The EHR Downtime Task Force—convened under the auspices of the AMC PSO—brought together information technology, emergency preparedness, risk management, and patient safety experts to develop guidelines to address the patient safety considerations that arise when EHR systems are unexpectedly unavailable.

While the guidelines are geared toward organizational leaders, here are the highlights for clinicians.

Participate in drills.

  • If a drill is not conducted for one of your usual shifts, connect with your organization’s EHR downtime team. Not only should all clinicians participate in a drill, but drills should cover a variety of times and locations to ensure that a robust plan covering all contingencies is developed.
  • Be mindful of which inter-system dependencies may no longer be reliable during a downtime event, e.g., Lab-Pharmacy or CPOE-decision support, and the impact this will have on your practice.

Know who calls the shots, and how you’ll know what’s going on.

  • Avoid confusion by knowing the process—who makes the decision and how it’s communicated—for activating an EHR downtime situation.

Talk about it—appropriately.

  • Participate in huddles to ensure you’re up to speed with the current situation, and to efficiently share patient care-related information.
  • Communicate with and update families early and often. Reassure them that patient care is being supported via the downtime plan.
  • Share any concerns you may have appropriately, e.g., with your colleagues and the EHR downtime team; don’t share your frustrations through social media.

Use paper forms safely.

  • Transfer paper forms with a warm, verbal handoff.
  • When appropriate, have your peers manually verify orders and calculations, and do the same for them.
  • If you have experience with paper charting, mentor your colleagues who don’t.

Take care of yourself.

  • Extra work will be required. If you get to the point of feeling overwhelmed or burned out, inform your EHR downtime team: they may be able to assign resources to assist you.

It’s not over for you until it’s over for everyone.

  • Until the “all clear” is given, assume that not everyone has access to complete patient information. Restoring the EHR system(s), reconciling information among those systems, and entering information from paper forms is time consuming and can’t happen all at once. You may find yourself in a downtime “twilight” while system recovery is underway, during which some systems or departments may be restored before others.

The complete EHR Downtime Guidelines are available here.

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