I am sure that most practices do not spend time thinking about redundant systems to manage and maintain their EMR, EHR, and Practice Management System. We had a major slow down earlier this week when we needed to move all practices to the back-up systems. This made me think of what does a physician office do if their server is down? Do they lose production for a ½ day, a day, two days, or a week? Does an office have a back-up plan if the systems are down? What is the disaster recovery plan? Good cloud-based companies have thought through these issues to maintain your data. When there is a system outage, how a team reacts, learns and improves their systems is important for minimizing the down time for practices.
One of our practices placed the outage disaster recover into perspective for me. Prior to switching to PhysicianXpress, this large practice had a server in their office for the practice management system. A practice in the same building complex moved to a server-based EMR System a few years ago. This year, there was a major lightning storm that ‘fried’ the router of the practice we served and ‘fried’ the server of the practice that was on a server-based practice. Our client needed to install a new router and they were back up and running with no loss of data. The other practice was not so lucky. A server in the office can deliver faster speeds; the down side is that the practice needs a qualified team of IT personnel either on staff or on call to insure back-ups are occurring multiple times per day. Even in this case, not many practices have redundant systems (2+ servers hosted in different locations to minimize chance of loss in a disaster like a building fire).
No system is available 100% of the time. An up time average of 99.95% means that there are >4 hours a year that the system is down. We evaluate system components and design to identify areas to increase system up time as well as verification of data back-up systems. We are in the pursuit of the perfect system design and operation – this requires continuous improvement reviews and changes. When evaluating a system, there are some good questions to ask including: how many locations and how often is the data backed up for my practice? Who is responsible for the back-up? What has your company done in the last 12-24 months to improve the back-up and recovery? If using a cloud based system, can I maintain a daily copy of our records and schedule on a local computer for read-only access?
There are a number of reports related to the reliability of the data in Electronic Health Record Systems. In fact, there are even international publications looking at the actual reliability of the data in the system (see http://www.scielo.cl/pdf/jtaer/v4n2/art06.pdf
By Alhaqbani, Josang, and Fidge). This component shows that there are data errors by other systems or users of the system. In the United States, some insurance companies calculate the HEDIS scores of practices (e.g. evaluating the vaccines given to a select number of patients versus an established recommended vaccine schedule). Their systems miss data routinely (e.g. they capture the vaccines given in the office but not the vaccines given in the Hospital or other locations). This is another area of Medical Reliability compared to the reliability of the hardware or software.