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Downtime – Clinic Operations (101.056)

Downtime – Clinic Operations (101.056) - Policies, Administrative, UWMF, UWMF-wide, Clinic Operations, Health Link

101.056

UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: Downtime – Clinic Operations

Effective Date: April 17, 2012
Approval: See Authorization
Supersedes Policy Date: October 8, 2010
Contact: See Authorization
Reviewed: February 5, 2013


PURPOSE:
To provide guidelines for UWMF managed clinics during Health Link system outages. The goal is to help assess the
scope of the outage, communicate the outage to the Support Center, deploy tools and
supplies to clinic staff and providers, have systems in place to ensure both the integrity of patient
data in Health Link, and assure that routing of patient data or results in Health Link is maintained.

POLICY:
UWMF managed clinic employees are responsible for knowing this procedure and their expected roles
during system outages. The policy should be reviewed with new employees and providers at the
clinic or department and again annually.

Information Services requires that each Clinic Manager appoint three members of each site/department/clinic to be
Outage Charge Persons, including the Clinic Manager and after-hours contact information (ex: manager cell phone).
These names will be communicated to the Support Center and to the Safety Coordinator before an outage occurs or bi-
annually. Any changes to this list of names will be communicated on a timely basis. The first available person on the list
will be the Outage Charge Person. The other two will act as back-up.

Include after-hours procedure for downtime (I.S. on call – who to contact, etc)

SUPPLIES:
Each site or department should have a Downtime Kit available. Included in the Downtime Kit:
1) Downtime Visit Navigator form: To be used by reception, providers and clinical staff in the course of a patient visit or
telephone/refill encounter. Entry can take place in Health Link after the system is restored (see Procedure Section
#5).
2) Service Records and Forms: To be used by providers, clinical staff, laboratory staff and radiology staff as a temporary
means of ordering tests and documenting charges. *Note: service records are sent to clinics with annual revisions
from the Encounter Form Specialist in PBS. The phone number is 608-829-5244.
3) Downtime procedure for each specific department/site/clinic that indicate roles, levels of responsibility, and the
specific communication requirements and procedures that should be followed (as applicable) after recovery of the
system.
4) Health Link downtime instructions which are organized by level of outage.
5) Downtime PC and Printer: Information Systems will provide the hardware, location of the Downtime PC/printer, and
instructions on how to use the downtime printing program.
6) The location of downtime capable EKG/Spiro machines (if available in your clinic).

PROCEDURE:
1) Gather information about the outage. Outage Charge Person (first available of the three on the clinic’s list) will
determine whether the instance involves:
a) ___Power Outage
b) ___Health Link Down
c) ___Internet Down
d) ___How many PCs and/or Winterms are unavailable after rebooting
e) ___Phone System Down
f) ___GroupWise Down

2) Communicate the Outage
a) Outage Charge Person places call to the Support Center at Cisco X5-5474 or (608) 829-5474 [long distance: 1-
800-829-5474], communicating:
i) Site/department/clinic affected

ii) Details about the outage obtained above in Procedure #1 (specific rooms or workstations, applications,
systems, telephones, power affected, time outage began)
iii) Their name and complete phone number where they can be reached (should be a cell number if phones are
down)
iv) If Outage Charge person leaves a message when calling the Support Center they should mark it urgent
(following instructions from the voice mail). The Support Center will return the call within 15 minutes when the
call is marked urgent. If there is no response, please call the Support Center again.
***NOTE*** The level of outage will be determined by the Support Center. For more information about the
support center, please see the MF Support Center Policy on U-connect.
b) Outage Charge Person ensures that all affected users are notified and updated of downtime status
c) Outage Charge Person collaborates with the Support Center to review step by step downtime instructions
(included in downtime kit) based on the level of outage (Clarify LEVELS to the outage charge person/manager
and how to get in through alternative means).
i) Alternative Access: Normal access to Health Link is down however alternative access is still available.
ii) Level 1, 2, or 3: Health Link is only accessible via Health Link Downtime PTA and paper documentation is
necessary.
iii) Level 4: No access to Health Link or Health Link Downtime PTA. Downtime printing and paper
documentation are necessary.
d) Outage Charge Person and Support Center contact should discuss possibility of getting laptop and/or use of
wireless aircard to the site.

