Townsville Hospital & Health Service iemr Business Continuity Plan 12 July 2016

Townsville Hospital & Health Service ieMR Business Continuity Plan 12 July 2016 V1.0 Authority and planning responsibility The Townsville Hospital ...
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Townsville Hospital & Health Service ieMR Business Continuity Plan

12 July 2016 V1.0

Authority and planning responsibility The Townsville Hospital integrated electronic Medical Record (ieMR) Business Continuity Plan (BCP) is authorised by the Chief Operating Officer, Townsville Hospital and Health Service (THHS) in accordance with the requirements of the Disaster Management Act 2003. This plan applies to all services and business units utilising the ieMR within THHS. Amendment List Proposed amendments to the THHS ieMR BCP are to be forwarded to: Title:

Chief Information Officer

Organisation: Townsville Hospital and Health Service Phone:

(07) 4433 1492

Email:

[email protected]

Any amendment to the Townsville Hospital and Health Service (THHS) ieMR BCP will be inserted into the plan as distributed, with the responsible officer certifying the amendments inclusion. All proposed changes will be subject to recommendation, approval and endorsement of the Townsville HHS Executive Team. The Townsville HHS ieMR BCP will be updated electronically and available via the Townsville intranet site. The electronic copy is the master copy and as such is the only copy that is recognised as being current. Version

Date

By

Description

0.1

23/06/16

Amie Raymond

Draft

0.2

30/06/16

Amie Raymond

New template and amendments

0.3

06/07/16

ieMR Digital Release Team in Consultation with CIS

Update of Downtime Business Continuity Procedures

1.0

12/07/16

Robyn Copley & Paul Sullivan

Content Verification Review and Finalisation

Distribution The Townsville HHS ieMR BCP is available to all Townsville HHS staff via the Townsville HHS website. Plan Review and Testing The Townsville HHS ieMR BCP will be reviewed annually or following any significant event. The Chief Operating Officer is responsible for ensuring the review of this plan. The plan will be tested following the initial completion of the plan and after any major revisions of the plan.

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CONTENTS Introduction..................................................................................................................................................... 1 1.1 General .................................................................................................................................................. 1 1.2 Aim ........................................................................................................................................................ 1 1.3 Purpose .................................................................................................................................................. 1 1.4 Intent ..................................................................................................................................................... 1 1.5 Scope ..................................................................................................................................................... 1 1.6 Governance............................................................................................................................................ 2 1.7 Planning assumptions ............................................................................................................................ 2 1.8 Supporting plans .................................................................................................................................... 2 2.0 Notification Process ................................................................................................................................... 3 2.1 External Notification .............................................................................................................................. 3 2.1.1 Scheduled Notification iAppS ieMR ..................................................................................................... 3 2.1.2 Unscheduled Notification Application Management Support (AMS)& iAppS ieMR ............................. 3 2.3 THHS Internal Notification ..................................................................................................................... 3 2.3.1 Scheduled Notification ........................................................................................................................ 3 3.0 Concept of operations ................................................................................................................................ 5 3.1 Incident Assessment .............................................................................................................................. 5 3.2 Response Management ......................................................................................................................... 5 3.3 Roles and Responsibilities ...................................................................................................................... 6 3.4 Townsville Hospital and Health Service Emergency Operations Centre (HEOC) ...................................... 8 3.5 Operational Debriefing .......................................................................................................................... 8 4.0 Risk Mitigation ........................................................................................................................................... 9 4.1 Hosted Solution...................................................................................................................................... 9 4.2 Downtime viewer (DTV) ......................................................................................................................... 9 4.3 Emergency Power .................................................................................................................................. 9 5.0 Routine Management .............................................................................................................................. 11 5.1 System Management Activities ............................................................................................................ 11 5.2 Preparedness Activities ........................................................................................................................ 11 5.2.1 Keeping Plans and Procedures Current .............................................................................................. 11 5.2.2 Checking Resource Availability.......................................................................................................... 11 5.2.3 Training ............................................................................................................................................ 12 6.0 Continuity Procedures.............................................................................................................................. 13 6.1 Paper based functions .......................................................................................................................... 13 6.2 Downtime ............................................................................................................................................ 13 6.2.1 General continuity procedures .......................................................................................................... 13

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6.3 Business Continuity Plan Scenarios ...................................................................................................... 14 6.3.1 ieMR Unplanned Downtime .............................................................................................................. 14 6.3.2 ieMR Planned Downtime .................................................................................................................. 17 6.3.3 HBCIS and ieMR Delayed HL7 Messages ........................................................................................... 20 6.3.4 HBCIS Downtime ............................................................................................................................... 23 6.3.5 ieMR and HBCIS Planned Downtime ................................................................................................. 25 6.3.6 KOFAX Downtime ............................................................................................................................. 25 6.3.7 Unplanned Power outage ................................................................................................................. 26 6.3.8 Emergency Department PASLink Downtime ...................................................................................... 28 6.4 Testing ................................................................................................................................................. 29 7.0 Power failure ........................................................................................................................................... 30 8.0 Loss of Network ....................................................................................................................................... 31 9.0 Device Failure .......................................................................................................................................... 31 10.0 Recovery Plan ........................................................................................................................................ 31 Appendix 1 - Definitions, Acronyms and Abbreviations ................................................................................. 36 Appendix 2 - Unit Downtime Monthly Checklist ............................................................................................ 38 Appendix 3 – Downtime Viewer (DTV) Locations ........................................................................................... 40 Appendix 4 – Downtime Viewer Location Maps............................................................................................. 41

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Introduction 1.1 General Townsville Hospital and Health Service (THHS) ieMR Business Continuity Plan (BCP) (this plan) provides for an all-hazards comprehensive approach to business continuity. It has been prepared to enable the efficient coordination of HHS and other resources to flexibly meet the demands of a disruptive event at the operational level through to the organisational level. This plan is supported by the Townsville HHS Emergency and Disaster Management Plan which provide detailed guides to assist management decision-making and staff response to various emergency situations.

1.2 Aim The aim of this plan is to reduce the impact of a disruptive ieMR event on THHS critical business functions and staff, patient and visitor safety.

1.3 Purpose The purpose of this plan is to clearly outline the procedures that need to be undertaken in the lead up to, during and after the unplanned loss of access to the ieMR, including supporting systems and medical devices as they directly impact the ieMR. This plan will include:     

Authority to activate the BCP, including triggers leading to this decision Notification processes Roles and responsibilities Communication channels to be utilised Business Continuity Procedures for planned and unplanned downtime

1.4 Intent This plan is not a single unified plan – it is a set of specialised ‘action-orientated’ response plans detailing the continuity strategies and the actions required for their effective implementation.

1.5 Scope The Townsville HHS ieMR critical business function categories are as detailed: Critical Business Function

Scope of services

Information Communication & Technology Systems

ieMR and the individual modules that make up the ieMR & supporting systems where the ieMR is affected. The Queensland Health Network (Wi-Fi and Ethernet) and the Local Area Networks where the ieMR is affected.

Disaster Management/ Emergency Preparedness

Power Outages where the ieMR is affected. Services or key resources that underpin organisational preparedness to respond to incidents/events and activation of DM plans and sub-plans.

Table 1 THHS ieMR critical business function categories

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1.6 Governance The ieMR BCP is a contributory sub-plan designed to specifically detail ieMR downtime procedures. The ieMR BCP is managed and governed through the Emergency Planning and Continuity Management Committee. The Executive Compliance and Risk Committee are responsible for the effective oversight of the Townsville HHS Business Continuity Management (BCM) program. The Townsville HHS Emergency Planning and Continuity Management Governance Committee are responsible for the effective management of the Townsville BCM program and to ensure that BCM is embedded across all facilities in the Townsville HHS.

Figure 1 THHS BCM Governance Structure

1.7 Planning assumptions The following planning assumptions have been made: 

This plan does not replace the requirement for detailed BCP at the department/business unit level



All disruptive events requiring Townsville HHS-wide coordination will be managed in accordance with the Townsville HHS Emergency and Disaster Management Plan

1.8 Supporting plans The following plans support this BCP: 

THHS Disaster Management Plan



THHS Business Continuity Plan



TTH Local Support Model



Health Services Information Agency (HSIA), Support Model and System Management Guide (SMSMG).

