Characteristics of health IT outage and suggested risk management strategies: an analysis of historical incident reports in China

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Although in a developing country, nearly 50% of Chinese hospitals have some form of basic EHR, practice management system, Picture Archiving and Communication System (PACS), and Computerized Physician Order Entry (CPOE). This article analyses the EHR downtimes in China. The authors gather all the publicly available data or incidents of EHR downtime in China and provide a qualitative analysis. [1]


Data collection was primarily conducted by carrying out internet search using major search engines like and The content of the articles and reports retrieved were manually read to ensure it is indeed pertaining to downtime. A deductive grounded theory approach was used for data coding and recurring themes that emerged from the data were used to understand common causes of health IT outage.


The authors retrieved 116 articles pertinent to health IT outages. The average health IT outage was 18 hours and 6 minutes. About 69.8% of the outages occurred in the morning due to over capacity and vulnerable software and hardware components. Of these 80% of the outages were associated with large hospitals and could be due to the advanced EHR systems used in these settings. All health IT outage incidents identified in the data resulted in some kind of negative outcome. In some cases there was unrecoverable data damage, patient death and others mostly lead to severe financial losses.


1. News reports on internet can be valuable data source for identifying common causes of health IT downtime. 2. The results of the study clearly indicated a need for a procedure to report IT downtime to analyze, understand and prevent further events. 3. Institutions lack transparency and accountability in terms of reporting IT downtime events.


Many disaster studies commonly indicate that the preparedness of hospitals to face unplanned downtimes is very weak. Hospitals, although few, have back up plans but often fail to verify their efficiency unless struck by an event. In the article discussed, the downtime was attributed to system overcapacity. This leads to the question as to whether the hospitals had sufficient number of systems to handle patient population? Separately, even in cases, where the outcome was a death, no clear account was given about the downtime. Also, the financial losses were mostly associated with lawsuits. This makes me wonder if the hospitals deliberately avoided giving a detailed account for the downtime to avoid further consequences. Certainly, in my opinion, natural disaster driven downtimes will not lead to lawsuits. Clearly, in developed countries the accountability for reporting downtime events has a higher standard.


  1. Lei, 2014. Characteristics of health IT outage and suggested risk management strategies: an analysis of historical incident reports in China.