The purpose of this standard is to ensure that:
All users and IT staff are aware of the procedures to be used during an outage
All users and IT staff are aware of the communication plan for downtimes and outages
Last Revision: December 2009
EHR/Transcription Downtime Policy & Procedure
1. Users should check the IT Service Center status line by calling 1-800-999-9999, option 7. The status
line will describe the problem, the next update and the estimated time of repair. If the user suspects a
problem and it is not listed on the status line, a new ticket should be generated with the IT Service
2. For any known problems, the analyst on-call will send an e-mail (if available) to the EHR Users e-mail
distribution group, which should include all physicians, providers, management, and super-users. A
page (if available) will also be sent to the designated EHR group.
3. In the event of a large scale extended outage in which additional communication is needed, other
forms of communication such as conference calls, faxed updates, intranet postings, etc may be
initiated with affiliate administration.
4. The proper downtime procedure should be followed according to the level of outage.
Levels of Downtime:
1. EHR is completely unavailable on all clinic devices due to a server, network or electrical outage.
Users should revert to the downtime procedures.
2. The EHR web application is not available due to a Citrix server outage; however, the iPAQs are fully
functional. Users should revert to downtime procedures for those functions not available via the
3. All wireless devices are non-functional due to a wireless access point outage. This may affect an
entire clinic or only portions of a clinic. Users should perform all functions via the web application.
4. Printing/faxing are adversely affected due to a server outage or other technical malfunction.
Prescriptions not being sent via SureScripts should be generated via phone call or paper pad and
documented in EHR with an action of “record”. In the event that the issue is limited to specific stores,
IT staff will send an e-mail notification with the specific store name.
5. Billing/Results/Transcription interfaces are down or impaired. Follow individual processes as outlined
in this document.
Level 1 Outage: Procedure
EHR is completely unavailable on all clinic devices due to a server, network or electrical outage. Users
should revert to the downtime procedures.
1. In preparation for a potential outage, all clinics, at the end of a business day, will print the next day‟s
provider schedules. A master paper schedule will then be maintained during an outage in which THE
billing/scheduling system is unavailable. Triaging of patients will need to occur for any new requests
for appointments. (Please refer to the billing system downtime instructions in the event of a network
or electrical outage.)
2. If there is advanced warning of a potential downtime or if another clinic has connectivity and is able to
assist, the Patient Snapshot report should be printed for each scheduled patient.
3. If a super-bill (charge ticket) cannot be automatically generated, it will be hand-written with the
patient‟s name, DOB and account #.
4. If able to, the front office staff will make a copy of the insurance card. The demographics sheet will
be completed, either automatically or manually. All paperwork obtained at check-in will be sent back
with the patient, and attached to the downtime form. The pertinent patient information at the top of
the clinical downtime form will be completed by the front office staff or the clinical staff.
5. All phone messages will be recorded using the clinic‟s previous paper process or telephone message
pads and later scanned into the Office Notes folder.
6. If lab or radiology results are needed, and a paper result is not available, the clinical staff will place a
call to the performing lab or radiology site. Outstanding results will be queued in the interface for later
import into the EHR. If a paper result is available, the results will be distributed to the providers on
paper and treated like a non-interfaced result for the purposes of adding manual comments, etc. The
paper results should not be scanned, as the results will need to be verified and all comments added
once the system is available and the results have interfaced.
7. The nurse or clinical assistant will room the patient and complete the appropriate sections of the
downtime form. They will need to review the patient‟s current meds, allergies and problems and sign
the form. (If the Patient Snapshot report was printed pre-downtime, it can be used as a tool to review
and update the key information.)
8. The physician or provider can complete the downtime form or use Gas-n-Go dictation for acute visit
documentation. The preferred method would be the downtime form. Due to limited analog phone
lines, the phone dictation system should be reserved for H & P‟s or complex visits. (See the iPAQ
dictation guide card, available on the EHR intranet site, for information regarding how to use the
analog phone dictation system.)
9. During brief periods of downtime, it is highly recommended that the information, including the full
note, be entered into the EHR once available.
10. Use the former paper order requisitions when generating referrals, lab, rad or procedure orders. A
copy of the order should be kept for later entry into the EHR.
11. The allergies, problems, medications (including immunizations), vitals, and new prescriptions must be
entered into the EHR by a clinical staff member after the system becomes available.
12. The downtime form should be scanned (when available) into the Office Notes folder and the paper
copy destroyed. If the visit was recreated electronically, it is not necessary to scan the form.
13. If a refill or prescription is needed, the physician will utilize a script pad or phone in the medication to
the pharmacy. If a script pad is used, a copy of the script can be attached to the downtime
paperwork. All new scripts should be recorded on the downtime paper form for later entry into the
14. Refill requests sent to a clinical assistant or nurse can be phoned into the pharmacy. A paper log
with the patient‟s name, DOB, account number, and refills should be maintained, and kept for later
entry into the EHR. The form can be shredded once the information has been entered.