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2.0 Notification Process 2.1 External Notification 2.1.1 Scheduled Notification iAppS ieMR iAppS (previously SIM) ieMR are the Service Owners and are responsible for the end to end service of the system. Along with other iAppS and technical operations groups in eHealth Queensland, they are responsible for providing technical support for the ieMR solution and enterprise infrastructure (ie. Data centres, wide area network, local area networks etc.) and manage the relationship with the system and support vendor, Cerner. Planned downtime will be approved by the Townsville Hospital however; the downtime will be undertaken and managed by eHealth Queensland, specifically iAppS ieMR. Notification of planned downtime will occur a minimum of two weeks prior to the date and time of the downtime. This notification will be conducted via email to the DL-ieMR Change Notification distribution list. Membership of this distribution list will include key representatives within the business including, but not limited to:      

THHS Medical Records Team Leader, CIS (PH: 07 4433 1334) THHS Medical Records Scanning Unit (PH: 07 4433 1360) THHS Data Quality Manager, CIS (PH: 07 4433 4133) THHS Information Technology Services (ITS), Technical Operations Manager (PH: 4433 1389) THHS Emergency Department (ED) Business Practice Improvement Officer (BPIO) (PH: 07 4433 4235) After Hours Nurse Manager, AHNM (PH: 4433 3485)

2.1.2 Unscheduled Notification Application Management Support (AMS)& iAppS ieMR Cerner are the system vendor who will provide specialist application support from AMS division, including system and technical incident and problem support. In the event of unplanned downtime recorded by Cerner AMS, iAppS ieMR will be notified in the first instance for commencement of notification and communication with the THHS. Notification and communication will commence as soon as possible and iAppS ieMR will be responsible for monitoring the system.

2.3 THHS Internal Notification 2.3.1 Scheduled Notification Notification of planned downtime throughout THHS will be provided by CIS via email to ieMR users across the HHS. Planned notification advice will include the date and time of scheduled outage, proposed duration of outage, the services and systems that will be impacted if known and when normal service will be restored.

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2.3.2 Unscheduled Notification Notification of unplanned downtime will occur as soon as an issue is detected by CIS via email to ieMR users across the HHS. Notification advice will provide any information in relation to the outage that is available at the time. The Chief Information Officer (CIO) at their discretion will notify the Health Service Chief Executive (HSCE), Chief Operating Officer (COO), Executive Director of Medical Services (EDMS) and the After Hours Nurse Manager (AHNM) based on the severity of the outage (See section 3.0). Notification process or flow of information for both scheduled and unscheduled outages will follow the below flow diagram.

Issue Raised Externally

Issue Raised Internally

Unplanned Downtime Only AMS notify iAppS

Site User Calls 1800 198 175, or logs job through self-service centre

iApps Notify Site

iApps notified if escalation required

of Issues raised external to HHS

Site Updated via email

Site Distributes Information throughout HHS via distribution list emails

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3.0 Concept of operations 3.1 Incident Assessment The Townsville HHS will use the following incident classification system for ieMR downtime: Incident type

Description

Planned Downtime

Planned or Scheduled Downtime occurs with provision of notice of time of outage and length of outage.

Planned Downtime with Unplanned Extension of Downtime

Planned or Scheduled Downtime occurs with provision of notice of time of outage and length of outage however downtime occurs beyond planned length of outage.

Unplanned Downtime

Unplanned or Unscheduled Downtime includes any downtime with no prior notice of outage available.

Major Unplanned Downtime

Major Unplanned Downtime is any unplanned or unscheduled Downtime lasting 2 hours or more with no known resolution time or a resolution time of greater than 2 hours. This will be managed as a Code Yellow, internal emergency.

3.2 Response Management The following guidance informs incident response management responsibilities and actions: Incident

Length of Downtime 0-6 hrs

Managed by

Actions

CIS

 Provide Notice to ieMR users via email across HHS  Activate Unit Downtime Procedures  DTV devices remain unused unless clinically necessary

Planned Downtime with unplanned extension of downtime

6 – 10 hrs NB. >10hrs = Major Unplanned Downtime

AHNM

   

Minor Unplanned Downtime

0-2 hrs

CIS/AHNM

  

Planned Downtime

Major Unplanned Downtime, Code Yellow

>2 hrs CIS/AHNM with no known resolution time OR Resolution time > 2 hrs



AHNM Notifies ND on call Continue Unit Downtime Procedures Activate THHS ieMR BCP Plan DTV devices remain unused unless clinically necessary Activate THHS ieMR BCP Plan Active Unit Downtime Procedures DTV devices remain unused unless clinically necessary Notify COO and ND on call at discretion

    

Notify COO HEOC Stand-Up Continue Unit Downtime Procedures Continue THHS ieMR BCP Plan DTV devices accessed by all units

Table 3 THHS BCM incident classification

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3.3 Roles and Responsibilities A number of key roles will be essential for the success of the ieMR BCP and its use during downtimes, they are: Role

Responsible

After Hours Nurse Manager (AHNM)



Notification of unplanned downtime to ND on call and COO at discretion as per section 3.2 of this plan.



Maintaining access to DTV drawer key in the event that a unit/s misplaces theirs.



Ensure all units have activated their unit downtime procedures

Nursing Director (ND) on call

Will respond to correspondence from AHNM of unplanned downtime in accordance with section 3.2 of this plan.

Shift Coordinator (Emergency Officer (EO) & downtime Coordinator)

The shift coordinator is the identified EO and Downtime Coordinator in each clinical/operational unit. In the event of a downtime this role will ensure:

Hospital Incident Controller

Chief Information Officer

Manager, Clinical Information Services

THHS ieMR BCP V1.0



Downtime Kits are replenished and easily accessible



724 Downtime viewer passwords and key are accessed and used by the area if a Code Yellow is activated or if clinically required.

Under Code Yellow once the Incident Management Team (IMT) is formed, the Health Incident Controller is responsible for: 

The co-ordination and implementation of the Incident Action Plan and the return to normal operations once the emergency is resolved.



The ieMR Business Continuity and Disaster Recovery Plan.



Coordinating the initial communication of a major unplanned outage to HHS Executive and Emergency Management Coordinator.



Liaising with various ICT support teams on resolution activities – ie. iAppS ieMR, local DH project team, local SDU, local IT Services.



Updating HEOC/HIC/CIO as required on progress and status based on information provided by iAppS ieMR.



Determining extent of clinical impacts and subsequent communication to CIO and HIC.



Dissemination of restoration communications and status updates to HHS staff.



Enacting local medical record downtime procedures.



Providing support to clinical areas regarding use and access of 724 downtime processes if required during a major unplanned outage. 6

Role

Responsible

eHealth Qld iAppS ieMR



The end to end service supporting the ieMR systems.



Managing the relationship with the various sections of Cerner such as the Application Managed Service (AMS), Hosting and Managed Service (HMS).



Managing the major incident and resolution activities across all parties – vendors, other eHealth teams.



The coordination and support where there is integration or interfacing with systems managed by other technical support teams (e.g. HBCIS, Auslab etc.).

Townsville HHS IT Services

 Supporting and managing the 724 Downtime viewer service for the HHS including liaising and co-ordination of stakeholders  Validating the synchronisation of ieMR with the data pumps and downtime viewers – this does not include confirming validation of clinical data  Installation services for Downtime viewer client to designated and licensed laptops.  Backup and restoration services for the 724 Downtime Viewer data pumps (servers)

eHealth Qld Technical Operations (e.g. NOC, EOC)

 Managing and maintaining the enterprise infrastructure that supports the delivery and access to ieMR applications (networks, data centres, firewalls).

eHealth Qld Townsville SDU

 the support of local enterprise infrastructure within Townsville HHS and end user computing environment including local area network (wired and wireless), desktops laptops, All-In-One devices, printers.

The appointments listed above are the default appointments for key roles. Other Executive Directors and senior staff may also be called upon to support the IMT in the event of a Code Yellow, subject to the nature of the disruptive event. The primary appointment listed above is responsible for identifying at least two other staff members within their management structure to provide continuity for the role.

