CHEYENNE REGIONAL MEDICAL CENTER AREA: TITLE: TrueConnect Downtime/Recovery Procedure. Page 1 of 1 NUMBER: ADMIN-IM-32 ORIGINATOR: CMIO

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1 ORIGINATOR: CMIO Page 1 of 1 POLICY APPLIES TO: Cheyenne Regional APPROVED BY: CEO: COO: CHRO: CNO: CMIO: REVISION DATE: N/A new policy EFFECTIVE DATE: March 2013 POLICY REVIEW COMMITTEE (PRC) REVIEW DATE: February 2013 POLICY To ensure provision of patient care during Epic downtime, to include maintaining an accurate legal medical document of care provided. PURPOSE This policy is to assure a process for Epic planned and unplanned downtime to provide continuity of care and disaster recovery. Staff that provides patient care are responsible for ordering tests, documentation of care, and billing of procedures during this downtime. Notification: Planned Downtime: PROCEDURE o There will be a monthly downtime slot reserved the second Wed of the month from 1-3AM. o This downtime will only occur when there are updates to be made. o All staff will be ed 3 days prior to downtime then again the same day of downtime. Information Technology will notify Administrative Representative and Operators the day of downtime. o A Lynx Alert will be sent 15 minutes before downtime to begin and again 2 minutes before going down. Unplanned Notification: o Staff that recognizes a problem will call 7171 to report it. This will be analyzed and triaged to the right analyst on call to review. o A Lynx message will be sent immediately when identified that all or part of Epic is

2 Page 2 of 2 Process: down. o The Administrative Representative and Operators will be notified. o The Analyst will be called to evaluate the issue and begin resolving. The Analyst will notify the appropriate IT manager who will notify the Executive on call if the issue cannot be resolved in that first half hour to discuss solutions available. o A Lynx Alert will be sent when the system is back on line. BCA_PC and BCA Web (Business Continuity PC and Business Continuity Web): BCA_PC and BCA Web-These are solutions available for reports if we have backup power. The BCA_Web will also require the intranet. They are distributed throughout the organization. They will contain basic reports that have current information that may be needed during the downtime. These reports are run on a schedule to keep them updated to current information. The reports time of refreshing will vary with the type of report data. The BCA_PC will be labeled for clear identification. Documentation on how to access these solutions will be laminated beside the BCA_PC. Registration: When the patient comes in, a downtime face sheet will be created with as much information as possible. The downtime account # will be given to this patient and labels will be created on the Stand Alone Label program. One of these labels will be put on the armband. On recovery, records will be updated in this order: 1. ER Patients transferred to a bed 2. Direct Admits-Inpatients 3. ED Patients 4. Outpatients Specimen accounts will be created in the Lab for those specimens coming in during the downtime. Order Process: Use the Downtime Requisition Form to place orders to all ancillary departments, except Lab and Pharmacy-found on the Intranet/Forms Quick Links/Downtime Forms/Downtime Requisition. Lab orders should be placed on the Laboratory

3 Page 3 of 3 Downtime Order Requisition Downtime Form. Lab tests requiring collection of a specimen by the floor staff need to be placed on a separate requisition and should accompany the specimen to the lab. Ancillary departments (Lab, Radiology) are responsible for entering all stat, now, and routine orders performed during the downtime into the computer systems, at the time the requisitions are received if ancillary system is operational, or when the system is back on-line. Pharmacy orders need to be faxed to the pharmacy. The transfer center will maintain one copy of the current downtime forms. The process for handling future orders is outlined in item #2 below. 1. If the order is for a stat or now test, call the ancillary department (Lab, Radiology) and notify the staff of the order. If the order is for a lab test, keep the requisition on the unit and the phlebotomist will pick it up when they come to draw the patient. All other ancillary department orders (Radiology, Cath Lab, Dietary orders, Clinical Nutrition Consults) need to be faxed or scanned to the ancillary department performing the test. If the orders are for routine tests, fax or scan the order to performing department. 2. If the order is written for a future date and time, it is the responsibility of the floor staff to place the order(s) on the appropriate downtime requisition form and place it in the downtime accordion file folder in the slot that corresponds with the time of the future order. If the computer remains down, the floor staff is responsible to remove all the orders from the designated time slot, at least ½ hour prior to the time the order is scheduled, and will send it to the appropriate performing department for completion. When the computer system is back online, the floor staff is responsible to enter all future orders found in the accordion file into the computer system and shred the paper downtime requisitions. 3. Pharmacy will enter all medication orders. Please make sure all pharmacy orders are faxed to the pharmacy. 4. All new Dietary Orders and Clinical Nutrition Consults will be entered into the computer system, by the ordering department, when the computer system is back on-line. 5. Once orders are completed by the ancillary department, any results will be communicated to the ordering unit via telephone call or fax; lab results will be printed in the lab and sent to the floors. 6. Any patient charge(s) are the responsibility of the department responsible for verifying charges to enter when the system is available or manually, if necessary.

