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

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The use of electronic health records in hospitals is wide spread and the US government has implemented laws to promote its use. As with any other information technology (IT) systems, the health IT can have downtimes. In the past, IT or EHR downtimes have happened for several hours at a stretch and have been reported in both the US and Canada. The consequences of EHR downtime can be serious and the patient care cannot stop during this time. Since intense use of IT in health care has only started in the recent years, it is not surprising that there are not enough back up plans to tackle these downtime issues. In this article the authors identify/suggest contingency plans that could be employed to tackle unanticipated EHR unavailability.[1]


The authors conducted a survey using an eight-dimension sociotechnical model of safe and effective health information technology (HIT) use. The survey was distributed to Scottsdale Institute’s members (59 organizations), which have a mean score of 4.6 for Health Information and Management Systems Society (HIMSS) Electronic Medical Record Adoption (EMRA). The authors employ descriptive statistical methods to measure their responses using Microsoft Excel.


The survey response was 84% (50 responses of 59). The major findings are listed below. 1. At least one unplanned downtime was reported by 95% respondents and 70% had unplanned downtime for more than 8 hours in the past three years. 2. All respondents reported having uninterruptable power supplies (UPS), however only 50% tested them on a monthly basis. 3. While 96% had a back-up generator, only 79% tested them on a monthly basis and about 79% had more than two days of fuel available to run. 4. Further, 75% of the hospitals reported having a central and clinic-level read-only back up systems. Again, only a third tested their read-only systems monthly. 5. All respondents maintained a daily back up copy of their patient data in secure off-site location. Interestingly, less than 50% reported that their data was complete and encrypted and only few attempted to restore their backups on a quarterly basis. Two organizations never tested their backup.


Unexpected downtimes related to EHRs are common. However, even institutions with fully implemented and routinely used EHR systems do not have a robust contingency plans to keep the system running during downtimes.


This report is one of the few studies to address the issue of implementation of contingency plan for EHR systems. The choice of institutes chosen for this study was very impressive, because the Scottdale members/organizations have implemented advance EHR model (employs computerized physician order entry with clinical decision support and major ancillary systems, clinical data repository for results review etc.,). The fact that these hospitals with advanced EHR models have such poor contingency plan only emphasizes on the lack of preparedness of hospitals to face unexpected situations. This report kept me thinking about how the hospitals would handle the prolonged downtimes in times of natural calamities like hurricanes.

Related Articles and Resources

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Downtime procedures for a clinical information system: a critical issue

ONC-Sponsored SAFER Guide for Contingency Planning [2]


  1. Sittig, 2014. Contingency planning for electronic health record-based care continuity: a survey of recommended practices
  2. SAFER Guide for Contingency Planning