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3.4 Townsville Hospital and Health Service Emergency Operations Centre (HEOC) In the event that a THHS Emergency Operations Centre needs to be activated the primary location shall be: THHS North Block, Executive Board Room Phone: (07) 4433 3385 Email address: [email protected] In the event that an alternate HEOC Command Room is required, this will be located at the following site: THHS Level 2 Acute Block, Surgical Meeting Room Phone: (07) 4433 3385 Email address: THHS-EOC-MGR @health.qld.gov.au Please refer to the TTH Emergency and Disaster Management Plan for the full list of resources available at each location.

3.5 Operational Debriefing Recovery helps to bring closure to an event and includes debriefing of personnel involved to ensure learning can be captured and processes refined to improve the health response emergency and disaster events. Key Recovery Activities are: 

Retrospective Documentation



Scanning



Documentation of the event



Replenishing stock in unit downtime kits



Ensuring passwords for the downtime 724 viewer is reset (if required) and distributed to all relevant units



Ensure Downtime Viewer (DTV) keys remain with the Shift Coordinator



Document lessons learnt



Recommendations



Procedure & BCP review

It is the responsibility of the Hospital Incident Controller to ensure a timely debriefing of all involved staff in the THHS response. Outcomes from the debrief will be used to inform further revisions to the Plan. Key staff from THHS may participate in other debriefings as required.

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4.0 Risk Mitigation A number of risk mitigation strategies have been put in place as part of the Digital Hospital Program and ieMR implementation. The items included below are specifically called out.

4.1 Hosted Solution Cerner is contracted to provide hosting services covering three aspects of system management:   

Hosting Management Services Operational Management Services, and Application Management Services.

Having the hosted solution means that the data and system configuration is held at the Cerner data centre. Therefore, any incident which impacts the THHS data centre or the THHS site may result in loss of access to ieMR data however the data itself should not be compromised. Cerner operates a highly secure and fully redundant environment and has contractual commitments regarding service levels. This means that there is full failover of hardware and full replication of the solution to an alternate location in real time to cover any failure in their environment. Cerner is also responsible for ensuring standard operational processes such as backup, system management and monitoring and security are of the highest standard.

4.2 Downtime viewer (DTV) THHS will be using Cerner’s 724 Access Downtime Viewer (724 DTV) which provides 7x24 hour access to clinical data currently available in the ieMR when access is not available. The 724 DTV provides access to 30 days of historical clinical data up until the point of loss of access to the ieMR and/or network. Summary patient information can be viewed and/or, allowing clinical staff to continue to provide care. It is important to note that the 724 DTV will not provide a view of any prior scanned documents or CTG and ECG results. Printing from the 724 DTV devices is only possible when the network remains available. The use of 724Access is described below in the contingency procedures however THHS recommends that priority is placed firstly on patient care and that 724 DTV is only accessed in the case of a Code Yellow, unless it is clinically necessary to do so. The 724 Access Downtime Viewer application runs on secure, dedicated laptops which are strategically located in 10 locations across the hospital, providing easy access for clinical areas (See Appendix 3 for detailed list of locations, see Appendix 4 for DTV location maps). Although careful consideration has been given to clinical priority areas for the placement of the 724 DTV laptops their portability allows extra contingency in the event that some areas may be experiencing a greater clinical urgency for the 724 DTV. DTV laptops are not to be used for any purpose other than to view medical information during system downtime

4.3 Emergency Power Uninterrupted Power Supplies (UPS) and generators are used to provide emergency power at THHS across a wide range of relevant functions/equipment. This includes the 724Access Downtime Viewer laptops (battery operated and can be recharged at emergency power points), the wireless network, bedside medical devices (battery operated and can be THHS ieMR BCP V1.0

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recharged at emergency power points), workstations on wheels (battery operated and can be recharged at emergency power points) and the telephone systems.

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5.0 Routine Management The primary components of routine management of the BCP and associated procedures are shown below.

5.1 System Management Activities Please refer to the TTH Local Support Model for Routine System Management Activities.

5.2 Preparedness Activities 5.2.1 Keeping Plans and Procedures Current The ieMR BCP and supporting documentation will be kept up-to-date to ensure it remains valid to the business activities currently undertaken at the sites. Consideration of the ieMR BCP and supporting documentation will be included within each project undertaken with THHS. As part of the planning of each project, an assessment of the impact on the ieMR, the ieMR BCP, the downtime procedures and other supporting documentation will be completed. Following any downtime test or actual downtime, the learning from the downtime review process will be incorporated into the BCP and supporting documentation as required. Each time the ieMR BCP or supporting documentation is updated, it will be provided to the relevant parties, and incorporated into downtime packs and training and testing materials.

5.2.2 Checking Resource Availability An important part of preparedness is making sure that the required resources are available during downtime. Each month the Unit Downtime Coordinator in each unit will check the following: The downtime pack is accessible and contains the correct and a sufficient amount of forms, up- to-date instructions, a valid 724Access Downtime Viewer application username and password, pens, additional paper and toner for the downtime printer The downtime computer can be accessed via the key and the computer is turned on The downtime printer has sufficient paper and toner in it Should any of these elements be missing the Unit Downtime Coordinator will immediately replenish the resources. The Unit Downtime Coordinator will need to report any technical issues to the Info Service Centre on 1800 198 175. A monthly checklist for the Downtime Kit and 724Access Downtime Viewer in each unit has been provided in Appendix 2.

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5.2.3 Training Training in the ieMR BCP and supporting procedures will occur in a number of contexts; As part of the testing processes described above and as part of Disaster Management training and exercises. To assist with staff knowledge of the downtime systems/processes and ease of use during downtimes, quick reference guides are included in the downtime pack. Annual dry-run training will occur in order to maintain staff training and knowledge on downtime procedures.

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6.0 Continuity Procedures 6.1 Paper based functions A number of functions will still be managed using paper forms. These include (but are not limited to): •

Medication Management



Acute Resuscitation Plan (ARP)



Consent Forms

These functions are not included in the continuity procedures below and these forms will not be included within the Downtime Kits.

6.2 Downtime 6.2.1 General continuity procedures During the event of a downtime a number of continuity procedures will need to be completed to ensure that patient care and safety is maintained for the duration of the event. These procedures are shown below. Please note these procedures do not include supporting system downtime except where the downtime directly impacts the ieMR. These procedures are focussed on access to and the recording of information within a patient’s chart, patient safety and care should take priority. All paper forms completed during downtime are to be stored with the patient’s Current Encounter Chart (CEC).

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6.3 Business Continuity Plan Scenarios The following information relating to the Utilisation and Preparation of 724 Access Downtime Viewers (724 DTV’s)and Downtime Kits, relates to all Business Continuity Plan Scenarios: 

THHS recommends that the 724 DTV is accessed only in the event of a Code Yellow, if however the clinical requirement for DTV’s is necessary as a last contingency, the Shift Coordinator will access the DTV at their discretion.



If DTV’s are activated, staff will be able to access them using the Quick Reference Guide located within the downtime kit.



DTV keys and password are available within the Downtime Kit, accessible via the Shift Coordinator.



Paper order forms, clinical documentation forms, spare wrist band labels, specimen labels and CEC labels are available in the downtime kit within their ward/area



Re-familiarise staff with Downtime procedures and quick reference guides



Implement local unit plans for downtime as required



Printing from DTV’s is only possible if the network is still available, if the network is not available the DTV is a view only device.

NB. Scanned documentation, ECG and CTG results are not viewable on the 724 DTV.

6.3.1 ieMR Unplanned Downtime Overview of Downtime Procedure: ieMR PowerChart Unplanned Downtime Task

During ieMR Downtime

After ieMR Downtime

Document Scanning

 

No scanning activities can be conducted Continue preparation of documents



Patient registration and updating patient demographics

  

Continue to register in HBCIS.



Continue to view and update patient information in HBCIS. Registrations and data updated in HBCIS will not be viewable in the ieMR.



