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Policies,Clinical,UW Health Clinical,Medical Records and Communication,Medical Record

Ambulatory Health Link Downtime and Recovery (3.2.5)

Ambulatory Health Link Downtime and Recovery (3.2.5) - Policies, Clinical, UW Health Clinical, Medical Records and Communication, Medical Record

3.2.5


UW HEALTH CLINICAL POLICY 1
Policy Title: Ambulatory Health Link Downtime and Recovery
Policy Number: 3.2.5
Category: UW Health
Type: Ambulatory
Effective Date: September 29, 2016

I. PURPOSE

To establish a process for continuing the services and care of patients as related to Health Link in the event
of a planned or unplanned Health Link (HL) downtime for ambulatory departments.

Areas Affected/Stakeholders(s):
All UW Health adult and pediatric ambulatory clinics, and services that are live on Health Link (i.e. UW
Home Health, Employer Services)

II. DEFINITIONS

A. Planned Downtime: Advance notice of Health Link being available; typically lasting less than four (4) hours.
Exceptions for planned downtimes lasting more than four (4) hours may be made on a case-by-case basis.
B. Unplanned Downtime: Unexpected loss of access to Health Link.
C. Health Link (HL) Downtime Environment.
i. Is an exact copy of the production database and is current up to the point in which the Health Link
production environment went down.
ii. Can be accessed via the Downtime Icon on configured personal computers shared workstations,
and winterms.
iii. Is dependent on network availability.
D. Designated downtime computer and printer.
i. Consists of a Business Continuity Access (BCA) computer and attached printer.
ii. The BCA computer contains select reports to support continuity of care.
iii. The computer and printer must be connected to an emergency backup outlet or power source.
E. Health Link Downtime Binder: A reference binder created to assist staff and providers during the downtime.

III. POLICY ELEMENTS
A. All departments and ancillary systems owners are responsible to maintain their own downtime procedures
(e.g. AcuDose, physiologic monitors, nurse call, etc.)
B. Paper forms.
i. Clinical documentation will be recorded on Downtime paper forms to document patient
care/assessments and will be maintained in the paper chart until scanned into Health Link.
ii. Any form used during a downtime must be developed and approved by UWH Enterprise Content
Management Department and have a minimum of two patient identifiers recorded on the form.
iii. Laboratory and radiology forms must be labeled with patient’s full name, medical record number,
and date of birth.
C. Surgical Services Department (SSD) and Anesthesia documentation (including medication administration)
completed as a part of the ambulatory encounter is covered by UW Health clinical policy #3.2.6, Inpatient
Health Link Downtime and Recovery.
D. For ambulatory clinics and services utilizing Rover as a part of the encounter, this functionality is covered by
UW Health clinical policy #3.2.6, Inpatient Health Link Downtime and Recovery.

IV. PROCEDURE

A. Downtime preparedness.
i. Department or Clinic manager is responsible for creating and maintaining the Health Link
Downtime Binder and determining a central storage location.
ii. The following are minimum requirements for the Health Link Downtime binder
a. Monthly verification to, ensuring the current version of all forms and a reasonable number of
copies of each is available to continue care in case of power failure and copies cannot be
made.
b. A master copy of the following forms will be made available in the Health Link Downtime
Binder for use when the BCA computer is not available:



UW HEALTH CLINICAL POLICY 2
Policy Title: Ambulatory Health Link Downtime and Recovery
Policy Number: 3.2.5

