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Working Offline When Your EHR Isn’t Available

Posted on April 23, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Many of you will likely remember my series of posts on EHR down time: Cost of EHR Down Time, Reasons Your EHR Will Go Down, and SaaS EHR Down Time vs. In House EHR Down Time. Needless to say, it’s pretty much inevitable that sooner or later you’re going to encounter EHR down time. The key to EHR down time is to think ahead about how you’re going to deal with your EHR being inaccessible.

I started thinking about this a bit more when I came across this FAQ item on Practice Fusion’s EMR user forums.

When there’s a planned maintenance ahead:
•Print your daily calendar for the next day’s schedule
•Know your offline alternatives for handling labs and prescriptions
•Have a plan to document your patient visits so you can input them in the EMR later
•Clear out your To do list and complete any pending Rx refill requests the day before
•Update your web browser and Adobe Flash to the current version

Preparing your office:
•Have a prepaid wireless 3G hub or other back-up internet system ready to go in the event your main internet is down
•Use laptops with good batteries and connect computers to surge protectors and battery back-ups for short term power interruptions
•Identify a second location that you could use temporarily in the case of a serious, long-term outage such as a fire or flood

I’ll always remember the reaction of the director of the health center where I first implemented an EMR to the discussion about “What do we do if the EMR is down?” She basically said, “We can still take care of the patient. We just might have to ask a few more questions.”

Now I’m sure there are cases where a physician might choose not to treat a patient without access to their EHR. There are certainly also cases where you can treat a patient better, faster and with more information with an EHR, but those can either be rescheduled if that’s the case. It’s certainly bad customer service and you should employ techniques to minimize EHR downtime as much as possible. My point is that it’s usually not life or death when the EHR is down. Think about how many patients are treated in an ER every day with no access to the patient’s medical record.

With that said, it is a disruption to the clinic and will be a BIG disruption to your clinic if you don’t have a solid plan of attack for when (not if) your EMR is inaccessible.

I’d focus your efforts in two areas:
•Minimize EMR Down Time
•Plan of Action for When Your EMR Goes Down

Most people do a pretty decent job with the first part. The second part people don’t often give much thought. You can start with some of the comments from Practice Fusion above to build out your plan. I also think it’s worth making a plan for short down time versus long down time. It’s quite different to deal with 5 minutes of down time than 5 days. You should consider both options.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 91-95

Posted on July 29, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time for the second entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

95. Background check the vendor’s support team
This is such great advice. You’re guaranteed to have to call your EHR’s support number. You want to know what kind of answer you get. Certainly this can be learned by asking current clients of the EHR vendor. Although, don’t just ask the clients the EHR vendor gives you. Also, be sure to call other users of that EHR system to understand what kind of support they get when they have an issue.

Online forums are also a great place to learn about support. Just be aware that online you’re likely only going to read about the best and worst experiences that people have had with an EHR vendor. Of course, you can also always just give their support number a call and see what happens. Cold calling their support could teach you a lot about the type of service they provide.

94. Ask how the vendor ensures disaster recovery and business continuity
This is particularly important when you’re dealing with a SaaS EHR vendor. Don’t be shy asking them for details of how they’re doing this. In fact, if I were an EHR vendor I’d have a nice detailed explanation of how we’re doing it. If they’re doing it right, they’ll be happy to talk through the details.

If you’re considering a client server based EHR software, then some of this will fall to you and your IT team. However, your IT team can often only implement certain disaster recovery and business continuity features if your EHR vendor supports those features. So, be sure to have a competent IT person look over the EHR vendors capabilities. Plus, you might want to put these capabilities in your EHR contract since they often say one thing about disaster recovery and then deliver another.

93. TRY to use a vendor that actually has standards in their system I find this point from Shawn interesting. My first problem with it is that unfortunately we don’t have great standards in healthcare IT (yet?). However, a few that are easily recognized are HL7 and CCR/CCD. I honestly can’t say I’ve seen any vendor that doesn’t support HL7 though. So, since they all do it, that won’t help you much.

The other side of this coin is the various systems that an EHR vendor uses. Do they use a standard SQL database and a common programming language or do they use a proprietary database and programming language? I’m not sure this should be a complete deal killer, but there is some benefit to choosing an EMR system that uses a standard SQL database. Particularly if we’re talking about a client server EMR system. However, for most people this won’t likely have much impact on them. The only exception being that the language and/or database they use might be an indication of how “legacy” their EHR software is.

92. Google “product name + support forum”
There’s some real value for an EHR vendor to have an online support forum. In some cases, EHR vendors have support forums that are run by a third party. I think we can all see the value in sharing experiences using a specific EHR software with someone else who uses that same software. A lot of learning can happen that way. You’ll be amazed at how creative some people are and how vastly different they might use the same software.

My only problem with some of these third party online forums is that it can often mean that the support from that EHR vendor isn’t very good. Why do I say this? Because if the EHR vendor support was better, people wouldn’t have had to turn to these third party forums to get support. You can usually see if this is the case by browsing the threads of the forum and see how many complain about not getting support from the vendor and so that’s why they found the online forum.

I wouldn’t say an online forum is absolutely essential for an EHR company, but if they have one you should know about it and see what it’s like before you buy.

91. Google “product name + Twitter / Facebook / etc…
It seems that I wouldn’t knock an EHR company as much as Shawn does when it comes to an EHR vendor’s presence on things like Twitter and Facebook. Shawn says that it could be a sign that they’re stuck in the past. While this could be true, it could also just mean that they’ve chosen other forms of marketing that fit their skills and abilities.

While I don’t necessarily count lack of social media presence as a huge minus, it can be a huge plus. Twitter has become a great way for me to get support. For some reason companies like to listen more when I broadcast my need in a public forum. So, EHR companies that listen on the likes of Twitter might be a benefit for you when you’re not getting the support you need. Plus, an EHR vendor’s Twitter, Facebook and blog can tell you a lot about the personality of an EHR company. Something that can be really important in your assessment of the company.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.