THHS ieMR BCP V1.0

Scanning Unit staff to commence scanning. Any batches that did not reach the ieMR during the 30 minute pre downtime window will need to be rescanned. HBCIS remains the ‘source of truth’ for patient demographics and updates to occur in HBCIS as soon as possible Verify any registration / patient information (e.g. demographics) updated in HBCIS have flowed through to ieMR.

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Overview of Downtime Procedure: ieMR PowerChart Unplanned Downtime Generating ieMR Encounters & Printing labels & Wrist Bands

   

Direct Entry Documentation within the ieMR



Verify that patients ‘arrived’ or ‘admitted’ into HBCIS during downtime have had a corresponding encounter generated in the ieMR. Once the encounters have appeared in the ieMR, ieMR labels can be printed for those encounters. Patient Wrist Band labels can be printed to replace any hand written wrist band labels during downtime.

Staff will hand write on spare blank labels located within the Downtime Kit.



It will not be possible to view and enter clinical information in the ieMR.



Resume direct entry of documentation against the current encounter within the ieMR.



Complete documentation on paper using the ieMR downtime forms available in the downtime kit, templates are available on QHEPS or the Digital Hospital website. Store all forms in the patient’s CEC or EW.



Documentation completed during downtime may remain in the CEC or EW for scanning on discharge. However, critical notes should be sent for priority scan in order to minimise the disruption of chronology within the ieMR.



Please note: Risk assessment and allergies & alerts downtime forms are printed and completed by hand; Progress note downtime templates can be typed into then printed. Ensure the five (5) points of identification are recorded on all documentation (i.e. first name, last name, DOB, gender, URN).

      

THHS ieMR BCP V1.0





 Orders

Patients ‘admitted’ or ‘arrived’ patients in HBCIS will not generate a viewable encounter in the ieMR. It will not be possible to manually create an ED encounter in the ieMR It will not be possible to print ieMR labels, including pathology specimen labels. It will not be possible to print Patient Wrist Band labels.

It will not be possible to view and make orders in the ieMR  Complete Pathology and Radiology order requests on the paper  order forms available in the downtime kit. Results can still be viewed in Auslab, The Viewer and IMPAX/XERO, provided these systems are not affected by the downtime. If Pathology results are reported over the phone a Pathology Report (Verbal) form should be used to record the results provided. If the DTV has been accessed active and past radiology tests and procedures may be viewed and/ printed from the DTV. provided to theradiology treating clinician. Upon request result reports will be manually created and provided to the treating clinician.

Resume direct entry of orders within the ieMR Orders complete on paper during downtime will be processed and results will feed into the ieMR when system available.

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Overview of Downtime Procedure: ieMR PowerChart Unplanned Downtime Device Integration





ECG and CTG’s completed during downtime may remain in the CEC or EW for scanning or filing on discharge. However, critical results should be sent for priority scan in order to minimise the disruption of chronology within the ieMR.

In addition to above;   Clinicians will create an ephemeral (temporary) record in Microsoft Word to record clinical information at the point of care.   This temporary record must be recorded on a Word template that includes 3 key points of identification: Name, DOB, URN. 

Copy and paste ephemeral record created in Microsoft Word into the ieMR. The temporary record is to be deleted following finalisation of the ieMR progress note (and not saved to any network drives). Documentation completed on manual forms during downtime may remain in the CEC for scanning. However, critical notes should be sent for priority scan in order to minimise the disruption of chronology within the ieMR.

   Community

Integrated device results such as CTG and ECG will not feed directly into the ieMR. Results are to be printed direct from each machine with paper print-outs placed in the CEC for scanning. Additional paper is available in the Unit Downtime Kit. Previous results may not be viewable and if clinically required subsequent tests should be conducted.



Further downtime forms will be available in the travel downtime kit specific for community clinicians. Store all forms in the patient’s CEC or EW. NB: Community staff will not have access to the 724 DTV’s, however historical charts may be accessed if available/required. Emergency

In addition to above 

THHS ieMR BCP V1.0

Quick Registration & Subsequent Triage of new patients in Firstnet will not be available. Triage Nurses will utilise the Triage Downtime forms located within the Emergency Department Downtime Kit.



Nursing Staff will retrospectively triage all patients triaged on paper forms during the downtime in order to maintain reporting data.

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6.3.2 ieMR Planned Downtime Overview of Downtime Procedure: ieMR PowerChart Planned Downtime      

Prior to Downtime

  

Recommendation: Continue to document within the ieMR until downtime commences. Prior to downtime commencing, clinicians should print any documentation recorded within ieMR that is required to remain available during the ieMR downtime period. Add relevant clinical information to Patient Flow Manager and incorporate into clinical handover and ensure clinical handover adequately prepares the on-coming shift to take accountability and responsibility for provision of clinical care throughout downtime period. Ensure allergies recorded in the ieMR are also recorded on the medication chart. Verify functionality of ieMR downtime templates on the QHEPS Ensure all scanning ceases at least 30 minutes prior to scheduled downtime Clear all scanning queues and ensure validation queue has been cleared and the documents appear in the ieMR (minimum 30 mins before downtime to ensure documents are not lost) Service Groups to replenish stocks of all forms for downtime kits in their respective units Ensure paper is available and loaded ready for printing in integrated devices Print latest clinical information and latest ECG and CTG images for patient s where it is clinically relevant.

Task

Prior to ieMR Downtime

During ieMR Downtime

After ieMR Downtime

Document Scanning



Ensure all scanning ceases at least 30 minutes prior to scheduled downtime

 

No scanning activities can be conducted Continue preparation of documents



Patient registration  and updating patient  demographics

Continue to register in HBCIS.

 

Continue to register in HBCIS.



 Generating ieMR Encounters & Printing labels, Wrist Bands

 

 

THHS ieMR BCP V1.0

Continue to view and update patient information in HBCIS. Ensure that all data entry is complete and up to date



Ensure all ieMR Encounters are  completed prior to planned downtime Ensure that there are adequate  stocks of ieMR Patient Labels and blank wrist bands located in  the CEC Print Patient Lists from ieMR Ensure all patient wrist bands are printed prior to downtime

Continue to view and update patient information in HBCIS.  Registrations and data updated in HBCIS will not be viewable in the ieMR. Patients ‘admitted’ or ‘arrived’ patients in HBCIS will not generate a viewable encounter in the ieMR. It will not be possible to manually create an ED encounter in the ieMR It will not be possible to print ieMR labels.



Scanning Unit staff to commence scanning. Any batches that did not reach the ieMR during the 30 minute pre downtime window will need to be rescanned. HBCIS remains the ‘source of truth’ for patient demographics and updates to occur in HBCIS as soon as possible Verify any registration / patient information (e.g. demographics) updated in HBCIS have flowed through to ieMR. Verify that patients ‘arrived’ or ‘admitted’ into HBCIS during downtime have had a corresponding encounter generated in the ieMR. Once the encounters have appeared in the ieMR, ieMR labels can be printed for those encounters.

17

Overview of Downtime Procedure: ieMR PowerChart Planned Downtime Direct Entry Documentation within the ieMR

 

Orders

   

Ensure adequate CEC’s or EW are available Ensure Downtime Kits are  replenished with up to date resources Pre-Print any relevant documents  - Patient tracking list - Patient Summary (Diagnosis, Allergies, Alerts, Problem List, Admission Details)  - Vital Signs, Progress Notes, recent ECG etc.

It will not be possible to view and enter clinical information in the ieMR. Complete documentation on paper using the ieMR downtime templates available on QHEPS. Print forms and store in the patient’s CEC or EW.

Where possible complete all required orders in the ieMR prior to downtime. Ensure adequate manual order forms are available in the Downtime Kit Print a list of Orders completed and pending Print required specimen labels prior to downtime

It will not be possible to view and make orders in   the ieMR Complete Pathology and Radiology order requests on the paper order forms available in the downtime kit. Results can still be viewed in Auslab, The Viewer and IMPAX/XERO, provided these systems are not affected by the downtime. If Pathology results are reported over the phone a Pathology Report (Verbal) form should be used to record the results provided. If the DTV has been accessed active and past radiology tests and procedures may be viewed and/ printed from the DTV. Upon request radiology result reports will be manually created and provided to the treating clinician.

