Downtime

***Call FMH/DC Customer Support Desk at x5460 for questions during a downtime***

Document Revised: August 5, 2010

Clinical Applications SCENARIO What do I do? Scenario 1: Cerner Downtime

This is any downtime that affects any Cerner Products (PowerChart, FirstNet, SurgiNet, RadNet, PathNet, etc)

Utilize FMH/DC Downtime Policy and Procedure and pull out designated downtime tubs on your unit.

Follow department protocol during downtime.

All users must sign out of Cerner when notified and stay logged out until the system has been cleared to log on.

Look for updates via e-mail from FMH/DC IT Customer Support Team. It may be wise to designate one or two people on unit to look for these updates.

PCLA and AKREAD are available for accessing some patient information during downtime. AKREAD is used ONLY during a scheduled downtime.

Scenario 2: BMDI is down

Bedside Medical Device Interface that feeds result from a central monitoring station to Cerner IVIEW tab

Ensure that the bed has been associated with correct monitor in Cerner. Contact FMH/DC IT Customer Support Team to report problem and manually input data per unit protocol.

Scenario 3: Philips Central Monitoring System is down Cardiac Monitoring at both bedside and nurses station

If central station is down, bedside monitors will still work. Must do regular rounds to very patient condition/status. Contact BioMed x1812 or through Admin Coordinator 800-607-3974 (pager).

Scenario 4: Laboratory is down

Lab will follow department downtime procedure for scenario 4a-4c. All lab results during an extended downtime will be faxed to the floors. If Cerner is DOWN concurrently with any of the lab applications, see Scenario #1. Nursing units and Lab should keep open channel of communication for orders with a frequency to ensure completion.

4a) RALS is down

The computer that talks directly with Cerner regarding inputting of data from ISTAT

If Cerner is DOWN concurrently, follow down time procedure.

Continue to dock ISTAT per normal as when RALS comes back up, the information will flow over to Cerner as it should and sync up.

4b) TELCOR is down The computer that talks directly with Cerner regarding inputting of data from glucometers

If Cerner is DOWN concurrently, follow down time procedure.

Continue to dock glucometer per normal as when TELCOR comes back up, the information will flow over to Cerner as it should and sync up.

4c) IMPAC is down Blood Gas Analyzer

**Different from Cancer Tx Center IMPAC***

If Cerner is UP and running, lab will manually input results into Cerner for availability.

Lab personnel will check/reboot IMPAC computer located in the Lab.



Clinical Applications (Cont) SCENARIO What do I do?

Scenario 5: Radiology is down

NURSING: please fax any NEW orderables to 458-6976 and call Radiology at 458-5661 to notify them of the

order. Once the system comes back up, Radiology will place the order in Cerner.

RADIOLOGY: will follow intradepartmental protocol during downtime.

If you have questions regarding downtime contact: Eric Cray, Radiology DBA x6916.

5a) Powerscribe The Radiology dictation system

A full report will not be available until approximately 2 hours of downtime has passed, radiology will revert back to using standard dictaphone to produce a report.

For emergent cases, the Radiologist will verbally notify attending MD of results.

Intranet down – application will not be accessible.

5b) PACS

This is where Radiology images are stored

Viewing images will be down completely.

Hard films will be printed if they are available (only will hold a certain number).

Any new exams during a downtime are printable.

Intranet down – application will not be accessible.

5c) MRS (Mammography

Reporting System) is down

The department will use paper documentation. All reports will be dictated after the system is back up. Emergent cases will be handled to the Radiologists discretion – verbal information, use of other system if possible.

Scenario 6: Pharmacy is down

In the event of a power outage, Cerner is down, or the pharmacy isn’t receiving scanned orders . . . it’s important to get allergy information to them in an alternative way (ie.fax, phone, etc) for patient safety.

6a) Pyxis Connect Document imaging software used to digitally view and store scanned orders

Fax all orders.

6b) PhaMedMgr Pharmacist piece of Cerner used to manage a patients medication profile and access PowerChart

Refer to Scenario #1.

6d) Kinetics Program Pharmacy uses to calculate specialized doses

Pharmacy handles this internally.

6e) Multum The drug interaction and allergy checking data base that Cerner uses

Automated drug interactions do not occur and adding or modifying an allergy may not be possible.

Notify Pharmacy of any new allergies or modifications of allergies in the event Multum is down or Cerner is down.




6f) Pyxis Med Station System

The machine in which medications are stored, inventoried and charged from.

Continue to use individual stations.

Double check all meds against orders if machine is on “critical override”.

Call Pharmacy for needed meds if station is down.

Scenario 7: Cloverleaf Interface Engine is down. The interface engine is the computer that allows Cerner to talk with all the other applications.

Use downtime requisitions for Lab and Radiology.

OK to enter all other orders into PowerChart as per normal. After the interface comes up the information will be directed to appropriate location like it does normally.

If the patient isn’t in PowerChart, use downtime tubs for charting.

Please note** if a patient is discharged or transferred during interface down time, the location will not be correct until the interface is up and data allowed to flow.

