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Recently, we came across a funny healthcare tweet — which sounds like an oxymoron, I know, but bear with me. It came from the user @DrGlaucomflecken, an ophthalmologist and comedian. He was sharing a TikTok video he made about what happens when a hospital EHR system goes down.

In it, a doctor in hospital scrubs is sitting at a monitor, wondering how staff will be able to write patient notes without the ability to enter them electronically. In strolls, a “50-year-old attending” physician, also played by Dr. G. In his hands are a clipboard and a pen. He clicks the button on the pen and proceeds to jot down notes while keeping his eyes fixed on the younger, and presumably more tech-savvy, doctor, then tosses the clipboard over to him, hitting him in the face.

When we see what the older doctor has written, we can make out only the words “Progress Notes” at the top. Everything else is completely illegible.

If you’ve ever received written instructions or a prescription from a doctor with poor handwriting, you can relate. But the video hints at a far more serious issue: What do nurses, medical technicians and doctors actually do when electronic systems get knocked offline? How are they supposed to interpret a doctor’s notoriously sloppy, hand-scribbled notes, assuming they remembered to leave them at all? And how will they transcribe them into the EHR once access is restored?

In other words, what are the practical ramifications of a systems downtime for patient care? How is healthcare quality affected when clinical staff are scrambling to adjust their workflows to revert to printed copies of patient records and other information?

‘Awkward, rarely used protocols’

This was one area of focus in a recent panel discussion Interbit hosted with two leading nurse technology leaders.

“Unplanned downtimes create very chaotic environments where clinicians — nurses specifically — have to resort to these very awkward, very rarely used protocols,” said Grace Jaime, RN, MBA, regional leader of the healthcare practice at Cognizant and one of the panelists. “And I think the biggest impact to patient experience and also to the care team is they’re spending a lot of time in the EHR.”

“During the documentation process,” she continued, “you have clinical decision support. In a downtime that goes away. In a downtime, the ability to understand the patient story across the episode of care, that also goes away. So the patient story becomes fragmented. What we’re left with is clinicians really trying to work with retrospective entry of information and really trying to piece together that patient’s story.”

And that adds up to loads of work, as one doctor told Bloomberg about what it was like at a hospital in Oregon that was hit with ransomware and had to resort to paper records. “The increased workload is astronomical for all hospital employees and will inevitably have an impact on patient care,” he said.

Downtimes are almost inevitable

Downtimes happen frequently in hospitals. It’s not just cyberattacks that disable entire hospital systems and render networks useless, although those have been on the rise. They can be much more localized, affecting only certain departments, wings or towers.

They can result from either a planned event, like a server migration or software update or from an unplanned downtime, like a power outage, a natural disaster, or when a cable is accidentally cut by construction workers.
While recovery is clearly important — you need to get your electronic systems back up and running as soon as possible to minimize business disruptions and risks to patient care and safety — clearly, it isn’t enough. You need a well-articulated contingency plan for what to do when your normal systems are knocked offline.

Consider the issues with two common downtime strategies:

Paper records — Printing copies of records and distributing them to caregivers is both time-consuming and expensive, in terms of printer wear and tear, paper, and other supplies. Plus, will clinical providers get the information in time to help patients? What if the paper records get mixed up or misplaced? It can take a long time to find something buried in a stack of papers.

Redundancy/backups — This involves duplicating the same data, through frequent backups or other means, yet it doesn’t always mean that users have access to the information. Worse, in the case of a cyberattack, backups may in fact be duplicating the malware, which typically gets deposited in a system and spends time spreading through the network only to be triggered at a later date. This means you could be infected long before you know it, and bringing the system back up requires a deep dive to make sure it’s free and clear of any viruses.

Auditors expect hospitals to have a disaster recovery plan and a contingency practice to restore access to data on a timely basis. But you still need to care for the patients who are already in your hospital and the steady stream showing up for care.

You need a plan in place to care for patients seamlessly in any event.

Interbit Data provides data transmission and downtime access solutions to healthcare organizations. Speak to an expert to learn about mitigating downtime risks.

If you have questions about cybersecurity solutions or how you can mitigate risk at your healthcare organization, contact us any time. We’d love to hear from you.

Arthur Young

Arthur Young is a visionary healthcare information systems entrepreneur who has focused Interbit Data’s offerings on providing secure and reliable methods of connecting users with HCIS information. Prior to founding Medical Systems Solutions (the precursor to Interbit Data) in 1997, Arthur spent 10 years with MEDITECH and three years at JJWild.