     

THHS ieMR BCP V1.0



Resume direct entry of documentation against the current encounter within the ieMR. Documentation completed during downtime may remain in the CEC or EW for scanning on discharge. However, critical notes should be sent for priority scan in order to minimise the disruption of chronology within the ieMR.

Please note: Risk assessment and allergies & alerts downtime forms are printed and completed by hand; Progress note downtime templates can be typed into then printed. Ensure the five (5) points of identification are recorded on all documentation (i.e. first name, last name, DOB, gender, URN). Resume direct entry of orders within the ieMR Orders complete on paper during downtime will be processed and results will feed into the ieMR when system available.

18

Overview of Downtime Procedure: ieMR PowerChart Planned Downtime Device Integration

   

Emergency



THHS ieMR BCP V1.0

Print the most recent ECG where clinically relevant. Print the most recent CTG where clinically relevant. Ensure adequate memory space available on unit devices Ensure thermal paper is loaded into machines and that the Downtime Kit contains further stock As Above

   

Integrated device results such as CTG and ECG  will not feed directly into the ieMR. Results are to be printed direct from each machine with paper print-outs placed in the CEC for scanning.  Additional paper is available in the Unit Downtime Kit. Previous results may not be viewable and if clinically required subsequent tests should be conducted.

In addition to above  Triage of new patients in Firstnet will not be available. Triage Nurses will utilise the Triage Downtime forms located within the Emergency Department Downtime Kit.



ECG and CTG’s completed during downtime may remain in the CEC or EW for scanning or filing on discharge. However, critical results should be sent for priority scan in order to minimise the disruption of chronology within the ieMR. Staff are to resume normal use of device integration within the ieMR.

Nursing Staff will retrospectively triage all patients triaged on paper forms during the downtime in order to maintain reporting data.

19

6.3.3 HBCIS and ieMR Delayed HL7 Messages Overview of Downtime Procedure: Delayed HL7 Messages Between HBCIS and ieMR Patient ‘admitted’ or ‘arrived’ on HBCIS by staff. Staff checks the ieMR and a corresponding current inpatient / outpatient encounter has not appeared. This is due to a HL7 messaging delay between HBCIS and the ieMR. During a HL7 message delay, both HBCIS and the ieMR will continue to be available for viewing, but there will be limitations for direct data entry into ieMR.

Identification of a HL7 message delay Task

During Downtime

After Downtime

Patient registration and updating patient demographics





HBCIS remains the ‘source of truth’ for patient demographics



Generating ieMR Encounters & Printing labels



The ieMR current encounter will not be automatically created.

 

Continue to ‘admit’ and ‘arrive’ patients in HBCIS It will not be possible to print ieMR labels for current encounters that have not yet appeared in the ieMR. Staff are to ensure that the five (5) points of identification are recorded on all documentation (e.g first name, last name, DOB, gender, URN). Staffs to identify patients affected by the message delay and routinely check if the relevant information has arrived in this patient’s ieMR encounter.

Upon resolution of the HL7 messaging delay, real-time HBCIS Admission. Transfer and Discharge messaging will be restored and automatic encounter generation from HBCIS admissions and arrivals will resume. Continue to register, update and view patient information in HBCIS. Continue to ‘admit’ and ‘arrive’ patients on HBCIS – automatic ieMR encounter generation has been restored. Resume printing of labels from the corresponding ieMR encounter.



Direct Entry Documentation within the ieMR

THHS ieMR BCP V1.0

Continue to register, update and view patient information in HBCIS.



It will not be possible to document against the current encounter in the ieMR for Outpatients and Emergency.



Inpatients admitted prior to downtime will have an encounter which can be documented against.



Where there is no encounter available complete documentation on paper using the ieMR downtime templates available on QHEPS. Print forms and store in the patient’s CEC or EW.



Ensure the five (5) points of identification are recorded on all documentation (i.e. first name, last name, DOB, gender, URN).

  



Resume direct entry of documentation against the correct inpatient / outpatient encounter within the ieMR.



Paper documentation completed during the HL7 messaging delay should be checked to ensure the appropriate ieMR label has been affixed.

20

Overview of Downtime Procedure: Delayed HL7 Messages Between HBCIS and ieMR Orders

       

Device Integration

Community





Device integration will still be available for encounters created prior to the Downtime.



Where there is no current encounter available, ECG’s and CTG’s are to be printed and stored within the CEC or EW as per the manual process described in ieMR Planned/Unplanned Downtime plans.



During a HL7 message delay, both HBCIS and the ieMR will continue to be available for viewing, but it will not be possible to view and enter clinical information in the ieMR.

 

THHS ieMR BCP V1.0

 During a HL7 message delay, both HBCIS and the ieMR will  continue to be available for viewing, but it will not be possible to view and enter clinical information in the ieMR. It will not be possible to view and make orders in the ieMR for Outpatients and Emergency. Inpatients admitted prior to downtime will have an encounter which can be ordered against. Complete Pathology and Radiology order requests on the paper order forms available in the downtime kit. Results can still be viewed in Auslab, The Viewer and IMPAX/XERO, provided these systems are not affected by the downtime. If Pathology results are reported over the phone a Pathology Report (Verbal) form should be used to record the results provided. If the DTV has been accessed active and past radiology tests and procedures may be viewed and/ printed from the DTV. Upon request radiology result reports will be manually created and provided to the treating clinician.  During a HL7 message delay, both HBCIS and the ieMR will continue to be available for viewing, but it will not be possible to view and enter clinical information in the ieMR.

Encounters created prior to downtime may still be documented against. Where an encounter cannot be created, an ephemeral (temporary) record in Microsoft Word will be created to record clinical information at the point of care.



 

Resume direct entry of orders within the ieMR Orders complete on paper during downtime will be processed and results will feed into the ieMR when system available.

ECG and CTG’s completed during downtime may remain in the CEC or EW for scanning or filing on discharge. However, critical results should be sent for priority scan in order to minimise the disruption of chronology within the ieMR. Staff are to resume normal use of device integration within the ieMR.

Resume direct entry of documentation against the correct outpatient encounter within the ieMR. Any manual documentation completed during the HL7 messaging delay should be checked to ensure the appropriate ieMR label has been affixed.

21

Overview of Downtime Procedure: Delayed HL7 Messages Between HBCIS and ieMR 

This temporary record must be recorded on a Word template that includes 3 key points of identification: Name, DOB, URN.



Further downtime forms will be available in the travel downtime kit specific for community clinicians. Store all forms in the patient’s CEC or EW. NB: Community staff will not have access to the 724 DTV’s, however historical charts may be accessed if available/required. Emergency

THHS ieMR BCP V1.0

In addition to above



As above



Quick Registration functionality of FirstNet will be compromised.



Advise CIS of FirstNet URN’s used during the delay so that record merging can occur if necessary.



Manual Search of HBCIS to locate URN



Quick Registration of patient using the HBCIS URN or if a new patient, continue through Quick Registration and assign a FirstNet URN.



Register patient in HBCIS as normal, assigning to the FirstNet URN is applicable.



Triage to occur as normal once quick registration has occurred.

22

6.3.4 HBCIS Downtime Overview of Downtime Procedure: HBCIS Down Prior to Downtime



Task

During HBCIS Downtime

After HBCIS Downtime

Patient registration and updating patient demographics



Unable to register in HBCIS. Utilise pre-registered ‘unknown’ URN’s when necessary



HBCIS remains the ‘source of truth’ for patient demographics and updates to occur in HBCIS as soon as possible

 

Unable to view or update patient information in HBCIS. Follow HBCIS downtime processes.



Enter all downtime information recorded on downtime sheets / forms.



Enter ‘arrive’ and ‘admit’ information into HBCIS to allow the associated current inpatient and outpatient encounters to be generated in ieMR Verify that patients ‘arrived’ or ‘admitted’ into HBCIS during downtime have had a corresponding encounter generated in the ieMR. Once the encounters have appeared in the ieMR, ieMR labels can be printed for those encounters.