4 Page 4 of 4 Clinical Documentation Recovery: Planned Downtime Process: All documentation will be back charted into the computer for the first hour of the downtime, excluding, ER, OR, and PACU (these patients could be in and out before the end of the downtime). At the start of the second hour, paper packets for each patient will be used. These packets will be kept on the unit and prepared by the unit secretary. Each unit will define what forms need to be in their packets. Unplanned Downtime: All documentation will be back-charted for the first half hour of the downtime, excluding ER, OR, PACU (these patients could be in and out before the end of the downtime). At the half hour time, paper packets for each patient will be used. These packets will be kept on the unit and prepared by the unit secretary. Required documentation that needs to be back charted for the extended downtime (the time after the first hour for planned or the half hour for unplanned downtime) is: Height Weight Allergies I&O totals Last vital signs Home meds if the patient is being admitted during this time. Nursing will wait until new and transferred patients have been entered by admissions. Nursing will not document medication administration until pharmacy has completed their entry. The unit is responsible for copying the paper documentation after the downtime, stamped with copy and the copied sheet put on the chart on the floor. The originals should be put in the HIM basket for HIM to pick up at their usual pickup times and scanned into the electronic chart within 24 hours.

5 Page 5 of 5 Ambulatory Clinics: BCA_PC and BCA Web (Business Continuity Access_PC and Business Continuity Web)-These are solutions available for reports if we have backup power. They are distributed throughout the organization. They will contain basic reports that have current information that may be needed during the downtime. These reports are run on a schedule to keep them updated to current information. The reports time of refreshing will vary with the type of report data. The BCA_PC will be labeled for clear identification. Documentation on how to access these solutions will be laminated beside the BCA_PC. Notification of downtime will be the same as the inpatient units. In the event that power to the clinic has been lost, the clinic may close at the provider s discretion. Reception: Upon notification of a downtime or loss of power, the receptionist will print the current and next days schedules using the BCA_PC. If the clinic needs to be closed and patients rescheduled due to a loss of power to the building, the receptionist and clinical support staff will call all scheduled patients to cancel their appointments. Patients affected by the loss of power to a clinic will be placed on a call list to be rescheduled at the end of the downtime or when power is restored. The patients may be rescheduled at the time of power outage if backup power allows. During downtime, when the patient arrives in the clinic, including established patients, a current demographic form will be completed. Clinical Documentation: Paper packets for downtime will be created by the clinical staff. Paper packets include the following: Progress sheet with the date, time, patient s name and date of birth. Order form for procedures or outgoing referrals. Lab requisition when applicable. Required Documentation: The following information will be documented on the progress note by the clinical support staff for every patient seen during the downtime: 1. Reason for visit 2. Height

6 Page 6 of 6 3. Weight 4. VS 5. Allergies 6. Current Medications 7. Medications Administered (include Manufacturer, Lot number, Exp. date) 8. Any other pertinent information by clinic The Provider will handwrite or dictate a complete SOAP note based on the visit. All paper notes will have the patient s name and date of birth on each sheet and will be signed, dated, and timed. Order Process: STAT or now orders for ancillary departments, except Lab, will be completed using a paper requisition/order form. Lab orders need to be documented on the progress note and placed on a separate requisition and should accompany the specimen to the lab. Ancillary departments (Lab, Radiology) are responsible for entering all stat, now, and routine orders performed during the downtime into the computer systems, at the time the requisitions are received if ancillary system is operational, or when the system is back on-line. The transfer center will maintain one copy of the current downtime forms. The process for handling future orders is outlined in item #2 below. 1. If the order is for a stat or now test, call the ancillary department (Lab or Centralized Scheduling ) and notify the staff of the order. Arrange for the lab courier to pick up samples if applicable. Orders for all other ancillary departments (Radiology, etc.) need to be faxed or scanned to the ancillary department performing the test. 2. If the order is written for a routine test or future date and time, it is the responsibility of the clinical support staff to place the order(s) on the appropriate requisition/order form and place it in the downtime file folder. When the computer system is back online, the clinical staff is responsible to enter all routine and future orders found in the downtime file folder into the computer system and shred the paper downtime requisitions.

7 Page 7 of 7 3. Once orders are completed by the ancillary department, any results will be communicated to the ordering unit via telephone call or fax; lab results will be printed in the lab and sent to the clinic. 4. Any patient charge(s) are the responsibility of the department responsible for verifying charges to enter when the system is available or manually, if necessary. Clinical Documentation Recovery: Required documentation: Within 24 business hours of the end of the downtime, an encounter will be created for each patient visit that occurred during the downtime and all pertinent information will be back-charted to the appropriate date and time for that encounter. The paper progress note and any hand written or dictated notes will be signed, dated, and timed and scanned into the EMR by the person designated at each clinic upon receipt of dictation or within 24 business hours of the end of the downtime. Future orders and referrals will be completed in the EMR within 24 business hours of the end of the downtime. Reference: Policy cross reference: This Policy replaces the following deleted policies: ADMIN-IM-23 Key words: