A Clinical information system (CIS) can suffer performance degradation, or even a complete "downtime", affecting one or more of its critical functions. Service interruptions can be planned (system maintenance) or unplanned; and can relate to the CIS itself or any of its dependencies (e.g., enterprise content management, dictation), infrastructure (e.g., servers, networks, workstations, devices) or infostructure (e.g., operating systems, interfaces, databases).
"Business continuity" relates to support of clinical and administrative workflows when CIS functions are compromised.
Scheduled downtimes are planned and occur at a known time. They are usually controlled, and durations are accurately predicted. Indeed planned downtimes occur at least quarterly in order to implement regular Epic updates. Notification is sent in advance and outages are brief.
Physicians should review instructions in a physician downtime essentials tip. In brief:
- The production (PRD) Connect Care environment is unavailable during a downtime. However, a read-only (PRDSRO) environment is available and provides full access to current patient information. Netcare also remains available.
- Physicians should try to save non-urgent orders or documentation until after a planned downtime ends.
- Essential orders can be recorded on pink order sheets from Downtime Toolkits available at all clinics, nursing units and other practice settings. These will be entered to Connect Care by support staff after the downtime completes.
- Essential documentation can be recorded to paper, also from the Downtime Toolkit, which will be attached to the chart by support staff post-downtime.
- Note that all blood product related orders must be phoned in to transfusion services.
- Those with eScription accounts can dictate longer documents (e.g. admission history & physical) with eScription, being sure to provide the pMRN (medical record number), patient name, birthdate and CSN (use 10 9s: 9999999999).
- After a downtime, physicians should consider validating orders and documentation.
Unscheduled downtime is unexpected and warnings typically are not given. PRDSRO may be available and the above steps can be followed by physicians. If PRDSRO is not available, other backups can be used.
A business continuity web application (BCA Web) provides access to essential clinical information, reports and utilities to help manage a downtime should PRD and PRDSRO be unavailable. Icons for this cloud-based service may be seen on Connect Care workstations.
In addition, all practice settings will have at least one workstation (BCA PC) that has a recent copy of Connect Care charts and summaries relevant to the setting. This workstation is connected to backup power, as is the printer that can be used to generate chart summaries, schedules and other supports.
Connect Care downtime and recovery information is currently maintained at downtime.connect-care.ca (insite) where a downtime procedures manual is maintained. If the website should become unavailable, contact the IT Service Desk and Solution Centre (1-877-311-4300) to get copies of downtime guides.