15. Please refer to your billing system policies for other downtime procedures.
Level 2 Outage: Procedure
A full scale Citrix outage is unlikely; however, if multiple servers are down, it may result in a
slowness which forces some users to initiate downtime procedures. The steps below pertain
only to those clinics with access to iPAQ devices.
The EHR web application is not available due to a Citrix server outage; however, the iPAQs are fully
functional. Users should revert to downtime procedures for those functions not available via the iPAQ.
Follow procedure #1 as outlined above, with the following exceptions:
1. The physician/provider can review the allergies, medications, problems, and documents via the iPAQ.
2. The physician can add new problems, allergies, and medications via the iPAQ; new immunizations or
administered medications should be documented on the downtime form for later entry into the EHR.
3. The physician could document the visit by using the iPAQ dictation functionality, including the clinical
staff‟s information indicated on the form.
4. New prescriptions and/or refill requests can be generated via the iPAQ if the outage is related to Citrix
only; however, the user will not be able to monitor the print/fax queue.
Level 3 Outage: Procedure
All wireless devices are non-functional due to a wireless access point outage. This may affect an entire
clinic or only portions of a clinic. Users should perform all functions via the web application on a wired
1. All functionality is available using the web application via the desktop. Wireless tablet PC‟s, laptops
and iPAQs are not functional.
2. For users with wireless tablets or laptops, they will need to be plugged into the nearest network
jack/port or docked in a wired docking station.
3. Desktop dictation or structured notes should be used instead of iPAQ dictation.
Level 4 Outage: Procedure
Printing/faxing are adversely affected due to a server outage or other technical malfunction. Prescriptions
not sent through SureScripts should be generated via phone call or paper pad and documented in the
1. All modules and devices are functional with the exception of the ability to print or fax a document or
2. Prescriptions should be documented per usual procedures with an action type of „record‟. The
prescription should then be phoned into the pharmacy. (Schedule I and II drugs may need to be
written on a script pad or held until printing functionality is restored.)
3. Any prescriptions that were previously marked as „retail‟ that did not fax prior to or during the
downtime will process once the server is functional.
4. In the event that there is a faxing issue limited to a specific store, IT staff will send an e-mail
notification with the specific store name and preferred method of alternate communication.
Level 5 Outage: Procedure
Billing/Scheduling/Results/Transcription interfaces are down or impaired. Follow individual processes as
outlined in this document.
Established patient in organization: If the EHR is not receiving transactions from the billing/scheduling
system, the patient‟s arrival status will not be updated. Follow clinic back-up procedures for notifying staff
of a patient‟s arrival. In addition, the provider schedules on the iPAQ and web application will not be up to
Because the patient is accessible via searching for their name, it is still appropriate to document in the
EHR. When starting a note, the patient appointment may not be available. Please create a new
encounter, dated appropriately, to attach to the new note.
New patient in organization: The patient name or account will not be accessible in the EHR. In this
instance, utilize the paper downtime form and follow guidelines as outlined in a Level 1 Downtime. Gas-
n-Go dictation is available by using a 99 account number. (See the iPAQ dictation guide card, available
on the AEE intranet site, for more information on Gas-n-Go dictation.)
1. If the results interface is down, new lab and radiology results will not be sent to the EHR.
2. Please call the respective lab or radiology location for results if they are necessary for the patient
encounter and a printed report is not available.
3. Lab and radiology results will queue in the interface and arrive in the EHR once the outage is
4. If a paper result is available, the results will be distributed to the providers on paper and treated like a
non-interfaced result for the purposes of adding manual comments, etc. The paper results should not
be scanned, as the results will need to be verified and all comments added once the system is
available and the results have interfaced.
1. If the transcription interface is unable to send documents to and from the EHR, the dictations will
queue in the interface and process once the outage is resolved. Documents will not be available for
review or signature until the outage is resolved.
2. It is highly recommended that no further dictation markers be processed during a known transcription
interface outage. The use of a complete structured note would be the preferred method of
3. Dictations can continue to be processed for later completion by the transcriptionist. If the downtime
extends beyond 48 hours, additional communication will be sent to the clinic.
Specialty clinics may use other appropriate forms in addition to or in place of the standardized downtime
form as necessary.
Levels of Downtime – Transcription:
1. Citrix and/or Transcription system is unavailable due to a server or electrical outage.
2. ADT/Transcription interfaces are down or impaired.
For outages less than 48 hours, no back-up procedures are required. In the event of a lengthy outage,
the transcriptionist may contact his/her manager for temporary assignment to a new job.
If the outage is greater than 48 hours, the transcriptionist will utilize the analog phone system to retrieve
the voice file and subsequently type in his/her local Microsoft Word application. The document would
then be printed to the local printer. The clinic would work with the TSO for pick-up or delivery of the
documents. A courier or overnight mail system may be used in this instance.