The majority of EHR downtime is due to maintenance and system updates that can be scheduled when they will have the least impact on clinical care. More concerning is unplanned downtime that can last for an unspecified period of time and affect any number of systems.

Unfortunately, unplanned downtimes are more common than we would like to believe. A recent survey of 50 health care institutions found that 96% of them reported at least one unplanned downtime in the three years prior to the survey (Sittig DF, et al. Int J Med Inform. 2014;83:797-804, http://bit.ly/2xSHOAy). More alarming, 70% had at least one unplanned downtime that lasted more than eight hours.

The most concerning consequence of the unavailability of an EHR is the risk to patient safety. In the same study, three institutions reported that one or more patients were injured as a result of a planned or unplanned downtime. Other studies have shown that most errors were because downtime procedures were not in place or not followed.

To mitigate the risk to patients, many institutions have developed toolkits that contain paper copies of clinical documents and procedures to follow when their EHR is not available. Many organizations have access to read-only systems during downtime to help with patient care. However, if these systems are not up to date, there are opportunities for error. Some organizations have a section on an internal website that provides updates on the status of their EHR and resources, including printable copies of paperwork.

Downtime toolkits also should contain instructions on how to use paper documents. We are entering an era when young physicians may go through training without writing a note by hand, much less an order. Even experienced physicians may have forgotten the necessary parts of a prescription if it has been years since they used a paper pad. This is just one example where considering all possible users of a toolkit can help inform contingency planning.

It also is important that all employees are aware of the location of physical and electronic toolkits.

Another significant challenge is identifying that an organization’s EHR is not available and notifying leadership so they can determine a plan of action. If the problem cannot be rectified easily, personnel must be notified that downtime procedures are in place.

One of the most frustrating parts of an unplanned downtime is not knowing how long it will last. Communicating to staff and updating them on the status of the EHR and solutions helps maintain morale and provides an avenue to monitor who needs additional support. Organizations should use multiple methods of communication, including email, websites, secure messaging, phone and fax.

Downtimes are an unavoidable part of health information systems. Using available resources to analyze procedures when your EHR is not available and implementing thoughtful improvements can help minimize the risks to patients and organizations.

Dr. Van Cain is the liaison from the AAP Section on Pediatric Trainees to the Council on Clinical Information Technology Executive Committee.