ELECTRONIC RECORD SYSTEM DOWN
DURING SITE OPERATIONAL HOURS, MEDICAL VAN, DENTAL VAN
Manual: PATIENT CARE, TREATMENT, AND SERVICES
CHAPTER: RECORD OF CARE / section: Emergency planning
Origin Date: april 2013 / review date:
PURPOSE: To define emergency situations related to the electronic health record
To define procedure(s) for handling emergency situations
POLICY:While it is the policy of InterCare Community Health Network to maintain consistent electronic documentation for all patient care, there will be times when the electronic system cannot be used. In these instances, the procedure below will serve as a substitute until the system is again functioning.
PROCEDURE:
A.Electronic Record system extremely slow or completely down:
1.Alert and Notifications
a.Staff at site identify that the electronic record system (EPM, EHR, EDR) is extremely slow or is down completely, or that an interface is not working.
b.Site manager or a designee(one call from each site) calls emergency phone # of one of the IncidentCommanders listed below, using the following priorities:
i.7:00AM – 6:00 PM – Ext 54321 or 269-427-7939
ii.If not able to reach above, between 6PM and 7 AM,and on weekends, call in this order (See Attachment A):
a.IT Director
b.MIS Director
c.Vice President of Operations
c.Notified commander collaborates with other commanders and attempts to diagnose problem.
d.Following assessment process, commanders determine potential length of down time and appropriate measures to be implemented based on time frame.
e.Commander(s) notifies designees at affected sites and InterCare Leadership Team of appropriate measures to be implemented. If email is down, this will be done by phone using the Admin Emergency Phone Tree(if the site is not notified within 15 minutes, the emergency documentation procedure is to be implemented by the manager or designee).
f.Designees at sites notify manager, and lead office and clinical staff, who will then make sure that all staff are made aware.
g.Staff will use emergency documentation procedure until notified that the situation has been remedied.
2.EPM emergency procedure (check-in):
a.All patients will check in using the Sign In half sheet.
b.For Established Patients (FOS duties):
i.Locate the patient in the Master Patient List.
ii.Print a copy of the demographicinformation.
iii.Ask the patient or responsible party to review the information on the demographic print out and make any appropriate changes.
iv.Make a copy of the front and back of the all current insurance cards.
c.For New Patients (FOS duties):
i.Ask the patient or responsible party to fill out a New Patient Registration form.
ii.Review the form to insure that it is entirely completed.
iii.Request a copy of any insurance cards.
iv.Process a Sliding Fee Application if appropriate anddetermine sliding fee level.
d.After completion of forms as above (FOSduties):
i.Document name, date of birth, insurance or sliding fee level and provider on a paper encounter slip.
ii.Staple the MPL demographic, or the New Patient Registration form, and all insurance card copies and sliding fee documentation to the encounter form.
iii. Place the encounter packet in an individual folder (red for medical, blue for OB and green for dental), labeled with the patient’s initials and DOB, and will place this folder at the designated place in each site for easy retrieval by clinical or dental staff.
iv.The Front Office Specialist will record the patients name and date of birth and time of check-in completion on the Daily Visit Log.
3.EHR emergency documentation procedure:
Signature note: all paper documentation is to be signed on each page using the staff member’s first initial, full last name, and credentials.
a.Prior to emergency down time staff member(s) designated by manager makes copies ahead of time of paper forms using the EHR Emergency Plan Book (for medical and OBdepartments), and keeps on file.During emergency down time this staff member distributes the forms in packets (pediatric, adult, or OB) to clinical area(s).
b.During emergency down time:
i.Clinical Support Staff duties:
a.For each patient being seen, receives folder (red for medical and blue for OB) containing paperencounter and all attachments.
b.Chooses appropriate paper packet and completes screening documentation as per normal procedure.
c.Passespaper packet including billing encounter to provider.
d.Clinical staff taking phone messages from patients will document these interactions on paper, retain the paper messages in their own work area, and enter the information into the patients’ records during the Recovery period.
ii.Provider accesses the view-only “Downtime Emergency NextGen Application” (DENA) for patient clinical information, completes documentation and billing encounter.Passespacket to discharging staff member.
iii.Discharging staff member:
a.Documents discharge information and discharges patient.
b.Brings billing encounter along with the documentation for the visit to Account Specialist(s).
iv.Account Specialists will see to it that all completed packets areplaced in one designated place at each site and stored, overnight if necessary, in a secure location.
4.EDR Emergency procedure:
Signature note: all paper documentation is to be signed on each page using the staff member’s first initial, full last name, and credentials.
a.Prior to emergency down time staff member(s) designated by manager makes copies ahead of time of paper forms using the EDR Treatment Records Book, and keeps on file. During emergency down time this staff member distributes the forms in packets to the dental area(s).
b.During emergency down time:
i.Dental Assistant duties:
a.For each patient being seen, receives a green folder containing paper encounter and all attachments (printed off patient information from Master List, and a medical history completed by the patient or parent). If it is an emergency visit, a dental pain assessment form is completed by the patient.
b.Passes to dental provider: paper packet consisting of Dental 14, and Dental 19, either an adult or child medical history, and billing encounter.
c.Keeps Informed Consent forms available in case they are needed.
ii.Provider:
a.Completes documentation and billing encounter, choosing EDR Notes according to the specific treatment procedure being done.
b.Completes treatment after one x-ray is taken on the tooth to be worked on.
