110-16 Downtime Event and Notification Procedures for Computing Systems

Category: 
Administration
Sub-Category: 
IT & Communications
Subject: 
Downtime Event and Notification Procedures for Computing Systems
Policy Number: 
110-16
Effective Date: 
November, 2014
Next Review Date: 
November, 2016
Responsible Manager(s): 
Clinic Support Services Director
Information Systems Manager
Purpose: 

To describe notification steps and procedures to be followed during and after a planned or unplanned service outage of clinical information systems. 

Policy: 

In the event of a planned or unplanned service outage of clinical information systems, staff are notified and downtime event procedures are put into place. This policy explains how staff are notified of the outage, and describes the procedures to follow after notification is made.  The Clinic Support Services Director in consultation with the Information Systems Group (ISG) and the Clinic Manager determine as soon as possible when downtime event procedures start. Planned service outages are schedule by the Information Systems Group Manager. This policy applies whenever Student Health and Counseling Services (SHCS) computing services or the local area network become unavailable.

Procedure: 
  1. Notification
    1. Information Systems Group (ISG)
      1. In the event of an unplanned service outage ISG communicates to the Clinic Manager about which services are affected and provides an estimate, when possible, as to when the service will no longer be degraded. ISG may also make notifications to affected staff/locations directly as needed.
      2. In then event of a planned service outage ISG will notify by email all SHCS staff, or a subset of staff if the scope of the outage is limited, at least 24 hours prior to the outage.
    2. Clinic Manager
      1. In the event of an unplanned service outage, ISG notifies Urgent Care registration or the North Hall Receptionist and instructs them to make overhead announcements and/or staff notification related to the service disruption.  Announcements and/or notifications are clearly provided to Registration and Reception staff and must include the affected computing service, instruction on use of service, and if known, an estimated duration of disruption. 
      2. When the problem has been remedied, the Urgent Care registration staff or North Hall receptionist is notified to make an overhead announcement and/or notification stating the problem(s) have been resolved.
    3. Urgent Care Registration/North Hall Receptionist
      1. Makes overhead announcements/staff communication as directed by either ISG. 
      2. Announcement/staff notification must contain the affected service name, type of disruption (degradation or system unavailable), and instruction to staff (log off system or may continue using system if available).
      3. Announcements are to be repeated as directed from ISG.
    4. SHCS Staff Responsibilities
      1. Follow instructions from overhead announcement or applicable notification.
      2. Staff should switch to alternate procedures for conducting business, as directed.
      3. During the course of one of these situations, staff refrains from calling the Help Desk, unless other systems experience problems. Upon notification, the following procedures are enacted during downtime event.
  2. Event Procedures (for situations where the EHR system (PnC) or other systems are unavailable but the facility electrical system is functioning)
    1. All Medical Clinics
      1. Registration staff manually check-in patients arriving for scheduled appointments.  MA, in consultation with the provider, determines which patients are seen on an individual basis, i.e., no EHR info is available for the appointment, may need to reschedule.
      2. Staff document visit on paper forms: clinic note sheets, Lab, Radiology, and Referral paper order forms.
      3. Providers will not be able to provide patients with lab results.
      4. Point of Care Tests: MD, NP, RN, or MA fill out paper form, forward form with chart notes to Clinic Support Services Director for entry of POC order for accession.
      5. Providers write Rx on paper Rx pad.
      6. Medical Assistant staff, along with Registration staff are responsible for keeping an ample supply of downtime forms available in their areas.
      7. All forms for the visit are stapled together and forwarded to the Registration Supervisor
    2. Advice/Triage
      1. Registration staff initiates a paper charge form.
      2. Advice/Triage nurses in conjunction with the Clinic Support Services Director determine whether or not to continue phone advice function during downtime event.
      3. Advice/Triage nurses use paper Advice/Triage Nurse Record Form.
