Implications of electronic health record downtime: an analysis of patient safety event reports

Larsen, Ethan; Fong, Allan; Wernz, Christian; Ratwani, Raj M.

doi:10.1093/jamia/ocx057

Cited by 41 publications

(46 citation statements)

References 18 publications

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“…Inaccuracies or delays in patient information resulting from changes or enhancements in security are likely to disrupt the care process and adversely affect patient outcomes. Downtimes in electronic health records because of maintenance or malfunction has been associated with disruptions in laboratory and medication orders as a result of patient identification and communication problems . The data breaches studied in our analysis came from 2012 to 2016 and ransomware or infrastructure attacks were rare before 2016.…”

Section: Discussionmentioning

confidence: 99%

“…Downtimes in electronic health records because of maintenance or malfunction has been associated with disruptions in laboratory and medication orders as a result of patient identification and communication problems. 55 The data breaches studied in our analysis came from 2012 to 2016 and ransomware or infrastructure attacks were rare before 2016. Our findings suggest that ransomware attacks might have an even stronger short-term Difference−in−differences estimates with 95% CI Impact of breach on time to ECG negative relationship with patient outcomes than the long-term remediation efforts studied here.…”

Section: Discussionmentioning

confidence: 99%

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Data breach remediation efforts and their implications for hospital quality

Choi

Johnson

Lehmann

2019

Health Services Research

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Objective To estimate the relationship between breach remediation efforts and hospital care quality. Data Sources Department of Health and Human Services’ (HHS) public database on hospital data breaches and Medicare Compare's public data on hospital quality measures for 2012‐2016. Materials and Methods Data breach data were merged with the Medicare Compare data for years 2012‐2016, yielding a panel of 3025 hospitals with 14 297 unique hospital‐year observations. Study Design The relationship between breach remediation and hospital quality was estimated using a difference‐in‐differences regression. Hospital quality was measured by 30‐day acute myocardial infarction mortality rate and time from door to electrocardiogram. Principal Findings Hospital time‐to‐electrocardiogram increased as much as 2.7 minutes and 30‐day acute myocardial infarction mortality increased as much as 0.36 percentage points during the 3‐year window following a breach. Conclusion Breach remediation efforts were associated with deterioration in timeliness of care and patient outcomes. Thus, breached hospitals and HHS oversight should carefully evaluate remedial security initiatives to achieve better data security without negatively affecting patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Data breach remediation efforts and their implications for hospital quality

Choi

Johnson

Lehmann

2019

Health Services Research

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“…[4][5][6][7][8] Downtime events are considered to be any period in which any portion or all of the EHR system is disrupted. [9][10][11] Downtime events can have varying impacts depending on which systems are affected. For example, if the systems for patient registration go into downtime, the impacts to processing patient laboratory requests would be minimal once the patient data are manually entered.…”

Section: Background and Significancementioning

confidence: 99%

“…37,39 This approach is established in the literature and has been utilized for similar work in the past. 10,40 Open coding allows the researcher to develop the structure of the codebook based on the data itself when the outcomes are less known. Due to the unknown nature of downtime events and the experiences workers may have had, questions were tailored to target specific themes; however, the participants were free to tell as much or as little of their experiences regarding downtime as they felt compelled to share.…”

Section: Code Book Developmentmentioning

confidence: 99%

Continuing Patient Care during Electronic Health Record Downtime

et al. 2019

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Introduction Electronic health record (EHR) downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared. Objective The objective of this study was to assess the operational implications of downtime with a focus on the clinical laboratory, and to derive recommendations for improved downtime contingency planning. Methods A hybrid qualitative–quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several downtime events, including a hospital-wide EHR shutdown. Results During downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of downtime, and how to best address them. Based on these insights, recommendations for improved downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides. Conclusion This study documents the extent to which downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their downtime contingency plans need to find more effective methods to collect data during these times.

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“…PSE databases can be used as a compendium to find commonalities and focus research, and the Institute of Medicine has strongly recommended the use of these systems to learn more about medical errors 10 despite the recognized underreporting of adverse events. 11 These voluntary reporting databases have been used as a data source to explore a variety of research questions including the types of interruptions in the emergency department, 12 staff response to EHR downtime, 13 and as a general classification of the types of medical errors and adverse events occurring in hospitals. 14…”

Section: Introductionmentioning

confidence: 99%

Responding to health information technology reported safety events: Insights from patient safety event reports

Adams

Kim

Fong

et al. 2019

Journal of Patient Safety and Risk Management

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Objective: We analyzed the described resolutions of patient safety event reports related to health information technology to determine how healthcare systems responded to these events, recognizing that certain types of solutions such as training and education have a limited impact. Methods: A large database of over 1.7 million patient safety event reports was filtered to include those identified by the reporter as being related to health information technology. The resolution text was manually reviewed and coded into one or more of four categories: No Resolution, Training/Education, Policy, Information Technology-oriented solution. Results: Most events (64%) did not include a resolution. Of those that did, Training/Education was the most commonly reported single or component of a multi-pronged solution (55%), followed by Information Technology (45%). Only 59 events (6% of resolutions) described more than one method of resolution. Conclusion: Health information technology-related patient safety event resolutions most often described a solution that suggested additional training or education for healthcare staff, despite the recognized limitations of training and education in resolving these events. Few events suggested multiple resolution methods. Ensuring health information technology-related events are resolved and incorporate effective solutions should be a continued focus area for healthcare systems.

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Implications of electronic health record downtime: an analysis of patient safety event reports

Abstract: EHR downtime events pose patient safety hazards, and we highlight critical areas for downtime procedure improvement.

Cited by 41 publications

References 18 publications

Data breach remediation efforts and their implications for hospital quality

Data breach remediation efforts and their implications for hospital quality

Continuing Patient Care during Electronic Health Record Downtime

Responding to health information technology reported safety events: Insights from patient safety event reports

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