Quick Guide to Applications: Impact of Downtime

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2 Quick Guide to Applications: Impact of Downtime System Service Provided Connected Systems Services Lost if System is Compromised Epic Emergency Department All Core All health system wide downtime Ancillary (Lab, Radiology, Cardiology) Health System wide system Inpatient (Orders, Clinical documentation, BPAM, Pharmacy) Revenue Cycle: Billing, Patient Access, Scheduling Home Care Ambulatory 3M Abstracting/coding Epic Cannot code accounts Amicas/iConnect PACS (Picture Archiving and Communication System) Radiology images Amtelco Telecom: web paging, oncall schedules, directory Epic, Powerscribe, Viewpoint Epic Radiologists unable to review images. Radiology images unable to be launched via EMR Web paging, on call schedules, or hospital directory unavailable Angel Eyes Neonatal camera system Patient contacts cannot view babies API Time and attendance Staffing and scheduling Epic Unable to see timecards, quick badge, approve timecards. Unable to enter requests or see staff schedule. Aqure Lab Gas Analyzer CareFusion PFT (Viasys) Blood gas orders/results Epic Blood gas orders/results unavailable Pulmonary Function Testing Epic PFT recordings and reports unavailable CBORD Dietary system, Patient Menus via ipads, Cash Registers n Dining room and Café Data Innovations (DI) Connects lab instruments to Epic Epic Epic Cash registers and inventory in Dining Room and Cafes, Patient Menus via ipads unavailable Lab orders/resulted will not be transmitted Dragon Voice recognition software Epic Voice recognition for documentation unavailable 2

3 Experian Claims Epic Cannot transmit claims Can t take credit card payments File Shares/Amon GE Centricity Cardiology Access to H, S, and P drives Lotus Notes (requires N drives) Cardiac Cath lab images and charges Epic, Amicas Network drives and Lotus Notes (N drive) unavailable Cardiac Cath Lab images unavailable GE CPN Perinatal OB fetal monitoring strip Epic Fetal monitoring strips unavailable GE Connect GE DMS Cardiology Procedure Reports Epic Echo and cardiac catheterization procedures unavailable GE Muse EKG EKG tracings and reporting Epic EKG tracings, reports and Stress EKG tracings unavailable GE Viewpoint MFM ultrasounds and reports Epic, Amicas MFM reports will not be sent to Epic or Amicas Hologic Bone Density Bone density screenings and reports Epic, Powerscribe, Amicas Reports/images will not be sent Hyland Onbase Scanning Epic Scanning unavailable Image Vault Cardiac Echo images Epic, GE DMS Cardiac Echo images unavailable Imprivata Single Sign on = Fast Log In Cortext Unable to use badge tap, single sign on InterQual Utilization Review decision support tool for patient class determination Lotus Notes Administration LMS/Databases Meditech MM, Material Management GL, AP, PP Payroll General Ledger Epic (embedded in CM Navigator) Epic, API Unable to access computers Unable to send cortext messages Unable to determine patient class Lotus Notes databases unavailable Financial applications unavailable 3

4 M Modal Dictation System Epic Dictation system unavailable Morrisey MSOW Credentialing system Medical staff unable to access credentialing system Natus EEG EEG recordings and reports Epic EEG recordings and reports unavailable NDD Spirometry Respiratory program used mostly by SSMC for spirometry Epic Unable to take spirometry recordings Omnicell Medication Dispensing Epic Medication dispensing unavailable (can run on override) Outlook Calendar PenRad Mammography ordering, reporting, statistics Epic, Powerscribe Unable to access or calendars Mammography orders and reporting unavailable Powerscribe Dictation Radiology Epic, Amicas, Powerscribe Unable to send out Radiology reports QTEL Cardiac Rehab EKG/O2 recordings, exercise tracking for Cardiac Rehabilitation Epic Reports not available to be launched from Epic, cannot record/report QuadraMed Nursing acuity tool Epic Nurses are unable to classify ICU/NICU patients for acuity levels Quantros Incident tracking Unable to document incidents Rhapsody Interface infrastructure Communication between hospital systems (Epic/PACS, CBord, etc) and with remote partners (Harbor Medical, SSOrtho, SSPen, Atrius, Crown OB, etc.) unavailable rl Solutions Web based patient feedback software Patients are unable to enter feedback SnapComms SNAP messaging Snap messages unavailable Soft Bank/Soft Lab Spacelabs/Full Disclosure Blood bank system Epic Blood bank tests and results unavailable Vital sign monitoring Epic Vital sign monitoring unavailable 4

5 Stanley RFID RFID tracking of equipment location, temperature monitoring Cannot see locations of equipment, no alerting mechanism Surescripts E-prescribing Epic Unable to e-prescribe UniPOC Glucometers Epic Glucometers unavailable Zoll Rescue Net EMS EMR Pre hospital documentation EMS EMR Dispatching System Epic Pre hospital EMR information will not cross. EMS dispatch unavailable for tracking paper process 5