        1. Triage forwards Advice/Triage Nurse Record Form and the paper charge form (when applicable) to Urgent Care for any patients sent to Urgent Care.
        2. Self-care patient forms are forwarded to the Registration Supervisor.
        3. Triage and Advice nurses do not schedule appointments.
    3. Urgent Care/Same Day
      1. If possible, Registration staff prints screen shots of the urgent care clinic schedule.  Registration initiates a paper charge form for any patients triaged to UC via phone.
      2. Staff document visit on paper forms: clinic note sheets and Lab, Radiology, and Referral paper order forms.
      3. Providers will not be able to provide patients with lab results.
      4. Point of Care Tests: MD, NP, RN, or MA fill out paper form and forward form with visit notes to the Clinic Support Services Director for entry of POC order for accession.
      5. Providers write Rx on paper Rx pad.
      6. Medical Assistant staff along with Registration staff are responsible for keeping an ample supply of downtime forms in their areas.
      7. All forms for the visit are stapled together and forwarded to the Registration Supervisor.
    4. Appointments
      1. No appointments are scheduled.
      2. Patients are asked to call back to schedule an appointment.
    5. Pharmacy
      1. If the Pharmacy Information System is unavailable and PnC is unavailable:
        1. No prescriptions are filled at SHCS Pharmacy. 
        2. Clinics are notified of the problem and providers use paper prescription pads. Patients/clients can fill scripts at outside pharmacies or come back to our pharmacy when Pharmacy Information System is available.
      2. If Pharmacy Information System is available and PnC is unavailable:
        1. Providers use paper prescription pads.
        2. Pharmacy fills the scripts from the paper prescription pads instead of PnC generated scripts.
      3. If Pharmacy Information System is unavailable and PnC is available:
        1. No prescriptions are filled at our SHCS Pharmacy.
        2. Clinics are notified of the problem and providers print scripts locally, sign, and give to patient.
        3. Patients can fill scripts at outside pharmacies or come back to our pharmacy later.
    6. Clinical Lab
      1. If the Laboratory Information System (LIS) is unavailable and PnC is unavailable:
        1. Providers are notified that the LIS is unavailable and only urgent or stat testing is done in lab.  Lab will have limited ability to perform these tests.
        2. Providers order urgent tests on paper lab order forms that go directly to lab.
        3. Lab staff performs tests without the LIS.
        4. Lab staff print results from instruments and distribute to providers. Lab staff provides Lab Registration with copies of results to scan into the test after the order is placed by the Clinic Support Services Director.
        5. Lab hold as pending any non-urgent lab orders. These paper orders are sent to the Registration Supervisor after downtime for entry as order in the visit note.
      2. If the LIS is available and PnC is unavailable:
        1. Providers are notified that Harvest is available and they enter Lab orders on paper lab order forms.
        2. Lab enters order directly into Harvest from paper lab order form.
        3. If a test in the LIS has a result to send back to PnC, without PnC order, PnC automatically issues an accession so that the result can go to PnC as “unsolicited accession”.  This unsolicited accession does not generate a charge.  
        4. Lab forwards a copy of the lab order form to the Registration Supervisor. The Registration Supervisor enters the lab order as part of the visit note after downtime with accession comment explaining results are on unsolicited accession.  The accession of the order generates a charge.
      3. If the the LIS is unavailable and PnC is available:
        1. Providers are notified that Harvest is unavailable and only urgent or stat testing is done in lab. Lab will have limited ability to perform these tests.
        2. Providers order lab tests in PnC as usual.
        3. Lab staff performs tests without Harvest.
        4. Lab staff print results from instruments and distribute to providers. Lab staff provides the Registration Supervisor with copies of this to scan into the EHR.
        5. Lab hold as pending any non-urgent lab orders. These paper orders are sent to the Registration Supervisor after downtime for entry as an order in the visit note.
      4. If the LIS is available and PnC is available to Lab but PnC is not available to providers:
        1. Providers are notified that Harvest is available and they enter Lab orders on paper lab order forms.
        2. Lab staff enters order into PnC from paper lab order form and proceed as usual.
        3. Lab staff prints stat results and distribute as usual.
    7. Radiology 
      1. If the local Radiology system and Stentor are available but PnC is unavailable:
        1. Providers request X-ray orders on paper.
        2. Radiology staff checks in the local Radiology system to see if the patient has a medical record number. If not, Radiology staff manually creates a temporary MRN that will not duplicate a PnC MRN. Start with D999999 and work backwards.
        3. When system is back up Radiology staff issues a PnC MRN and change IDX/Stentor systems to match the PNC MRN.
      2. If the local Radiology system and/or Stentor are unavailable, but PnC is available:
        1. Images can be ordered in PnC, but images will not be acquired.
    8. CAPS Clinic and North Hall
      1. Registration staff does a manual check-in of clients arriving for scheduled appointments or drop-in. 
      2. Providers document the visit on the paper downtime form.
      3. Providers who prescribe write RX on an RX pad.
      4. Registration staff are responsible for keeping a supply of downtime forms available in their area.
      5. All forms for the visit are stapled together and forwarded to the Registration Supervisor.
  3. Recovery Procedures Following Downtime Event
    1. The Clinic Support Services Director or designee documents visits.
    2. All Clinics
      1. The appointment status is updated for each patient/client seen.  Patients/clients are manually checked-in, generating a charge ticket and encounter note. Appointments are scheduled and manually checked-in for both triage and urgent care visits.
      2. Documentation of the visit is entered into PnC using the “Downtime template”.  Orders are entered through the encounter note, along with the level of service and diagnosis codes.  All visit forms; treatment sheets, questionnaires, case notes, medical visit notes, POC Labs, and referral order forms are scanned directly into the PnC downtime template.
      3. Charges are generated based on coding from within the encounter note.  Lab and radiology charges are generated when the order is accessioned.
      4. Procedures, injections, and immunizations are entered into the PnC encounter note for appropriate charges and population of the EHR. 
      5. Completed encounter documentation and scanning are sent to provider for signature.
    3. Clinical Lab Entry of Lab Orders and Charges
      1. The LIS i(Harvest) s unavailable and PnC is unavailable:
        1. All lab orders are entered into PnC via the encounter note. 
        2. Lab staff accession orders in PnC, generating a charge, and an order sent to the LIS. 
        3. Tests are performed and transmitted back to PnC as usual. 
      2. The LIS (Harvest) is unavailable and PnC is available:
        1. Only STAT lab tests were performed.
        2. All orders are entered in PnC as usual.
        3. Results for STAT labs are manually entered into the LIS and transmitted to PnC. If unable to transmit, results are scanned into PnC and associated with the correct order.
        4. Routine test ordered in PnC are accessioned and performed when the patient returns. 
      3. The LIS (Harvest) is available and PnC is unavailable:
        1. Lab orders are entered into PnC via the encounter note.
        2. Results sent from the LIS to PnC during the time PnC was down, generate an unsolicited accession.  The unsolicited accession does not create a charge to the student. 
        3. Lab orders with results transmitted to PnC via an unsolicited accession are accessioned for billing purposes with a comment in the result field referencing the system down and that the result is on an unsolicited accession. 
    4. Point of Care Testing:
      1. The POC lab order is entered via the encounter note. 
      2. The order is accessioned with a comment stating the system was down.
      3. POC results are entered into PnC as usual with all paper documentation scanned with the lab order.
      4. The ordering provider acknowledges, electronically, all POC results in PnC.
    5. Pharmacy
      1. Pharmacy staff assures all hand written prescriptions are entered in PnC. 
    6. Radiology 
      1. For patients with no Medical Record number, Radiology staff auto-generate a medical record number in PnC. 
      2. Radiology staff enters/corrects the PnC medical record number in the radiology system. 
      3. All Radiology orders are entered in PnC via the encounter note. 
      4. Radiology staff accession orders that were taken during the system down, and enter a comment indicating the system was down.
      5. Radiology results are scanned into the order as usual.
Originated: 
February, 2003
Supersedes: 
January, 2012