Pain Management Coding Alert

Here's how to prep for an EHR shutdown.

If your electronic health record (EHR) system becomes unavailable for any reason, it could have adverse effects on both patients and practice. It could affect anything from pay cycles to treatments, so you need to be ready when the lights go out on your EHR screen.

Best bet: Use this advice on what to do if your EHR goes offline from Bob Steele, executive vice president of clinical services with the HCI Group in Jacksonville, Fla.

Create Downtime Policy

A good preemptive action to ensure your preparedness when EHR fails is having a "downtime policy" on file (and on paper, in case you can't access digital records). Everyone in the practice has a stake in the downtime policy, so staff buy-in is vital for the policy to be effective when you enact it.

Steele, who has managed EHR outages during three different hurricanes, says that once you establish protocols, ensure that all staff members are aware of them and fully understand the plan.  Once everyone's been trained on what to do during EHR downtime, form annual drills to confirm that everyone can put the plan into action.

During these mock downtime practice runs, each staff member should demonstrate what they would do in the event of an EHR outage. These practice sessions are of the utmost importance.

"Don't wait until an outage happens, as patient lives are at stake," Steele advises.

The following areas are key to creating your downtime policy, which you should tailor to your office or department based on your specific needs:

1. Patient Safety is Paramount

One of your focus areas when creating your offline EHR strategy should inevitably be patient safety, since it's critically important, and it could suffer in the absence of electronic records. Include the following aspects in your patient safety plan, Steele advises:

• Medication Administration: The practice needs to be sure that a methodology exists to continue the timely and accurate administration of medication, many of which are imperative and life sustaining/saving, Steele says. Practice managers should make sure this area of inpatient service is included in the downtime protocols.
• Allergy Identification: Allergic reactions can have disastrous results if the practice has no access to a patient's records. Be sure someone with medical records experience creates a mechanism to monitor and acknowledge patient allergies during downtime.
• Establish Code Status System: The patient's code status should be readily available and obtainable in emergency situations. "Do not rely on the EHR - ensure an alternative form of code status identification is in place, i.e., a colored armband, etc." Steele says.

2. Keep Operations Moving Smoothly

Even without an EHR to rely on, you must ensure that your office operates smoothly, which means you keep track of scheduled diagnostics and treatments as well as the continuum of care for your patients, Steele says. This could encompass various areas, including the following:

• Maintain Your Schedule: Ensure you have a way to keep track of appointments, admissions, therapy sessions, lab visits, and other important sessions.
• Revert to Paper: Have systems and products in place to convert to paper charting when your EHR goes down. This includes having the materials at hand, training staff on how to use them, and maintaining policies on when to use paper. For instance, your protocol might advise practitioners to plan on making late EHR entries if the system is only down for 30 minutes, but after the 30-minute mark, they might convert to paper charting.
• Keep Flow Sheets at Hand: Your paper supply won't be limited to encounter notes-you'll also need ample up-to-date copies of forms and flow sheets for other departments, such as requisitions for ordering lab tests, x-rays, consultations, and other information, Steele says.

3. Bills Must Remain Accurate

Losing your EHR doesn't mean you have to lose money in billing - you should have a plan in place to ensure that you capture all of the information necessary to submit claims and bills, Steele says.

Get to Know the System: You should be aware of how your financial system is built and configured.

Configure the Backup Protocol: Some systems are built for charges to go into a pending state if the system goes offline. Those should revert to active when the system comes back up.

Eliminate Duplicates: Some downtime protocols involve manual keying charges into the system, but if this is in your office's plan, ensure that when the system comes back online, it doesn't automatically generate charges as well - this could cause duplicate bills to go out to insurers and patients. If this happens you'll have to go back and reconcile the accounts and generate credits, Steele says.

4. Maintain Backups

You can put systems into place that may help you get EHR access even in the event of a storm, but those aren't foolproof, Steele says.

"While generators are good and a must to have, events such as hurricanes, earthquakes, and fire can knock them out as well," he advises. "A backup, emergency supply of all paper forms should be maintained and in current form should the occasion arise to need them."