1.This will be taken with regular x-rays, and developed in a chair side darkroom so the dentist can diagnose the problem. All sites have x-rays,
developer, fix, and a chair side darkroom available.
2.Patients requiring full mouth x-rays will be rescheduled as no full mouth x-rays will be processed while the EDR is down.
3.Informed Consent and x-rays will be scanned into the record when the program available again.
c.Sends folder with billing encounter and documentation for the visitto Account Specialist(s).
5.Check-Out:
a.At the end of each clinical/dental visit staff will escort the patientalong with the registration/documentfolder to the check out desk.
b.Billing Specialist duties:
i.Reviewed registration data.
ii.Calculate charges based on the information provided by the Provider on the paper encounter form.
iii.Collect insurance co-payments based on information available from the insurance card copies or if not available, from the patient/responsible party.
iv.Calculate sliding fee responsible amounts manually. If sliding fee level is not available for established sliding fee patients, the nominal fee will be used and the patient will be informed that he/she will bebilled for any additional amounts due.
v.Utilize three part paper receipts to document patient payments. Staple the top copy to the encounter form and give the middle copy tothe patient.
vi.Review with patient the provider’s orders for follow-up appointments (identified in the return to clinic section of the paper encounter).
vi.Informed patients that they will be called when the system is restored in order toschedule their next appointment.
vii.Store patient packets (overnight, if necessary, in a secure location).
6.After the emergency is over, the Recovery Procedure is initiated by site manager or designee.
7.EHR/Quest Interface or Quest failure: If EHR down time failure is to last an extended amount of time, the Quest Care360 will be utilized. If both the EHR & Quest system fail, Lab personnel will hand write on Quest requisitions and designate a fax machine that can print off lab reports. Once access is regained, results can be resent by Quest to provider’s PAQ. Any labs ordered in the EHR from the down-time can be reconciled.
8.Call Center: System Slow or Down:
A.During EHR down time the Call Center Representatives will:
i.Continue to take calls, handling operator calls and asking patients to call back later to schedule, confirm, or reschedule an appointment.
ii.Transfer urgent clinical calls to the appropriate clinical personnel.
iii. Transfer Medication Refill calls to the appropriate medlines.
B.Network/phone down time:
i.If phone system is down, and no Call Center Representatives are actively logged in, a message will play for callers giving them information to dial 911 for emergencies and InterCare’s After Hours Call Center for clinical triage needs.
B. Recovery after EHR down time:
1.All written visit documentation is gathered into one specified secure place at the site as assigned by manager until the system is again functioning (do not store in patient’s old paper chart).
2.Once the system has been restored:
i.Biller:
a.Initiates the data entry process by registering each patient and creating an electronic encounter for the appropriate date.
Dental Services Note: The dental chart is locked down at midnight on the date of service.If the treatment is keyed in a day after the date of service, the billers and dental assistants must work together to document the date of service in both the chart and to the insurance companies. All treatment will be put in on the date the EDR is again available with documentation in the record as to the actual date of service. The billers will change the date of service to the correct date for the insurance companies.
b.Distributes patient packets to appropriate clinical/dental staff.
ii.A clinical/dental support staff member from each team is given the applicable written information from patient. Clinical/dental staff members (beginning with the “screener”) will key in the information that they had previously written down from each visit. iii. Providers then complete their data from the visit and submit billing code.
iv.Discharging staff members complete the visit documentation, route packets as needed to lab and referral staff, and generate documents.
3.A special “Downtime” Master_IM or Prenatal Record will be generated which includes the following statement: All entries on this date of service were transcribed from paper “down time” documentation.
4.All lab orders will be processed electronically to contracted lab.
5.All paper entries will be transcribed into the EHR/EDR within 2 business days.
6.The Account specialist is responsible for determining when all registration and charge entry has been completed based on the Daily Visit Log.
7.The written information from the visits and contacts is to be routed to Medical Records Dept for scanning into the appropriate category in the electronic record and subsequent shredding.
References:Revision Dates:
CMO Approval Date:
Attachment A
Incident Commander Phone Numbers:
1.IT Director –
2.MIS Director -
3.Vice President of Operations -
*ATTACHMENT B – Individual Site Plan:
Site Name: ______
Person(s) responsible for making paper packets ahead, and also making additional packets if needed during down time:
Medical (adult and pediatric) packets: ______
OB packets: ______
Dental packets: ______
1. When any department at the health center discovers that the EHR system is extremely down or extremely slow, one person in that department notifies site manager or ______.
2.Site manager or ______calls emergency phone # of one of the Incident Commanders listed below, using the following priorities:
1.7:00AM – 6:00 PM – Ext 54321 or 269-427-7939
2.If not able to reach above, between 6PM and 7 AM, and on weekends, call in this order (See Attachment A):
a.IT Director
b.MIS Director
c.Vice President of Operations
3.Following the assessment process to diagnose the EHR issue,Commander(s) notifies site manager or ______of appropriate measures to be implemented. If email is down, this will be done by phone using the Admin Emergency Phone Tree.
4.Responsibilities of manager or ______:
a.If the site is not notified within 15 minutes, implements the emergency documentation procedure in all departments.
b.Monitors and assures that the paper process is in place and functional during the down time.
c.When notified by the commander that the electronic record is again functional,
notifies all departments that electronic documentation can be resumed.
d.Assures that the recovery process is initiated by the biller as soon as possible.
e.Monitors and assures that the recovery process is seen through to completion.
*Any changes to the above plan should be given to the EHR Training and Support Manager at Administration
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