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Whiteriver Service Unit

E.H.R. Interim Policy

Contingency Plan for Hardware and/or Network (EHR) Failures

April 2005
March 2005

Review Interval: Annual

Responsible: EHR Team
Folder: Organizational Focused Function
Chapter: Information Management

This Contingency Plan is to establish procedures to ensure that the mission of the
Whiteriver Service Unit can be accomplished in the event of a disruption in services
provided by the Information Technology (IT) department. The plan will provide a
process to reduce the effects of adverse events and provide alternate methods for
delivering critical interim support for EHR/RPMS, notify staff when such an event
occurs, and provide for an expedient recovery process.


1. All WRSU staff using the EHR/RPMS System must be notified when any type
of disruption is occurring or is planned. Disruption of the EHR can have
critical effect on patient care. The type of disruption and the anticipated time
of recovery should be communicated so Department Managers can plan on
necessary actions to take during the disruption. The IRM Staff is responsible
for notifying staff at both the Whiteriver Hospital and Cibecue Health Center
when serious/major disruptions are occurring.
2. A planned system shutdown to repair/maintain the system should be done
only when the outpatient clinic is closed. For planned system shutdowns, staff
at both facilities should be given at least 24 hours notice so that appropriate
planning may be accomplished in the clinic.
If a system shutdown cannot wait until when the clinic is closed, IRM staff
should attempt to wait until either lunchtime, after 1800 or Friday mornings
when use of the EHR/RPMS is minimal. Staff at both facilities should be
given as much advanced notice as possible to allow for proper planning.
3. For all unplanned network disruptions, staff at both facilities should be notified
as quickly as possible so that the proper level of the EHR/RPMS Contingency
plan may be initiated. This notification is very important for efficient, quality
patient care to continue at the health centers involved.
4. All possible efforts must be made so that downtime is kept to a minimum.
5. All staff involved in getting the system up and going again must be available
on a 24-hour basis to assure that recovery happens as quickly as possible.


A. Notification of Disruption in Service
1. When users encounter problems with the computer systems, please notify
IRM by the following:
Clinic Open- Notify IRM personnel via their pagers:
Russell Barker # 367-7818
Richard Cosen # 367-7817
Murray Leslie # 367-7968
Keri Gorman # 367-7817
If no response within 5 minutes, conduct an overhead page for IRM.

After Hours/weekends- Notify IRM personnel per the After Hours IRM
Support Procedure Policy

2. IRM will then perform simple troubleshooting to determine if this is a

hardware problem, software problem, connectivity issue, etc. At that time an
assessment of the degree of disruption will be estimated.
3. Limited software disruptions do not involve the hardware or network. After
IRM has performed the initial troubleshooting and has determined it is an
EHR software issue, the Clinical Applications Coordinator(CAC) will be
a. Phone ext 3624
b. Pager 367-7954
4. Limited hardware or network disruptions do not involve a complete shutdown
of the system and maybe hardware related. The IRM Staff will make every
attempt to eliminate the problem for the user.
a. If deemed a hardware problem and it is not correctable within 15
minutes, a replacement PC will be installed. The IRM department
will keep a minimum of 3 replacement PCs available for
Whiteriver and 1 for the Cibecue Health Center.
b. All incidents of disruption or significant slowing should be reported
to the IRM staff. An EHR trouble log is located on the server and
entries will be made for all reported problems. The EHR log will be
reviewed monthly to monitor trends and then be used to
implement potential solutions.
c. Clinic staff will need to determine if and when it is necessary to
implement the General Clinic Operational Procedure part of this
plan based upon clinic volume and estimated down-time. For
down-times extending greater than 15 minutes, it is expected that
clinic will implement the contingency plan.
5. Serious or major disruption in services will involve some amount of system
downtime. The IRM Staff will notify all departments at both the Whiteriver
Hospital and the Cibecue Health Center. They will announce over the
intercom system that the system will be shutdown or is already down, the

time of the shutdown, and the estimated downtime. This announcement must
occur 3 times so that all persons in various areas of the building(s) have a
chance to hear, i.e. Exam rooms. For Cibecue, the Health Center Director will
be notified and in their absence the Cibecue nursing supervisor should be
notified. In addition, IRM will utilize the EHR Broadcast Feature to notify all
users when there is advanced warning for a complete system shutdown.
This level of disruption will entail an implementation of the General Clinic
Operational Procedure part of this plan.
6. The IRM staff will keep staff informed of progress/anticipated length of

