Contingency Planning

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Download the PDF guide to access the checklist of recommended practices for self assessment and a supporting worksheet to identify action steps to achieve those recommended practices.

The Contingency Planning SAFER Guide identifies recommended safety practices associated with planned or unplanned EHR unavailability—instances in which clinicians or other end users cannot access all or part of the EHR. Occasional temporary unavailability of EHRs is inevitable, due to failures of software and hardware infrastructure, as well as power outages and natural and man-made disasters. Such unavailability can introduce substantial safety risks to organizations that have not adequately prepared. Effective contingency planning addresses the causes and consequences of EHR unavailability, and involves processes and preparations that can minimize the frequency and impact of such events, ensuring continuity of care.

EHR unavailability, which will occur in every EHR-enabled healthcare environment,2 represents a significant potential patient safety hazard that directly affects patient care. Documented potential hazards include an increased risk of medication errors,3 unavailability of images,4 and canceled procedures. The potential impact of EHR unavailability increases as such systems are deployed across multiple, geographically dispersed facilities within a healthcare system.1 The contingency planning team should include practicing clinicians to ensure that the technical components align with and support the clinical processes and workflows impacted by their decisions. The substitute workflows that must be designed and then employed during downtimes are particularly sensitive to clinician input and cooperation. In addition to the substantial initial contingency planning effort, a continuous, reliable review and maintenance process must be developed and followed. EHR safety and effectiveness can be improved by establishing proper downtime procedures, policies, and practices. The collaboration between clinicians and staff members in completing the self-assessment in this guide will enable an accurate snapshot of the organization’s EHR contingency planning status (in terms of safety) and, even more importantly, should lead to a consensus about the organization’s future path to optimize EHR-related safety and quality.

Interaction with HIPAA

While this guide focuses on patient safety, many of its recommendations overlap with standards and implementation specifications of the HIPAA Security Rule, which focuses on ensuring the confidentiality, integrity, and availability of electronic protected health information. Because the focus of the guide differs from that of the Security Rule, completing the checklist here will not equate with compliance with HIPAA. However, creating a contingency plan as required by the HIPAA Security Rule will address many, but not all, of the recommended safety-oriented practices in this guide. We encourage coordination of completion of the self-assessment in this SAFER Guide with contingency planning for purposes of HIPAA compliance to provide a uniform approach to patient safety and data protection.

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