1. Health Link Downtime Clinic Visit Navigator (301204-DT)
2. History and Clinical Notes (BG1280005-DT)
3. General Purpose Flow Sheet (1280030-DT)
4. Orders (1289137-DT)
5. Downtime Medicare Secondary Payer Questionnaire (NM#800060)
6. Downtime Patient Registration From (NM#800061)
7. Prescription pads
8. Health Link Downtime Conversion Notice (HIS300888)
9. Health Link Downtime Forms – Monthly Checklist
iii. Clinics/services may add additional UW Health approved forms to the binder as needed for their
patient population, and are responsible for ensuring the most current version is available.
iv. Department/clinic manager will maintain supplies for downtime printer in a central location
B. During planned or unplanned downtime:
i. Communication: Information Services will communicate via scrolling banner alert, or other
methods as necessary, with known details of the type and duration of the downtime as defined in
Administrative Departmental Policy AD-POL-005 UWH Health IS System Downtime Policy.
Clinic/Service Manager or designee is responsible for implementing appropriate clinical actions.
Chart Review:
ii. If “Use Downtime Icon” is communicated, all clinical information can be viewed via the Health Link
Downtime Environment (available on shared workstations) in the Chart Review activity and
Summary Reports as needed.
iii. If Health Link Downtime Environment is not available, downtime reports, such as problem lists,
active orders, medication list, and narrative notes can be printed as needed from the Downtime
computer.
iv. Patient Admission/Discharge Transfers (ADT) - admission process remains unchanged. Clinic staff
and providers will notify admissions by phone of patients requiring admissions.
v. Registration (Prelude).
a. Health Link downtime environment, when available will be used to access patient
information and verify patient information
b. Note any changes or additional information on Downtime Patient Registration Form.
c. Registration will complete as appropriate a Downtime Patient Registration Form for each
patient and instruct the patient to give the copy to receptionist at the clinical area.
d. Registration will complete a Downtime Medicare Secondary Payer questionnaire and any
other forms as appropriate to location where services are being provided.
vi. Scheduling (Cadence) Check in and check out.
a. Health Link downtime environment, when available will be used to access the schedule
and generate the Downtime Daily Activity Report (DAR) for the clinical area.
1. Scheduler will collect Downtime Patient Registration Form from each patient, and
if a patient arrives without the form
i. Scheduler with initiate phone contact with registration
ii. Scheduler will assist with updated initiating the Downtime Patient
Registration Form
b. Note any changes or additional information on the Downtime Patient Registration Form
c. Scheduler will communicate with the rooming staff that the patient has arrived.
d. Requests for, new or future appointments will be written on approved forms and include
appropriate information on how to contact patient or caller during the recovery phase.
vii. Orders Management.
a. Orders should only be written if they need to be carried out during the downtime.
b. Orders need to be written on approved forms.
c. The original order is to be scanned in the patient medical record during recovery phase.
d. Orders will be delivered to the appropriate department/location.
e. All available clinical and non-clinical staff should be utilized to deliver paper orders to the
appropriate location.
f. Telephone contact should be made as necessary to ensure the departments are aware of
the need for services.
g. All verbal or telephone orders obtained during the downtime MUST be cosigned by the
provider within 48 hours according to UWHC policy #8.16, Patient Care Orders.
viii. Medication Administration Documentation



UW HEALTH CLINICAL POLICY 3
Policy Title: Ambulatory Health Link Downtime and Recovery
Policy Number: 3.2.5

