The Ethics of Service Outages in Electronic Medical Records

Posted on April 29, 2013 I Written By

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

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?