3) Initiation of Paper Systems (Level 1-4 Outage)
a) Level of Outage
i) Level 1-3 – Users should log into the Health Link Downtime PTA environment
ii) Level 4 – When this level of system outage is declared by the Support Center, the Clinic Manager, Outage
Charge Person, or delegate should print and distribute downtime reports to appropriate staff
iii) More information can be found in the Health Link Downtime Instructions by Level of Outage – This document
can be found in the downtime section of the Health Link Outpatient Manager’s manual on U-connect.
b) Front desk/central registration should keep track of :
i) Patients checking in: Notify clinical staff of arrivals so patients can be roomed
ii) Patients phone calls: Use Downtime Visit Navigator forms or department-specific telephone message form to
route telephone/refill messages to clinical staff
iii) Patient copays: Enter into the system after recovery and mail receipt to patient if applicable
iv) Patients checking out: After recovery, each dept will determine if any After Visit Summaries will be distributed
to patients.
c) Designated staff should:
i) Distribute paper encounter forms from the “Downtime Kit” to all providers in rooms
ii) Use and/or distribute paper downtime visit navigator forms for documentation of the visit or telephone/refill
encounter
d) Document follow-through of telephone/refill encounters. (Dictation can be used for provider documentation.)
e) Providers should begin using paper forms as a temporary means of documenting visits, orders, charges,
diagnoses. (Dictation can be used for documenting the note.)
f) Clinic Laboratory staff should refer to Laboratory Downtime Procedure. Lab will return paper service records to
clinical staff for tracking after recovery. Lab staff will print extra copies of the SML lists as necessary for tracking
results after recovery.
g) Clinic Radiology staff should ensure that providers and clinical staff have appropriate radiology service records
and that they are returned to clinical staff for tracking after recovery.

4) Communicate updates to all staff and providers
a) Support Center should communicate updates in outage status to site Outage Charge Person via IS Online (U-
Connect), GroupWise, telephone or cell phone call
b) Outage Charge Person(s) or delegate will communicate updates to all affected staff and providers

5) Recovery procedures – at the clinic or patient care location:
a) Once outage is resolved and recovery is established, the Support Center will notify the Outage Charge Person of
the All Clear. The Outage Charge Person should note the time of recovery.
b) Outage Charge Person will notify all users to TURN ON affected equipment and log back in, if instructed to do so
by Support Center
i) Clinic Manager or Outage Charge Person will work with clinical staff and providers

(1) enter/abstract all information from paper forms initiated, Using discrete data fields when appropriate.
(e.g.Allergies, Medications, vitals, histories, forms, etc.) Begin with the “dot downtime” (.downtime)
smartphrase: “The clinical information below was entered after the encounter because of a system
outage that occurred at X:XX am/pm and was restored at X:XX am/pm.”
(2) Clinicians can dictate their notes or clinical staff or manager can assist with documentation in the
notes section.
(3) enter LOS, diagnosis, orders,etc into Health Link
(4) EKGs, tracings, spirometries can be sent to 414-SCANNING-HIS

“All hands on deck” may be necessary to ensure everything is caught up in the EMR/HER
*Clinic Managers may consult with Scanning, HIM, CDS or Clinic Operations for additional support for extended
outages.
c) Patient’s record will be documented with the “dot downtime” smartphrase so each record affected has accurate
information about the system outage (see 6a below).
d) Various other data can be sent to 414-SCANNING-HIS (EKG tracings, spirometry, forms) for consideration to be
scanned.,
e) Clinic Manager will ensure that all lab and imaging results have been received for tests performed and that they
are communicated to the patients.
f) Clinic Manager will work with providers to ensure dictated and entered documentation has been recovered.
Clinic Manager to review provider and nurse schedules to ensure all encounters have been closed.
6) Recovery procedures – in I.S.:
a) Before communicating to site(s) that users can log back in, Support Center will ensure that Image is the same
when system is upgraded or refreshed.

WRITTEN BY: Jennifer Cullen
Kevin Hennessey
Sandy Jacobson
Ellen Johnson
Sara L'Herault
Tyler Novogoratz
Sandy Schumacher
Joleen Sisler

AUTHORIZATION AND ANNUAL REVIEW:
Jennifer Cullen
Elaine Gerke
Jody McClain
Gary Olson

MEDICAL DIRECTOR REVIEW: