Contingency planning for electronic health record-based care continuity: A survey of recommended practices

• EHRs are essential to realize a high-performing healthcare system.
• Unexpected EHR downtimes appear to be fairly common among healthcare institutions.
• When EHR availability is disrupted, healthcare must continue.
• Most institutions have only partially implemented comprehensive contingency plans.
• Best practices are available to help prepare for and reduce the impact of downtime.

BackgroundReliable health information technology (HIT) in general, and electronic health record systems (EHRs) in particular are essential to a high-performing healthcare system. When the availability of EHRs are disrupted, alternative methods must be used to maintain the continuity of healthcare.MethodsWe developed a survey to assess institutional practices to handle situations when EHRs were unavailable for use (downtime preparedness). We used literature reviews and expert opinion to develop items that assessed the implementation of potentially useful practices. We administered the survey to U.S.-based healthcare institutions that were members of a professional organization that focused on collaboration and sharing of HIT-related best practices among its members. All members were large integrated health systems.ResultsWe received responses from 50 of the 59 (84%) member institutions. Nearly all (96%) institutions reported at least one unplanned downtime (of any length) in the last 3 years and 70% had at least one unplanned downtime greater than 8 h in the last 3 years. Three institutions reported that one or more patients were injured as a result of either a planned or unplanned downtime. The majority of institutions (70–85%) had implemented a portion of the useful practices we identified, but very few practices were followed by all organizations.ConclusionsUnexpected downtimes related to EHRs appear to be fairly common among institutions in our survey. Most institutions had only partially implemented comprehensive contingency plans to maintain safe and effective healthcare during unexpected EHRs downtimes.