American Medical Informatics Association (JAMIA) found that, over a three-year period, one health system reported 76 incidents of safety risks relating to downtime (including planned downtime). Lack of continuity of patient identification throughout lab testing processes was the biggest concern. As Healthcare IT News reported, study authors said, “Across the clinical domains and categories, patient identification and tracking of patient information were common areas for concern. EHRs are the primary platform for tracking patients and their associated clinical information, and without these capabilities, clinicians face difficulties.”
Inefficient use of resources – As an article from the AMA Annual Proceedings Archive notes, “Significant costs are incurred by system downtimes, due to additional personnel that must be called upon, inefficient paper-based downtime procedures, and data entry that must be performed once the system resumes operations.” HCIS downtimes mean that staff are spending more time than usual to retrieve patient information, communicate with other departments (such as lab, radiology, etc.), and make updates as patient care continues. This can mean that staff – from clinicians to administrators – are diverted away from their usual responsibilities, which will result in scrambling to catch up on tasks once the system is up and running again, as well as the possible need to pay employees for overtime. The health system may even need to bring on additional personnel to help carry the burden. All of this resource diversion can add up and negatively impact the bottom line.
Canceled procedures – The reality of system downtimes is that they often result in delayed or canceled procedures, which can be dangerous for patients. When Hackensack Meridian Health, a 17-hospital system in New Jersey, fell victim to a ransomware attack that brought down the entire system’s computer network for two days in December 2019, it resulted in the cancelation of about 100 surgical and other procedures, according to The Wall Street Journal. “This episode, as well as the growing number of cyberattacks on other healthcare organizations, businesses, municipalities, universities and other entities makes it clear that even the best preparation may not prevent a successful attack,” Hackensack Meridian said in a statement.
Diminished patient satisfaction/damaged reputation – Public opinion can make or break any business, and this is truer in healthcare today than it’s ever been before. With healthcare options ranging from primary care offices to urgent care to popup clinics within pharmacies, patients now realize they have a choice in where they receive care. This increased choice, combined with the ease of sharing positive and negative experience via social media, means that when patients are not satisfied, they will let you (and the rest of your potential customers) know. And while your staff may be doing their very best during a system downtime to maintain the quality of care for each individual patient, any perceived lapse (such as late medications or postponed or canceled procedures) is likely to be made public and can impact your reputation. According to one study from the Journal of Cutaneous and Aesthetic Surgery, “If we satisfy one customer, the information reaches four others. If we alienate one customer, it spreads to 10, or even more if the problem is serious.” The article also estimates that the loss of one patient due to dissatisfaction “can result in the loss of over $200,000 in income over the lifetime of the practice.” With CMS having just released its latest Hospital Compare Star Ratings in January 2020, and an update to the methodology behind the ratings planned for 2021, patient satisfaction is more important than ever.
As the previously mentioned AMA article notes, “Understanding and quantifying the costs incurred when an information system fails to function properly is essential to determine the value of investing in fault-tolerant systems with built-in redundancy.”
Alarmingly, the JAMIA study referenced earlier found that in nearly half of the patient safety events, downtime procedures were either not in place or not followed. “Few provider organizations practice their downtime procedures or assess their ability to safely and effectively deliver care during EHR downtime,” the authors said. “Without downtime procedure practice, gap analysis and iterative development of more robust downtime procedures, major safety hazards will persist.”
When you factor in all costs (both outcomes- and business-related) mentioned here, as well as the potential resulting downstream healthcare costs, it becomes clear that you can’t afford to be unprepared.
To learn more about how to prepare your health system for those inevitable downtimes, request a demo today.