Generating ieMR  Encounters & Printing labels   

Direct Entry Documentation within the ieMR





Tracking of CEC’s

THHS ieMR BCP V1.0



Ensure adequate stocks of HBCIS downtime sheets / forms are available. These are located on QHEPS

 Unable to ‘admit’ or ‘arrive’ patients in HBCIS for inpatients or outpatients. No new inpatient or outpatient encounters will be generated in ieMR as these patients cannot be ‘admitted’ or ‘arrived’ on HBCIS. It will not be possible to print ieMR labels for new inpatients or outpatient admissions / arrivals during downtime. Continue manual creation of ED encounters within ieMR to generate a current ED encounter and print associated ieMR labels  Any patients who are not able to be ‘arrived’ or ‘admitted’ into HBCIS during downtime will be unable to have documentation directly entered into the ieMR against a current inpatient / outpatient encounter. Instead, complete documentation on paper using the ieMR downtime templates available on QHEPS. Print forms and store in the patient’s CEC.  Continue ‘business as usual’ direct data entry into the ieMR for all ED patients, chronic renal encounter patients and all patients who were already ‘admitted’ or ‘arrived’ prior It will not be possible to track CEC’s or EW’s on HBCIS.



Once the patient who were unable to be ‘admitted’ or ‘arrived’ during the downtime have had these functions completed in HBCIS and a corresponding current encounter has been generated in the ieMR, staff are to resume direct entry of documentation against the correct inpatient / outpatient encounter within the ieMR. Documentation completed during downtime may remain in the CEC or the EW for scanning on discharge. However, critical notes should be sent for priority scan in order to minimise the disruption of chronology within the ieMR. Resume tracking CEC’s and EW’s on HBCIS.

23

Overview of Downtime Procedure: HBCIS Down Orders

Device Integration



No new inpatient or outpatient encounters will be generated in ieMR as these patients cannot be ‘admitted’ or ‘arrived’ on HBCIS.



It will not be possible to order pathology or radiology tests in the ieMR for those patients without a current encounter.



Encounters already existing in ieMR prior to the downtime will not be effected and can be ordered against.



No new inpatient or outpatient encounters will be generated in ieMR as these patients cannot be ‘admitted’ or ‘arrived’ on HBCIS. Device integration will still be available for encounters created prior to the Downtime.



Community

Emergency

THHS ieMR BCP V1.0



Where there is no current encounter available, ECG’s and CTG’s are to be printed and stored within the CEC or EW as per the manual process described in ieMR Planned/Unplanned Downtime plans.



No new outpatient encounters will be generated in ieMR as these patients cannot be ‘arrived’ on HBCIS.



It will not be possible to print ieMR labels for new outpatient during downtime.



Encounters already existing in ieMR prior to the downtime will not be effected



 







In addition to above





Quick Registration is to occur with a Firstnet UR to be assigned





Triage and encounter creation can continue as normal



HBCIS downtime forms should be used to capture correct patient demographic information.

Once the patient who were unable to be ‘admitted’ or ‘arrived’ during the downtime have had these functions completed in HBCIS and a corresponding current encounter has been generated in the ieMR, staff are to resume direct entry of ordering against the correct inpatient / outpatient encounter within the ieMR. Orders complete on paper during downtime will be processed and results will feed into the ieMR when system available. Once the patient who were unable to be ‘admitted’ or ‘arrived’ during the downtime have had these functions completed in HBCIS and a corresponding current encounter has been generated in the ieMR. Staff are to resume normal use of device integration within the ieMR.

Once the patient who were unable to be ‘arrived’ during the downtime have had these functions completed in HBCIS and a corresponding current encounter has been generated in the ieMR, staff are to resume direct entry of documentation against the correct outpatient encounter within the ieMR. Documentation completed during downtime may remain in the CEC or the EW for scanning on discharge. However, critical notes should be sent for priority scan in order to minimise the disruption of chronology within the ieMR. As Above Advise CIS of FirstNet URN’s used during the Downtime so that record merging can occur

24

6.3.5 ieMR and HBCIS Planned Downtime Overview of Downtime Procedure: Both ieMR PowerChart and HBCIS Planned Downtime Refer to the individual processes listed above relating to planned downtime for both ieMR PowerChart and HBCIS

6.3.6 KOFAX Downtime Overview of Downtime Procedure: KOFAX Scanning Application Down Prior to Downtime

 

Task

During Kofax Downtime

After Kofax Downtime

Document Scanning

 



Analyse the three scanning queues, starting from where the scanning process stopped working.



Check that previous documents in the batch that stopped did arrive in the ieMR



Check all batches completed in QC during the 30 minute period immediately prior to the downtime commencing have reached the Validation queue. Any batches missing from the Validation queue will need to be rescanned.



Batches that have made it into the Validation queue should be taken through the QA process to guarantee completeness



Resume scanning unit duties to scan documents into the ieMR



As the Scanning Unit resumes scanning duties, scanned documentation will become available for viewing

Viewing of patient information

THHS ieMR BCP V1.0



Medical Records Scanning Unit to have all of the scanning up-to-date prior to the planned downtime Communicate date, time and duration of planned downtime to appropriate staff

No scanning activities can be conducted Continue preparation of documents

The ieMR remains available to view patient information, perform direct data entry and print patient labels for all patients with existing encounters and scanned documentation.

25

6.3.7 Unplanned Power outage Overview of Downtime Procedure: Unplanned Power Outage Affecting ieMR Workstations not on Uninterrupted Power Supply, Network Still Active Note: critical areas may be able to access the ieMR and HBCIS by:

using a desktop PC that is connected to a ‘uninterrupted power supply’



using a notebook that has been charged prior to power outage

Task

During Power Outage

Document Scanning

Unless staff have access to a devices connected to uninterrupted power  supply there will: No scanning activities can be conducted  Continue preparation of documents

Scanning Unit staff to commence scanning. Any batches that did not reach the ieMR during the 30 minute pre downtime window will need to be rescanned.

Patient registration, updating patient demographics, admission, transfers, discharges, appointment scheduling functions

Unless staff have access to a devices connected to uninterrupted power  supply: It will not be possible to view / update patient information in HBCIS.   It will not be possible to complete Admission, Transfer or Discharges within HBCIS   It will not be possible to perform tasks associated with HBCIS  Appointment Scheduling

HBCIS remains the ‘source of truth’ for patient demographics and updates to occur in HBCIS as soon as possible

THHS ieMR BCP V1.0

After Power Outage

Verify any registration / patient information (e.g. demographics) updated in HBCIS have flowed through to ieMR. Resume HBCIS Admission, Transfer and Discharge transactions Resume HBCIS Appointment Scheduling transactions

26

Overview of Downtime Procedure: Unplanned Power Outage Affecting ieMR Workstations not on Uninterrupted Power Supply, Network Still Active Note: critical areas may be able to access the ieMR and HBCIS by:

using a desktop PC that is connected to a ‘uninterrupted power supply’



using a notebook that has been charged prior to power outage

Task

During Power Outage

After Power Outage

Generating ieMR Encounters & Printing labels

Unless staff have access to a devices connected to uninterrupted power supply: It will not be possible to create an ED encounter in the ieMR  It will not be possible to create an Inpatient, Pre-Arrival, Outpatient or No Visit encounter in the ieMR.  It will not be possible to print ieMR labels.  It will not be possible to view other repositories containing clinical information (e.g. The Viewer)  Consider phoning another ieMR site or area located outside the area affected by the power outage to view and telephonically report required clinical information if applicable



Verify registration / information updated in HBCIS from downtime sheets / forms have flowed through to ieMR.

 

Verify patient Admission, Transfer and Discharge data capture entered in HBCIS from downtime sheets / forms has generated a corresponding encounter in the ieMR. Verify patient Appointment Scheduling data capture entered in HBCIS from downtime sheets / forms has generated a corresponding encounter in the ieMR.



Resume ED encounters within the ieMR



Resume printing of ieMR labels

Unless staff have access to a devices connected to uninterrupted power supply: It will not be possible to view and enter clinical information in the ieMR.



Resume direct entry of documentation against the current encounter within the ieMR.



