Profile EMR Downtime Procedures - Prior, During, and Recovery

Introduction
Downtime Coordination and Reporting
Prepare your site in case of an Unscheduled Downtime
During an Unscheduled Downtime
Prior to a Scheduled Downtime
During a Scheduled Downtime
Appendix 1: Overview of EMR Downtime Preparation Checklist
Appendix 2: Overview of Prior Downtime Activities for Admin and Downtime Coordinator
Appendix 3: Overview of During Downtime Activities for Admin and Clinician
Appendix 4: Overview of After Downtime Activities for Admin and Clinical 

Introduction

This document outlines the procedures for staff to follow in the event of Profile EMR downtime. A downtime refers to the unavailability of the EMR system. It could be a scheduled event (less than 24 hours or greater than 24 hours) or unscheduled. 

Downtime Coordination and Reporting

Each site should designate a representative to act as the Downtime Coordinator. Responsibilities of the  Downtime Coordinator include:

• Ensuring that the clinic’s downtime box has copies of forms for clinical documentation
• Being the point person to communicate with Help Desk
• Helping to communicate the downtime procedures to the staff at your site and checking to ensure that EMR is up and running once the issue is resolved

Prepare your site in case of an Unscheduled Downtime

Refer to the Appendix 1: Overview of EMR Downtime Preparation Checklist for how to ready your site for a downtime.

During an Unscheduled Downtime

Documentation will have to take place outside of EMR, to be entered/transcribed/scanned into the LIVE environment once it is available.

Prior to a Scheduled Downtime

A scheduled downtime occurs when Profile EMR is made temporarily unavailable in order to complete technical work on the system such as an upgrade.

Documentation will have to take place outside of EMR, to be entered/transcribed/scanned into the LIVE environment once it is available.

Prior to the scheduled downtime, all teams affected will receive notification of the downtime by email detailing when EMR is unavailable.  Also, an EMR Headline will be sent as a reminder with 30, 10 and 5 minute warnings to log out. If you are logged in past this time, you will be automatically logged out and will lose any unsaved documentation. 

Refer to Appendix 2: Overview of Prior Downtime Activities

During a Scheduled Downtime

Scheduled Downtime (less than 24 hours in duration)

During this time there will be no access to any EMR environment. Documentation will be on paper. The EMR team will attempt to have this work completed overnight, when there are only minimal users on EMR.

Extended Downtime (close to or greater than 24 hours in duration)

There is a Profile EMR Downtime Environment available for long scheduled downtimes (typically greater than 24 hours) rather than for short scheduled downtimes (less than 24 hours) and consists of a read-only copy of the Live environment. You will not be able to go to CareConnect or MediNet using the toolbar icons in Profile EMR during downtime.  

To access the EMR Downtime Environment, sign into Citrix Portal, click on the IntraHealth folder, and click on the VCH PHC EMR – Downtime icon.

Refer to Appendix 3: Overview of During Downtime Admin and Clinical Activities

After a Scheduled or Unscheduled Downtime

• All EMR users will receive an email once the downtime is complete
• You can log into EMR as you normally would
• Documentation completed during downtime is to be entered/transcribed/scanned into the EMR 

The objective is to have all the information entered into EMR as soon as possible, ideally within 24 hours following downtime recovery.

Refer Appendix 4: Overview of After Downtime Admin and Clinical Activities 

Appendix 1: Overview of EMR Downtime Preparation Checklist

Every effort has been made to avoid a downtime of the EMR system, however in the event that a downtime does occur, each site must be prepared. This is similar to disaster planning and preparedness for your site. The following guide is a checklist to help with your downtime preparation:

☐ Select an EMR Downtime Coordinator for your site

Responsibilities include:

• Completing the steps listed in this Downtime Preparation Checklist
• Updating the downtime information for your site on a regular basis
• Acting as the primary contact person for Profile EMR Help Desk during a downtime. For example, assisting the EMR Help Desk in determining a problem, communicating the downtime procedures to the staff at your site, and checking to ensure that EMR is up and running once EMR Help Desk has completed any work.