General Clinic Operational Procedure

6. Health Summaries/Face Sheets

a. With an advanced notice of an impending system shut down, every
attempt should be made to generate a Health Summary and/or Face
Sheet for patients that have already checked-in to clinic.
b. The last version of the Face Sheet and Health Summary are available in
the soft chart.
7. Patient Registration
a. The patient will check-in at the front desk with the PBO clerk.
If the patient is presenting as a walk-in visit or for any nonappointment clinic, the clerk generates a File ID Slip, which contains
the name, DOB, chart number, check-in time, and where the patient is
signing up. Patient Registration staff will then periodically deliver
these slips to HIM and the slips serve as the chart request.
It patient is presenting for an appointment, the routing slip is given to
the patient and take the slip to the appointment location. The chart is
already at the appointment clinic location.
b. The PBO clerk will call the appropriate clinic only if the patient is
presenting for a physical and needs lab work.
c. Registration updates will be conducted on paper by the PBO staff.
d. The OPD Clerk will pick up the medical record from HIM and initiate a pcc
form for that visit.
e. Check-in and check-out times will done by handwriting patients name
and chart number as a list in clinic.
f. OPD Clerk will leave previous Health Summaries in the medical record.
OPD RN to review previous patient visits & Health Summary for care and
immunization information as needed.
g. Post Recovery Data-Entry:
Patient updates will be entered by PBO staff
Check-in and Check-out times will be entered by OPD staff
8. Provider Documentation
a. Providers will utilize the PCC form that has been appropriately stamped,
dated and timed by the OPD clerk for visit documentation.
b. Post Recovery Data-Entry:

Provider will write a brief note in EHR for that visit, noting
that a paper note exists, the note Title to be used
will be Paper Note
PCCs will remain in chart and HIM will sort pink copies to
be given to data entry staff
Data entry staff will code all pertinent data into RPMS PCC

9. Laboratory
a. Lab orders must be placed on the appropriate lab requisition form
b. In-house test - Pink requisition (Appendix A)
c. Send-outs - Blue requisition (Appendix B)
d. Addressograph or hand-write patient information on the form
e. Patient will carry requisition to laboratory check-in area
i. If obtaining specimen in clinic, stamp labels with the patient
addressograph noting date, time, initials of personnel ordering
and obtaining specimen and apply to the appropriate lab
f. Results:
i. Results will be picked-up by the respective OPD clerks on a
regular basis
ii. Critical values will be handled per the Critical Value Policy
g. Post-Recovery Data Entry:
i. Orders & results will be entered into the RPMS Lab package
by Lab Staff
10. Radiology
a. Diagnostic imaging orders will be placed on the Diagnostic Imagining

Request form.
b. Addressograph or hand-write patient information on the form.
c. Patient will carry requisition to DMIS check-in area.
d. Results:
i. DMIS will generate hard copied exams for physician viewing in
ii. Patients will return to clinic with hard copies once complete
iii. In the event of the inability to print hard-copies, results will only
be available in DMIS
iv. In the event of complete failure, DMIS will produce exam
results via the chemical method, which will include hard copies
Post-Recovery Data Entry:
i. If chemical processing utilized, digitize all films for entry into
ii. Ensure all exams available in Synpase
iii. All Orders will be entered into RPMS by DMIS staff
11. Immunizations
All immunizations will be deferred.
Patients will be instructed to return to clinic at a later date.


Notification of Reinstatement of EHR/RPMS Service

12. When the system comes back up, the IRM staff is responsible for notifying
staff at both health centers that the system is back up and running, ready for
use. This will be done via overhead announcement at least 3 times so that all
users have the opportunity to hear.
It is crucial that all services using the EHR are notified so that they may get
back on the system to provide quality patient care.



13. The WRSU IT Department:

Respond immediately to notifications concerning disruptions in
service. Utilize all available resources to get the system back to
Bring EHR Log to EHR Committee meeting monthly to discuss each
incident that occurs for the purpose to eliminating problems.
Notify WRSU staff at both facilities concerning any disruption in
operation of EHR/RPMS immediately.
Notify WRSU staff at both facilities of reinstatement of services as
soon as possible.
Be available per IRM Call-back Policy for IT support.
14. The WRSU EHR Committee shall develop and write the EHR Contingency
Plan document, incorporating input from the various users. The committee
Coordinate the development of the WRSU EHR/RPMS Contingency
Provide information and support to the Chief Executive Officer and
WRSU Executive Committee members.
Distribute the EHR/RPMS Contingency Plan to each WRSU
Conduct quarterly testing of the plan and observe its execution.
Evaluate and document the results of the EHR/RPMS Contingency
Plan test.
15. Department Managers shall be responsible for their respective areas of the
WRSU EHR/RPMS Contingency Plan. They shall:
Write the EHR/RPMS Contingency Plan for their respective
operational areas.
Write a Department specific EHR/RPMS Contingency Plan to
incorporate any processes that are department specific.
Activate the EHR/RPMS Contingency Plan when necessary. Have all
necessary hard copy plans, pccs, requisitions etc...readily available for


Update the EHR/RPMS Contingency Plan in response to testing or

other information.

Director of Professional Services

Supv. Computer Specialist

Clinical Application Coordinator