Documentation completed during downtime may remain in the CEC for scanning on discharge. However, critical notes should be sent for priority scan in order to minimise the disruption of chronology within the ieMR.



Resume CEC and EW tracking on HBCIS

Direct Entry Documentation within the ieMR

   Other

Staffs are to complete documentation on paper using the appropriate Progress note form or pre-printed clinical forms. Ensure the five (5) points of identification are recorded on all documentation (i.e. first name, last name, DOB, gender, URN). Store completed paper-based forms in the patient’s CEC or EW.

Unless staff have access to a devices connected to uninterrupted power supply there will: It will not be possible to track CEC’s and EW on HBCIS

THHS ieMR BCP V1.0

27

6.3.8 Emergency Department PASLink Downtime Overview of Downtime Procedure: Emergency Department - PASLink PASLink is an integrated system that allows FirstNet to perform a quick registration and generate a UR for new Emergency Department patients to TTH. This is necessary to allow triage and treatment to proceed without undue delays. The Quick Registration process only collects minimal patient data (name, gender & DOB) and still requires a full HBCIS registration to be complete directly after the Quick Registration. Task Patient registration, triage and updating patient demographics

During PASLink Downtime

After PASLink Downtime

 



  

THHS ieMR BCP V1.0

Manual UR search of HBCIS will be undertaken. Quick Registration for new patient encounters in FirstNet will still be able to occur If UR number cannot be located or the patient is new to the hospital a FirstNet UR should be assigned. Triage can continue as normal Continue to register, update and view patient information in HBCIS

Upon resolution of PASLink advise CIS of the FirstNet URN’s used during the Downtime.

28

6.4 Testing The ieMR BCP and supporting documentation will be tested annually, at a minimum. Planned downtime provides an opportunity, in a relatively controlled and low risk environment, to ensure that staff are aware of what to do and that systems and processes work effectively. However planned downtimes usually occur when volumes and staffing are low in order to ensure minimum disruption, therefore testing will occur outside of these times.

THHS ieMR BCP V1.0

29

7.0 Power failure THHS has back-up generators to ensure that areas are able to continue to function in the event of power loss. Procedures around this are documented within the Facility Continuity Plans. It is important to note that during a power failure scanning is unable to continue. For information on what to do when the Kofax (scanning) system is not available see section 6.0 above. The 724 Access Downtime Viewer and supporting medical devices have their own local back-up batteries. Information relating to this is shown below. Device

Approximate battery back-up duration

724 Access Downtime Viewer – a standard Windows 7 MOE laptop is used to access the 724 Access Downtime Viewer application. This laptop will show the battery power available before a recharge is required.

4-8 hours

Phillips ECG Carts – the battery power indicator will indicate time remaining on each charge

At least 45 minutes of continuous Rhythm printing

THHS ieMR BCP V1.0

30

8.0 Loss of Network The contingency procedures documented above include loss of network causing loss of connection to the ieMR.

9.0 Device Failure All faults and issues with medical devices should be managed using the THHS Local Support Model.

10.0 Recovery Plan This Recovery Plan is intended as a guide only. Patient safety principles take precedence. The decision to enter clinical information into the ieMR manually, or have the information scanned and reconciled upon discharge post a downtime period will be at the discretion of the Local Line Reporting Manager in consultation with the Divisional Executive Team. 0 – 2 Hour Downtime

2 – 4 Hour Downtime

4 - 12 Hour Downtime

> 12 Hour Downtime

Admission History (Admission clinical assessment)

Initial manual process.

Admissions (Registration of admissions)

Initial manual process. Retrospective documentation of all admissions and registration of patients will be required during Recovery.

Retrospective documentation by medical and nursing staff.

Initial manual process. Scanned documentation reconciled upon discharge. Summary documented. Critical elements entered into ieMR, e.g. including RRT activations, AHD, ARP orders



Implement *HBCIS Downtime Plan as required



Maintain Patient Flow Tracking Log to document Admissions during downtime



Retrospective input and correction of data will be required during Recovery Phase.

*Consider additional AO support in high patient flow areas, e.g. ED, Preadmissions. Admissions (Patient Flow Tracking)

THHS ieMR BCP V1.0

Initial manual process. Retrospective documentation of all admissions and registration of patients will be required during Recovery. 

Implement *HBCIS Downtime Plan as required



Maintain Patient Flow Tracking Log to document Admissions during downtime



Retrospective input and correction of data will be required during Recovery Phase. *Consider additional AO support in high patient flow areas, e.g. ED, Preadmissions.

31

0 – 2 Hour Downtime

2 – 4 Hour Downtime

4 - 12 Hour Downtime

> 12 Hour Downtime

Allergies & Alerts

Initial manual process. Allergies to be documented on paper Medication Chart. Retrospective documentation by medical/ nursing/ pharmacy staff during Recovery Phase.

Problem list

Initial manual process. Retrospective documentation by medical staff

Discharges (Patient Flow Tracking)

Initial manual process. Retrospective documentation by medical staff

Initial manual process. Retrospective documentation by medical staff *Consider retrospective scanning of clinical documentation in high patient flow areas (*will not be entered in the Problems list for future encounters)

Initial manual process. Retrospective documentation of all discharges of patients will be required during Recovery. 

Implement *HBCIS Downtime Plan as required



Maintain Patient Flow Tracking Log to document Discharges during downtime



Retrospective input and correction of data will be required during Recovery Phase.

*ED: Patient ‘Statement of Attendance’ record to be mailed to patient’s address *Consider additional AO support in areas that have experienced high discharge numbers, e.g. ED Discharge Summaries

Retrospective documentation of discharge summaries during Recovery Phase by medical staff as indicated.

Height and Weight

Retrospective documentation by nursing staff.

*As clinically indicated: Retrospective documentation to be considered by nursing staff.

Retrospective documentation by nursing staff.

*As clinically indicated: Retrospective documentation to be considered by nursing staff.

I & O Fluid Balance

THHS ieMR BCP V1.0

During downtime to be documented on Observations chart or progress notes – to be reconciled in scanning process.

During downtime to be documented on Observations chart or progress notes – to be reconciled in scanning process.

32

0 – 2 Hour Downtime

2 – 4 Hour Downtime

4 - 12 Hour Downtime

> 12 Hour Downtime

Documented on Progress Notes – reconciled during scanning process.

Interdisciplin ary Plan of Care (Progress Notes)

Documented on Progress Notes, entered into ieMR retrospectively by health clinician

Inter-hospital Transfers Out of THHS

The Electronic Medical Record is to be printed from the Downtime 724 Viewer prior to transfer.

Medication History

*Consider summary report as clinically indicated



Photocopy paper documents prior to transfer



Maintain Patient Flow Tracking Log to document Inter-hospital Transfers during downtime



Retrospective input and correction of data will be required during Recovery Phase.

Printing of medication history from 724 Viewer. Retrospective documentation by medical staff

Documented on Progress Notes – reconciled during scanning process. *Consider summary report as clinically indicated

Medications

Current processes are to document Medication Orders on the paper based Medication Chart. Future processes once electronic Medications Medication is implemented: To Be Advised.

Pre-existing Paper-based Documents

No change. Reconciled at scanning upon discharge. Paper documents to remain in CEC.

Pathology Orders



Manual process during Downtime.



Paper based order forms to be utilised. Existing patient ieMR labels or handwritten patient information to be utilised on order form as available.



Specimen tubes to be handwritten as no access to specimen label printing.

Refer to AUSLAB Downtime Plan Pathology Results



Results made available on AUSLAB.



In the event of a concurrent AUSLAB downtime; critical results to be phoned to Ordering Medical Officer by Pathology. All other results printed to areas as required.



Pathology results to be reconciled to the ieMR chart during the Recovery Phase by Pathology staff.

Refer to AUSLAB Downtime Plan

THHS ieMR BCP V1.0

33

0 – 2 Hour Downtime Patient Flow

2 – 4 Hour Downtime

4 - 12 Hour Downtime

> 12 Hour Downtime



Maintain Patient Flow Tracking Log to document Admissions/Transfers/Discharges during downtime



Retrospective input and correction of data will be required during Recovery Phase.



