EHRs are going to crash and go offline from time to time. But are physicians and hospitals prepared to deal with the fallout when this happens? The answer seems to be “maybe.”
Of course, physicians and hospitals have plenty of reasons to avoid EHR downtime.
For one thing, EHR crashes can have a major impact on care delivery. After all, without EHRs, physicians may have no access to patient data, which could lead to care complications or adverse events.
Also, downtime adds addition pain (and expense) to the situation. According to one estimate, unplanned system failures can cost $634 per physician per hour. Meanwhile, according to Dean Sitting of the University of Texas, a large hospital may lose as much as $1 million per hour when their EHR is down. Those are scary numbers.
Unfortunately, despite the costs, strain to the hospital operations and consumer complaints arising from downtime, many hospitals refuse to invest in preventive technologies such as a backup data center, arguing that they’re just too expensive. As a result, hospitals can be offline for a long time when their EHR system crashes, which typically has a nasty ripple effect.
One example of how EHR downtime affects hospital operations comes from Sutter Health, the largest health system in northern California, whose EHR went offline for more than 24 hours in May. The crash took place when a fire-suppression system was activated in the system’s data center.
During the shutdown, Sutter hospitals followed a series of steps often used by its peers, such as cutting elective surgeries, transporting patients to other hospitals and discharging patients who weren’t very sick. They also switched over to paper records. But despite these efforts, Sutter still faced some problems that weren’t addressed by its plans.
For one thing, younger doctors were thrown a curve ball, as many had never worked with paper charts. This alone gummed up the works during the downtime episode. There were no signs that these doctors made any mistakes due to using paper records, but the risk was there.
Then there were the effects on patients – and some were ugly. For example, when Santa Clara resident Susan Harkema’s father died, she called Sutter Health’s Hospital of the Valley to arrange for removal of his body to a crematorium. According to a story appearing in San Jose Mercury News, Harkema tried a hotline and backup numbers but couldn’t reach anyone due to the outage. It took 8 hours for a hospice nurse to arrive and collect the body, the newspaper reported.
Another patient tweeted that they had to go out of the Sutter system for critical care, which left the treating physicians without care history to review. “It was stressful and scary, and we still aren’t sure we have a successful outcome,” they said.
The net of all of this seems to be that hospital downtime policies could use more than a few tweaks, and more importantly, a better failsafe protecting EHRs from going offline in the first place. Sure, no EHR system is perfect, and crashes are inevitable, but providers can be better prepared.