a. Approved forms will be used.
b. All in clinic administered medications must be authenticated so these can be entered in
Health Link during the recovery phrase.
c. All original documentation will be scanned into the patient’s medical record.
ix. Documentation Charging.
a. Level of service, facility charges, and supplies given to the patient will be documented on
the Health Link Downtime-Clinic Visit Navigator form as appropriate.
x. Clinical Laboratory Procedures
a. For planned downtimes, only specimens for critical and time sensitive tests should be
collected.
b. For unplanned downtimes, labs needed to support continued patient care should be
obtained.
c. Lab will call the unit/department with critical results. Communication of all other results will
be based on patient need and resource availability.
d. Any available staff should be utilized to hand deliver lab specimens and results.
e. Transcription of paper order will be done as required by Clinical Laboratory procedure and
protocol.
C. Recovery: Once downtime is over the following recovery procedures will occur. Be aware the sequence of
recovery activities is important to assure the patient's record is accurate and the re-establishment of proper
workflows.
i. Implement Recovery activities in the following sequence (ensuing procedures identify
accountabilities).
a. Admission/Discharge/Transfer recovery activities
b. Registration
c. Check-in
d. Order Reconciliation/Order Entry
e. Medication Verification by Pharmacy, as appropriate
f. Medication Administration
g. Clinical Documentation
h. Charging/Billing
i. Scheduling follow up
j. Encounter closure
ii. Depending on the length of the downtime, staff may receive additional communication about how to
initiate and complete the recovery process.
iii. Communication: Information Services will communicate via scrolling banner alert, or other methods
as necessary, to indicate the Health Link system is now available. Clinic/Service Manager or
designee is responsible for implementing appropriate clinical actions.
iv. Patient Admission/Discharge Transfers (ADT).
a. All patient admissions entering through the Emergency Department will be issued a
Medical Record Number (MRN) by the Emergency Department staff, as appropriate.
b. All other patient arrivals will be issued a MRN by the Access Service Department (Bed
Control), as appropriate.
v. Registration.
a. All information on Downtime Patient Registration Form and any other approved forms will
be entered.
b. Hospital Account Record (HAR) created as appropriate
vi. Scheduling/Cadence.
a. All patients will be checked in and any changes noted on DAR or other approved forms
will be entered within 24 business hours
b. All patients should be contacted within 24 business hours for appointment follow up.
vii. Order Reconciliation/Order Entry.
a. Orders received during the downtime that require transcription into Health Link should be
back dated/timed to reflect the original order date/time using the order mode of
“Transcribed”.
b. In general for orders were the service was provided during the down time, it is the
receiving department’s responsibility for entering the order back into Health Link:
1. Radiology orders > Radiology services
2. Medications > Pharmacy



UW HEALTH CLINICAL POLICY 4
Policy Title: Ambulatory Health Link Downtime and Recovery
Policy Number: 3.2.5

3. Therapy or other ancillary consults > Receiving service
4. Patient care orders > Entered by ordering provider or designated staff
5. Physician consults to other physicians > Entered by ordering provider or
designated staff
6. Laboratory orders > Laboratory services
i. Order is entered into the Lab Information System following receipt of the
paper order;
ii. Order will be generated in Health Link when the results are posted to
the patient’s medical record.
7. EKG, Echo, PFTs > Receiving service
8. Supply and equipment orders > Entered by ordering provider or designated staff
c. Assistance with transcription of future order can be delegated to appropriate clinical staff.
1. Orders must be written on the Health Link Downtime-Clinic Visit Navigator form
or other approved form
2. Forms must be authenticated by authorizing provider
3. Forms must be sent to scanning.
viii. Medication Administration Documentation.
a. Medication administration documentation will be transcribed from transcribed from the
Health Link Downtime Clinic Visit Navigator or other approved form into Health Link.
ix. Documentation of Charging and reconciliation
a. Level of service will be entered into HL.
b. Facility charges and supplies given to the patient will be entered into HL by clinical staff.
c. Charge reconciliation process will be complete
x. Other Clinical Documentation.
a. The clinic manager or their designee completes each encounter in each patient’s record
by:
1. Chief complaint 892 Downtime.
2. Enters a progress note in each patient’s record, using downtime SmartPhrase
“.uwdown”. This SmartPhrase will contain required information such as the date
and time of the downtime and will provide instruction on where in Health Link to
find additional documentation.
xi. Close encounter and scanning
a. Close the encounter , with appropriate co-signatures
b. Send all paper medical records including documentation (internal and external) to for
scanning into HL.

V. COORDINATION

Author: Director, Outpatient Health Link Operations
Senior Management Sponsor: VP, Chief Information Officer
Approval committees: UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: September 19, 2016

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VI. APPROVAL

Peter Newcomer, MD
UW Health Chief Medical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VII. REFERENCES



UW HEALTH CLINICAL POLICY 5
Policy Title: Ambulatory Health Link Downtime and Recovery
Policy Number: 3.2.5


UW Health clinical policy #3.2.6, Inpatient Health Link Downtime and Recovery
UWHC policy #8.16, Patient Care Orders
UW Hospitals and Clinics Emergency Operations Plan
Health Link Downtime Reference Guide

VIII. REVIEW DETAILS

Version: Revision
Next Revision Due: September 2019
Formerly Known as: Hospital Administrative policy #6.45