title: Contingency planning for electronic health record-based care continuity: a survey of recommended practices.
abstract: BACKGROUND
  Reliable health information technology (HIT) in general, and electronic health record systems (EHRs) in particular are essential to a high-performing healthcare system. When the availability of EHRs are disrupted, alternative methods must be used to maintain the continuity of healthcare.
  
  
  METHODS
  We developed a survey to assess institutional practices to handle situations when EHRs were unavailable for use (downtime preparedness). We used literature reviews and expert opinion to develop items that assessed the implementation of potentially useful practices. We administered the survey to U.S.-based healthcare institutions that were members of a professional organization that focused on collaboration and sharing of HIT-related best practices among its members. All members were large integrated health systems.
  
  
  RESULTS
  We received responses from 50 of the 59 (84%) member institutions. Nearly all (96%) institutions reported at least one unplanned downtime (of any length) in the last 3 years and 70% had at least one unplanned downtime greater than 8h in the last 3 years. Three institutions reported that one or more patients were injured as a result of either a planned or unplanned downtime. The majority of institutions (70-85%) had implemented a portion of the useful practices we identified, but very few practices were followed by all organizations.
  
  
  CONCLUSIONS
  Unexpected downtimes related to EHRs appear to be fairly common among institutions in our survey. Most institutions had only partially implemented comprehensive contingency plans to maintain safe and effective healthcare during unexpected EHRs downtimes.
authors.affiliation: University of Texas School of Biomedical Informatics and the University of Texas - Memorial Hermann Center for Healthcare Quality & Safety, Houston, TX, USA. Electronic address: dean.f.sittig@uth.tmc.edu.
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.affiliation: Department of Clinical Effectiveness and Performance Measurement, St. Luke's Episcopal Health System, Houston, TX, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gonzalez
authors.affiliation: Houston VA HSR&D Center of Innovation at the Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
mesh_terms: D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D066289:Data Curation / Q000379:methods*; D017598:Efficiency, Organizational; D057286:Electronic Health Records / Q000458:organization & administration* / Q000592:standards*; D063005:Health Information Systems / Q000458:organization & administration*; D017146:Models, Organizational; D009937:Organizational Objectives; D011159:Population Surveillance; D017410:Practice Guidelines as Topic
keywords: Electronic health records