The Ethics of Service Outages in Electronic Medical Records

I love my electronic medical record. Life is very different and much more appreciated in the digital, uber-organized, instantly available, anywhere, anytime world of EMRs. Thank the heavens that they are here to save us, both healthcare providers and patients.

However, my particular EMR system has gone out of service twice in the past two months, much to my disappointment. Both times were for, it seems, less than an hour, but extremely painful to live through.  Moreover, since there have been multiple service outages over the past few years, I have gotten more accustomed to the emergency changes that our office needs to take immediately the moment we discover an outage and patients continue to roll in for their visits.

However, it still makes me wonder what ethics might be involved here. On the one hand, occasionally every service might be expected to have outages. Power, water, mail, etc.  Few if any of these services need to run in real time continuously for the protection of people’s lives. However, medical records systems really should run or be available continuously because of the need to make, in real time, medical judgements and plans that affect peoples’ lives.  There is a real problem when medical records are suddenly inaccessible during meetings between healthcare providers and patients.  Obviously, there are differences in the liabilities depending on setting of patients in hospitals and those in outpatient office practices.

I am not a computer programmer and don’t know the possibilities for obtaining backup records immediately (or if this is even possible) when an EMR service fails.  One would think that a backup server/service could be activated, but in our periodic transient cases we have found that this has never happened.  Nothing really “kicks in”.  We simply wait for service to be restored and in the meantime start searching for lab results through our online access to major commercial lab suppliers (i.e. LabCorp, Quest).

Unfortunately, I do not know the solution to this problem, although it seems to be an issue of product development.  In the past it has occurred when new versions of the software were upgraded, but this has not been the case in every instance that we have experienced.  Currently, there are no regulatory agencies that seem to have jurisdiction to police  real-time backup safety requirements for an EMR system, which leaves a big hole regarding liability and responsibility.

I have to wonder how often this occurs for other EMR systems?

About the author

Dr. Michael West

Dr. Michael West

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at


  • Dr West – any reputable EHR vendor must include a way to access a patient’s medical records in case of an emergency. The emergency can be something as benign as losing internet connectivity between your location and the EHR server or a more severe server problem. In any case, the vendor should have a documented plan for getting immediate help when this happens. The practice should have in place a protocol that tests the reliability of the backup system the vendor employs and it should be tested a least once a week if not on a daily basis. Access to your vendor and a proven protocol to enact emergency access will minimize the effect of outages on patient care.

  • Dr. West makes an important point. In the, we ask vendors if they have full backup and recovery for both their database and their application. We also ask about editing audit trails. However, I think we also need to directly address how the system deals with sudden failure.

  • Bob, I completely agree with you. Unfortunately, when our services have gone out, gaps have occurred between 20 minutes up to several hours of time without access to the records. The only feedback we get from the company during the episodes seems to be that they are working on restoring services quickly as possible. Unfortunately, this can really impair the quality of care that our providers can give to patients who have visits during these outage time periods. It’s really frustrating and scares the bejesus out of us every time happens.

  • Carl, your words “sudden failure” are such a key. With the acute nature of medical office visits and their real-time discussions that require immediate access to records, it should ideally be unacceptable for any amount of downtime beyond 5 minutes at a time. My follow up visits are only budgeted at 20 min each (which is actually very generous compared with those of PCPs). I think expectations for EMR companies have to be very high here.

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