Scenario 8: MS4 Down/I-Series/AS400 This is the computer system that handles patient admissions/transfers/discharges, demographics, charging and billing.

Utilization of I-Series downtime procedure if applicable to your department.

All registration and visit activity (admissions, discharges, transfers) are manual.

Use paper process.

Label printing will be DOWN.

Account numbers will be given but will need to be manually written on appropriate correspondence. Schedule reports from MS4 that routinely print out will not print until system comes up.

Scenario 9: Provation down (Procedure Room only)

Outpatient/Special Procedures Documentation and GI/Pulmonary imaging tool. ***web-based (nurse portion only)***

Nurse portion (Multicare) is web-based, so if internet is down – tool will not function. Revert back to paper process.

Doctor portion (Provation MD) is installed locally on each hard drive, move to a portable computer cart as a temporary measure until fixed locally.

Scenario 10: OB Trace View Fetal monitoring system

Downtime forms on unit.

Manual monitoring from printed strips.

Strips sent to HIRS to keep with patient chart.

Scenario 11: Epiphany Down (RT only)

RT’s cardiopulmonary documentation tool ***web-based***

Revert back to paper process and scan documents/strips.

Use RT downtime procedure.

Epiphany is web-based, if internet is down – Epiphany is unavailable.




Scenario 12: PowerWorks Cerner remote hosted application for both EMR and Patient Management Systems ***web-based***

Utilize Clinic downtime procedure and utilize paper forms until system back up.

Utilize printed schedule from night before to work from.

If Citrix Portal Down: 1-800-277-7330, Option 2,1 Client Number 57232 Code FMCC_AK

If EMR Down: 1-800-277-7330, Option 3,1 Client Number 57232 Code FMCC_AK

If PM Down: 1-800-277-7330, Option 2,1 Client Number 57232 Code FMCC_AK

If Network/Internet is down: call FMH Support Desk x5460.

Scenario 13: Axiom Sensis XP

AXIOM Sensis is a cardiac cath-lab recording, data management and reporting system for electrophysiological and hemodynamic studies

Ensure connections to and from AXIOM Sensis system have not become disconnected.

Reboot the system by following the step for step guidelines set forth in the User’s manual.

Contact the FMH/DC Customer Support Desk at extension x5460 to report problems and to contact the Cardiology IT on-call team member.

If above has been performed or it’s an emergency, contact the Siemens Medical Uptime Service Center at 1-800-888-7436:

ffor Technical Support: press option 2, option 3, option 2

ffor Application Support: press option 3, option 3, option 2

*Cardiac Cath Lab intra-operative procedures will not be performed until the hemodynamic system is fully operational*

Scenario 14: Axiom Artis Cardiac cath-lab angiography system that provides enhanced cardiovascular imaging

Ensure connections to and from AXIOM Artis system have not become disconnected.

Reboot the system by following the step for step guidelines set forth in the User’s manual

Contact the FMH/DC Customer Support Desk at extension x5460 to report problems and to contact the Cardiology IT on-call team member *Cardiac Cath Lab intra-operative procedures will not be performed until the imaging system is fully operational*

Scenario 15: Scanning of documents and Viewing down (Ascent Capture, Applicationxtender)

Scanning and viewing not necessarily down at same time (one can be up when the other is down).

PowerChart will be up if one or all of these are down).

15a) Ascent Capture The scan module for medical records

Notification to all departments by IT.

Units are told to not release documents for scanning until notified.

HIRS will pick up items once scanning can resume.

15b) ApplicationXtender Database of all scanned document

Scanned documents are unavailable until application back up.

For emergent cases call HIMS x5457.

Scenario 16: Clinical Reporting – Chart Server is down Chart Printing Server

Notify FMH/DC Customer Support Team of your issue.

Printing of the chart is down until brought back up.



Clinical Applications (Cont) SCENARIO What do I do? Scenario 17: Medical Record Printing down (MRP)

Printing of medical records will not be available until this application is fixed.

Notify FMH/DC IT Customer Support Team so they can dispatch the problem.

Scenario 18: IMPAC – Cancer Tx Center Used to plan radiation treatments **Different than the IMPAC - Blood Glucose Analyzer for Lab***

Pat Schooly at Cancer Treatment Center calls the manufacturer and they will send someone up to fix the problem.

Scenario 19: Comet down

Long-term care documentation – careplans

Utilize downtime forms.

Direct communication with the Arizona Help Desk regarding fixing application as they manage it.

Clinical Downtime Applications SCENARIO What do I do? Scenario 20: Read-Only Data Base Down (AKREAD)

Utilize PCLA.

Scenario 21: PCLA down Patient Chart Local Access – used for downtime to access information up to 3 days back. Pulls information during uptime periodically, information should be accurate within 2-6 hours

If a specific machine will not run PCLA, notify FMH/DC IT Customer Support Team and move to your other PCLA machine (as it’s likely at least one will work).

If unable toaccess any PCLA machine on your unit, call the Administrative Coordinator as they have access to PCLA – All locations.

Contact FMH/DC IT Customer Support Team.