Some units may be required to use Whiteboards to maintain an accurate tracking list map during a Downtime (e.g. ED)

Consider additional strategies for transparency of bed availabilities during Downtime utilising Patient Flow Manager (PFM). Patient identification wristbands

Patient labels



Existing ieMR armbands to remain on patient.



Hand written armbands to be used on new patients (and patients without an armband during downtime).



New ieMR armbands printed post downtime.



Existing ieMR labels to be used. In the event that there are no ieMR labels available, all clinical documentation forms are to be handwritten with the patient’s full name, UR Number, and Date of Birth.



Additional ieMR labels are to printed post downtime. ieMR labels to be attached to all clinical documentation forms prior to scanning at discharge: *Refer to ieMR Business Rules – patient labels.

Progress Notes

*Retrospective documentation.

Radiology Orders



Manual process during Downtime.



Paper based order forms to be utilised. Existing patient ieMR labels or handwritten patient information to be utilised on order form as available.



Order form to be faxed or hand-delivered to Radiology during Downtime period.



Results made available on IMPAX.



In the event of a concurrent IMPAX downtime; critical results to be phoned to Ordering Medical Officer by Radiologist. All other results printed to areas as required.



Radiology results to be reconciled to the ieMR chart during the Recovery Phase by Radiology staff.

Radiology Results

THHS ieMR BCP V1.0

Scanned documentation. Summary documented. Critical elements entered into ieMR, e.g. including RRT activations, deterioration of patients, AHD, ARP orders

34

0 – 2 Hour Downtime Registration

2 – 4 Hour Downtime

4 - 12 Hour Downtime

> 12 Hour Downtime

Initial manual process. Retrospective documentation of all admissions and registration of patients will be required during Recovery.



Implement *HBCIS Downtime Plan as required



Maintain Patient Flow Tracking Log to document Admissions during downtime



Retrospective input and correction of data will be required during Recovery Phase.

*Consider additional AO support in high patient flow areas, e.g. ED, Preadmissions. Risk Assessments

Admission Nursing Risk Assessments to be delayed until post Downtime period. Patient Safety principles to be applied as indicated (e.g. Falls Risk interventions, Pressure injury preventative strategies, etc).

Specimen Labels

Patient information on specimen containers to be handwritten during downtime.

Transfer of Patients (internal)

Initial manual process. Retrospective documentation of all internal transfers of patients will be required during Recovery. 

Implement *HBCIS Downtime Plan as required



Maintain Patient Flow Tracking Log to document Transfers during downtime



Retrospective input and correction of data will be required during Recovery Phase.

*Consider additional AO support to assist with retrospective documentation Vital Signs

THHS ieMR BCP V1.0

All vital signs are documented on the paper based observation forms by the nursing staff and stored in the CEC. Vital signs to be added to the ieMR during the Recovery Phase (via manual process)

Enter the last 3 sets of vital signs Document summary of clinical deterioration into the ieMR during the Recovery Phase as clinically indicated.

35

Appendix 1 - Definitions, Acronyms and Abbreviations Name

Definition

AO

Administration Officer

ARP

Acute Resuscitation Plan

AUSLAB

State wide laboratory information management system (LIS) provided by PJAS

BCP

Business Continuity Plan

CEC

Current Encounter Chart

Cerner

Clinical software provider contracted by QH for the ieMR

DDU

Day of Discharge Unit

DOH

Department of Health

ECG

Electrocardiogram

ED

Emergency Department

EDS

Enterprise Discharge Summary

eHealth

The program responsible for implementing electronic health solutions into Queensland Health

eMR

Electronic Medical Record

ESI

External Systems Inbound Interface (Cerner)

EW

Encounter Wallet

HBCIS

Hospital Based Corporate Information System – Current Qld Health Patient Admissions System (PAS) – iSoft product.

HEOC

Health Emergency Operations Centre

HL7

Health Level Seven messaging standard for healthcare environments

HMS

Hosting and Management Services Agreement (ICT2239c) with Cerner Corporation.

iAppS

Integrated Application Services

ICT

Information and Communications Technology

ICU

Intensive Care Unit

ieMR

Integrated Electronic Medical Record build on the Cerner Millennium Solution

IMPAX

Radiology System used to view images

IMT

Incident Management Team

IT

Information Technology

Millennium

Cerner clinical application suite used for the QH ieMR

OERR

Order Entry Results Reporting

OPD

Outpatients Department

THHS ieMR BCP V1.0

36

Name

Definition

PASLink PFM

Patient Flow Manager

PJA Solutions

AUSLAB software vendor

PowerChart

Cerner Millennium Desktop Application

QH

Queensland Health

QRIS

Queensland Radiology Information System (RIS)

RRT

Rapid Response Team

SIM

Systems Integration Management Team

SIM ieMR

Systems Integration Management Team – integrated electronic Medical Record

THHS

Townsville Hospital and Health Service

TTH

The Townsville Hospital

UPS

Uninterrupted Power Supply

UR

THHS ieMR BCP V1.0

37

Appendix 2 - Unit Downtime Monthly Checklist Monthly Downtime Checklist Unit Ward:

Completed By: Name:

Date Check Completed: Task /

/

Downtime Kit 1

Downtime kit is easily accessible

2

Forms: all required forms are in the kit

3

Reference Guides are in the kit

4

Adequate wristbands and pens are in the kit

5

Spare paper is in the kit (including for

6

Spare ieMR labels including Specimen labels are in the kit

7

Spare Pens

Signature: Variance – Action

Action

Required

Completed (Initial and Date)

724 Downtime Viewer 8

Key to access the secure cabinet can be located and works

9

The Downtime 724 Viewer computer is turned on (it should be left on at all times) and plugged into

10

emergency power The Username and Password for the Downtime 724 system can be located and works

11

Patients for that unit can be located in the Downtime 724 system (tracking list)

THHS ieMR BCP V1.0

38

12 Patient data in the Downtime 724 system is complete and up to date 13 Patient data for that unit can be printed from the Downtime 724 system

THHS ieMR BCP V1.0

39

Appendix 3 – Downtime Viewer (DTV) Locations No.

Server No.

Physical Location of DTV

Workstation I.P Address

Port Number

Room No.

Printer Connected

1

1

Emergency Department, Acute Fishbowl, (bottom of shelf near med reg computer)

10.208.128.157

TSVHS-NB-N1-AS 568S

NG.920B

QH10441701

2

2

Emergency Department, Short Stay Unit (Underneath Telemetry Monitor)

10.208.128.158

TSVHS-NB-NG-AX 359X

NG.933

QH10449828

3

1

Women's & Children's Clinics, Reception Area (Underneath Battery Chargers, R/H side of desk)

10.209.32.102

U6UC-SWG-146

AG.470

QH30733184

4

2

Children's Ward, On shifties desk near printers

10.209.34.89

U6-WD-WG-140

WG.160

QH30726139

5

1

Cardiac Ward & Surgical Clinical Decisions Unit (SCDU)

10.208.129.120

TSVHS-NB-N1AU-172U

N1.066

QH30582244

6

2

Renal Dialysis, Second Nurses Bay (R/H side underneath bench)

10.209.17.121

U6AC-NE-1079

A1.141

QH10441715 - Need to confirm

7

1

10.209.14.208

UCWD-W1-070

W1.175

QH30735104

8

2

10.208.130.93

AC-NW-02-019X

N2.122

QH30735219

9

1

Maternity Unit, Nurses Station Left handside beneath patient charts, under bench

10.208.69.30

TSVHS-WD-L2AY-065

W2.8150

QH10082520

10

2

Surgical Ward 2, Back of Nurses Bay, Underneath top shelf that houses Battery charges

10.209.26.64

U6WD-E2-150

W2.133

QH30735205

THHS ieMR BCP V1.0

Medical Ward 3, (W1.175, Cupboard in front of nurses bay) Neonatal Unit (Special Care Nusery), Pinnacles Meeting Room, Underneath top cupboard, Printer located in Neonatal Unit

40

Appendix 4 – Downtime Viewer Location Maps

THHS ieMR BCP V1.0

41

THHS ieMR BCP V1.0

42

THHS ieMR BCP V1.0

43

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