☐ Create an EMR Downtime Box for your site and keep in a central, easily accessible area. Contents should include:

• Blank copies of Client Sign-in sheets, see: Profile EMR Downtime Forms (Admin & Clinical)
• Blank copies of SOAP Encounter Note, see: Profile EMR Downtime Forms (Admin & Clinical)
• Blank copies to Community Risk Screener, see: Profile EMR Downtime Forms (Admin & Clinical)
• Prescription pads
• Paper encounter notes
• Paper copies of lab requisitions
• Paper requisitions for ultrasound, x-ray, etc.
• Blank client label stickers
• Paper copies of frequently used forms

Reserve the contents of the EMR Downtime Box for downtime procedures ONLY

☐ Place a copy of the downtime procedures in the box

• The downtime procedures describe what to do prior to, during, and following a downtime of the EMR system. 

☐ File copies of all the paper downtime forms for your program area

• Blank forms have been created to help capture the information that would normally be entered into EMR, such as scheduling, activity recording, and clinical functions.

☐ Review the EMR Downtime procedures with staff at your site on a regular basis

☐ Annually - update your site's downtime information (procedures and paper downtime forms) in your EMR Downtime Box and review downtime procedures with staff

Appendix 2: Overview of Prior Downtime Activities for Admin and Downtime Coordinator

Activity	Prior to the Downtime	Who
Notification	Print and post a downtime notice near each workstation	Downtime Coordinator
Downtime Preparation	Ensure Downtime Procedure Box is updated with relevant contents	Downtime Coordinator
Appointments	Print day sheets for booked appointments	Admin Support

Appendix 3: Overview of During Downtime Activities for Admin and Clinician

Activity	Manual Steps	Who
Registration	If Client Registration via PARIS was part of your workflow, enter information in PARIS, and bring client over into EMR once it is available	Admin
Scheduling, Walk–ins	For a scheduled downtime, use the printed day sheets to mark clients as they arrive For an unscheduled downtime, or clients without a booked appointment, manually enter client info on the Sign Up sheet for Scheduling and Walk-ins Keep a copy of the sheet to enter into EMR when available	Admin

Activity	Manual Steps	Who
Encounter Notes Prescriptions Requisitions	Whether or not the downtime environment is available, enter info onto Downtime Forms: (e.g. SOAP Encounter Note, Community Risk Screen, etc.), to be transcribed into EMR when it is available. Use paper Rx forms, paper requisitions and other forms from the Downtime Box If the Downtime environment is available, it is read-only.	Clinical
CareConnect & PharmaNet	Log into CareConnect to search for a specific client’s lab results. To access CareConnect, click on the CareConnect icon in your Citrix Portal.  Log into MediNet to search for a specific client’s PharmaNet profile. To access MediNet, go to https://medinet.ca/.  Log into Pixalere to search for a specific client's wound care profile in Pixalere. Results may also be available for review in the Downtime environment, but cannot be signed or annotated Please note that you will need the applicable login and password for each system.	Clinical

Appendix 4: Overview of After Downtime Activities for Admin and Clinical 

All information should be entered into Profile EMR as soon as possible following a downtime period. Documentation must be completed by the appropriate staff member to ensure accuracy and prevent errors.

Administrative Responsibilities

• Scheduling & Walk-Ins
  • Enter all data from Sign-Up sheets into EMR.
• Visit Information
  • Enter all visit details from Downtime Forms (e.g., SOAP Encounter Note, Community Risk Screen).
  • Scan and sign off paper documents during import, if applicable.

Clinical Responsibilities

• Active Problems, Service Codes, Diagnosis Codes, Referrals, Recalls
  • Enter all relevant data from Downtime Forms.
  • In a New Encounter, title the first contact as “Late Entry”.
  • See User Help File: Late Entry for entering actual date/time of the client encounter.
  • Note what documentation was completed during downtime that is being scanned to the client record
• Prescriptions
  • Enter prescription information from photocopies or Downtime Forms directly into the Scripts Module.
  • Add to Usual Scripts as needed.
  • Scan Controlled Prescription Forms into EMR
• Lab Results
  • Annotate and/or sign-off paper lab results if necessary.
  • For printed results, scan and sign before import if the clinician has already signed off.