Communications SCENARIO What do I do? Scenario 22: HILL-ROM Composer (Nurse Call System) is down Inpatient call system for nurse/staff/patient communications

If central station is down, call lights will still work but will not have voice communications. Designate personnel to monitor lights. If entire call system is down, make regular rounds to assess patient needs. Contact BioMed x1812 or through Admin Coordinator 800-607-3974 (pager).



Communications (Cont) SCENARIO What do I do?

Scenario 23: Widespread Phone Outage

Utilize emergency radios on the unit for communication.

Cellular phones are available at the FMH/DC IT Customer Support Desk and will be distributed during an outage to key individuals.

There will be designated “runners” to help with the flow of critical information. These people will have yellow vests on once a disaster has been declared. Runners will be designated on your unit at the time of a disaster.

Scenario 23a: Loss of Emergency Code Line (by dialing 86) (For use ONLY during phone outage)

Utilize emergency radios and have operator page on the back up overhead paging system.

There will be designated “runners” to help with the flow of critical information. These people will have yellow vests on once a disaster has been declared. Runners will be designated on your unit at the time of a disaster.

Scenario 24: Metrocall Paging System down

Call the operator to overhead page (for emergent situations).

Utilize phone system to call person directly (in or out of the hospital).

If phone system down, utilize emergency radio and/or cell phones as appropriate.

Scenario 25: Network Down The network is the connectivity between workstation and the server

See 25a-25c

25a) Network is partially down

Up to 1/3 of computers in your area may not be working.

Look for a PC that works and use that one, call IT immediately so the problem can be fixed.

25b) Network is completely down

Utilize FMH/DC downtime procedure and your units downtime tubs.

Use downtime requisitions/forms for all registration and orders.

Override Pyxis to take out meds as needed.

To clock in: swipe badge.

25c): Network connection to Denali Center and/or MDA building down

For new admissions, call FMH Admissions and have them register the patient.

Use downtime forms/requisitions for all orders.

Call in all requests for Blood Bank. Call department if you have not received faxed or printed orders.

Scenario 26: Vocera down

Wireless communication device used within FMH/DC.

Revert back to prior process of communications (phone, pagers, and designated runners if necessary).

Scenario 27: Printing is down

This could be a local hardware problem or a network problem.

Try printing to another printer in your area.

Notify FMH/DC Customer Support Team of your issue.



Other Applications SCENARIO What do I do?

Scenario 28: Emdeon down

Insurance eligibility inquiry

Department protocol is followed.

Claims: If phones are down, ZMOD is unable to transmit claims electronically but are stored until lines are up

again; at that time claims will be sent. Sometimes a phone number will change so if claims do not send – it’s practice to check the phone numbers.

Insurance eligibility: If the AS400/I-series/MS4 is down – this module will be down concurrently. If there is a

power surge the system has to be rebooted and resigned onto.

Scenario 29: WebMD

Electronic Claim Submission

In the event the external phone lines are not functioning, the system will hold claims and resend them when lines are operational.

Department protocol is followed.

Scenario 30: 3M – HDM Encoder: Coding software ***Web-based***

Log a ticket with the Support Desk

Will need to wait until application is back up in order to proceed

Scenario 29: 4 Rivers down Biomed and Engineering asset management tool ***Web- based***

Revert back to paper process used for work orders.

Scenario 30: TOAST down Designed to monitor quality and compliance within various departments – Tracer system ***Web-based***

Wait until the application is back up.

Continue to log info on paper and back enter the information when appropriate.

Scenario 31: Softmed Down

Clinical reporting of incident reports and adverse drug reactions. ***Web-based***

Use downtime forms to document.

Follow Downtime Policy and Procedure for notification of individuals involved if reporting an incident.

Scenario 32: Allscripts Down Allscripts is used by the Case Management Staff to perform Utilization Management, identify and address patient discharge needs, and document clinical assessments on patients

CMS Staff will document on paper during downtimes.

Use Case Management (CM) Notes to document discharge planning and assessment activities. Place a label with patient identifier on CM Notes downtime form and give to unit secretary for later scanning.

Use InterQual (IQ) Review Summary Worksheet to document all IQ reviews, avoidable/delay days, denial information and payer interactions.

CMS staff will receive referrals by pager or telephone as appropriate.

See Allscripts Downtime Process for Case Managers – Policy #10491 for more details and for recovery process

post-downtime.



Other Applications SCENARIO What do I do? Scenario 33: ScrubEX down Dispenses and accepts hospital uniforms

Alert Admin Coordinator – they have access to laundry and can grab a stack of clean scrubs. If Admin Coordinator is unavailable, call EVS Supervisor x4429 (24 hours x 7 days per week) to assist. Contact Gary Livengood via support desk to add users to a different machine if necessary or if multiple machines are

dysfunctional.

Scenario 34: Omnicell down

Patient charging system for medical supplies during hospitalization

ER/ICU: If unable to get into your cabinet in a downtime situation ONLY, contact your charge nurse or PCC for the key. ALL UNITS: paper forms are in your unit’s downtime tub. Please call Mikayla at x6940 or Murray at x5475 if there is a need for more. Once the form is full, or the system is back up – please fax the sheet to materials at x5087

Downtime

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Transcript of Downtime