Planned and Unplanned Downtime – Part 2 – Data Recovery Tactics

Standard MOI.14: The hospital develops, maintains, and tests a program for response to planned and unplanned downtime of data systems.
As discussed in Part 1 of the Downtime updates, planned or unplanned periods of time during which a computer system, server, or network are unavailable are considered data system interruptions and are often referred to as “downtime.” Hospitals must have procedures in place for planned and unplanned downtime that include managing data recovery following downtime.
The JCI standards do not specify the type of backup systems that must be used, only that there must be backup systems in place. There are various backup systems and recovery tactics that hospitals may include in their downtime plans, such as
  • Disaster recovery systems
  • Failover systems
  • Data backup systems
Disaster recovery systems are used to recover corrupted or deleted information that occurs as a result of unexpected downtime or outages. These systems are generally located off-site and are usually backed up daily, so there is the potential for some permanent data loss if this is the only system in place. Failover systems are on-site data recovery systems that are intended to minimize disruptions in data and patient care. When downtime occurs, the change to the failover system occurs within seconds or minutes, so patient data remains available to health care practitioners. Using a combination of these two systems, or other similar recovery systems, decreases the likelihood of significant data loss or prolonged inability to access patient information. These systems can be backed up in a variety of ways and no specific backup method is required by JCI; however, cloud-based data systems are becoming more common. Cloud-based backup systems must have adequate backup to prevent loss of data and minimize disruptions in patient care and mechanisms in place to preserve data integrity.  
Downtime plans must also include procedures to facilitate patient care. JCI standards do not specify what these procedures are, but do require that hospitals develop procedures for staff to follow during downtime; hospitals will develop these based on patient needs. In the past, many hospitals reverted to paper documentation during downtime. However, unplanned downtime may prevent staff from having the most up-to-date patient information printed and available for use. The complexity of maintaining paper records led many hospitals to implement “read only” systems that remain operational during downtimes. Read only systems allow health care practitioners to view crucial patient data but renders them unable to add anything to the medical record. Documentation may, therefore, need to be manually recorded or scanned into the medical record once systems have been recovered. Hospitals also need to develop procedures for reporting lab and other results during downtime.
Staff need to be familiar with the policies and procedures related to downtime. They should be trained on how to use alternative methods to access and record patient care information (read only systems, paper documentation), as well as how to report, receive, and record lab and other results. Staff need to be aware of when and how emergency testing of the data management systems will occur, and what their responsibilities are during these times. Finally, staff must know their role in the data recovery process.
Downtime and the potential for data loss can be detrimental to patient care if backup systems are not in place and staff have not been trained in downtime procedure. Thoughtful preparation for planned and unplanned downtime can minimize data loss and interruptions to patient care until data recovery occurs.