6 3 Levels of Downtime - 6

7 1. Downtime Tools BCA PC and BCA Web You can still access patient information during downtimes that can occur either as a planned part of an upgrade or as a result of an unexpected event like a power outage. Epic provides a business continuity access (BCA) system that contains multiple tools for use in different downtime scenarios Supports Ready Only (SRO), BCA Web and BCA PC. Using Supports Read Only (SRO) During a Level III downtime, you can access a view-only version of Epic by clicking on the SRO button on the desktop. This allows you to view all patient information accurate to approximately when the system went down, but will not allow you to do any in-system documentation. Accessing SRO 1. Click the SRO icon on the desktop 2. Log in with your Epic hyperspace credentials 3. View information as normal in a view-only mode a. Notice READ-ONLY MODE at top right of the screen b. Last Refresh Time displays the time the data was last refreshed Using BCA Web to View Reports During a Level III and Level II downtime, you can use BCA Web to view/print all BCA downtime reports from any computer. Log into BCA Web 1. Double-click on the icon for BCA Web on your desktop 2. Enter the same information you use to log into Hyperspace; press Enter or click Log In 7

8 Search for Patients 1. Click Patient Search in the BCA Web toolbar 2. Enter the patient name, MRN, and any additional information you have to search for the patient 3. In the search results, click the row for the patient to view additional information such as admission date and current location View Department Information 1. Click Folder List in the BCA Web toolbar to view a list of departments 2. Click the appropriate department link 3. From the list of reports that appears, click the report that you want to view to open it List of available folders may look different search for your department 8

9 Print Information from BCA Web When viewing any of the reports available in BCA Web, click Print if you need to print a hard copy of the report Using BCA Printing Application to View/Print Reports During a Level I downtime users will access the BCA Printing Application on specified computers to view and print critical patient information. All designated BCA computers have the BCA printing application installed. BCA computers have a Downtime BCA Device sign attached to the top of the monitor. Log Into the BCA Printing Application 1. Double-click the icon for BCA Printing on your desktop 2. Enter the information you use to log into Hyperspace and press Enter or click Sign In Print All Available BCA Reports 9

10 1. Click Print and choose to print all reports in the table or on the PC at once 2. In the Print window that appears, select the printer to use in the Name field and click Print View and Print Specific BCA Reports 1. To view all reports in a specific Department, select the department 2. To view all specific report types, select the report type 3. To view/print specific reports a. To preview a report, select the report that you want to view and click View b. To print one or more reports, select the reports and click Print You can select multiple reports by using CTRL + click c. Use the tag filters on the left side to choose groups of reports that you want to view and print 10

11 Using BCA PC to Access Information During Network Downtime During a Level I downtime when users cannot log into the computer with their Windows credentials users must log into the BCA computer with a generic local user. Log Into BCA PC as Local User 1. Contact the Command Center to receive the password for the local user 2. At the Windows log in screen, enter the username EPIC-BCA and the password provided 3. At the Log on to prompt, select the computer name and click Ok Log Into the BCA Printing Application 1. Double-click the icon for BCA Printing on your desktop 2. Enter the same information you use to log into Hyperspace and press Enter or click Sign In Print All Available BCA Reports 1. Click Print All to print all available BCA PC reports 2. In the Print window that appears, select the printer to use in the Name field and click Ok View and Print Specific BCA Reports 1. To view all reports in a specific Department, select the department 2. To view all specific report types, select the report type 3. To view/print specific reports a. To preview a report, select the report that you want to view and click View 11

12 b. To print one or more reports, select the reports and click Print You can select multiple reports by using CTRL + click c. Use the tag filters on the left side to choose groups of reports that you want to view and print 12

13 2. INPATIENT BCA WEB INPATIENT NOTES You can still access patient information during downtimes that can occur either as a planned part of an upgrade or as a result of an unexpected event like a power outage. Epic provides a business continuity access (BCA) system that contains multiple tools for use in different downtime scenarios Supports Ready Only (SRO), BCA Web and BCA PC. Using Supports Read Only (SRO) During a Level III downtime, you can access a view-only version of Epic by clicking on the SRO button on the desktop. This allows you to view all patient information accurate to approximately when the system went down, but will not allow you to do any in-system documentation. Accessing SRO 4. Click the SRO icon on the desktop 5. Log in with your Epic hyperspace credentials 6. View information as normal in a view-only mode a. Notice READ-ONLY MODE at top right of the screen b. Last Refresh Time displays the time the data was last refreshed Using BCA Web Data Entry During a Level III and Level II downtime, you can use BCA Web from any computer to enter Clinical Notes on patients during the downtime. This data will file back into the patient s chart in Hyperspace when the system comes back up. Log into BCA Web 3. Double-click on the icon for BCA Web on your desktop 13

14 4. Enter the same information you use to log into Hyperspace; press Enter or click Log In Search for Patients 4. Click Patient Search in the BCA Web toolbar 5. Enter the patient name, MRN, and any additional information you have to search for the patient 6. In the search results, click the row for the patient to view additional information such as admission date and current location Enter Notes 1. Select patient from a unit census or using Patient Search. 2. Click the Notes Entry link from the patient home page 3. At the Type field, select the type of note. Type in free text field. 4. Click Accept to complete the note. 14

15 Clinical providers have the ability to enter patient notes during downtime these notes can be seen by other providers and information will cross over when systems come up. 15

16 Using BCA Web to View Reports During a Level III and Level II downtime, you can use BCA Web to view/print all BCA downtime reports from any computer. View Department Information 4. Click Folder List in the BCA Web toolbar to view a list of departments 5. Click the appropriate link for your department/floor 6. From the list of reports that appears, click the report that you want to view to open it List of available folders may look different search for your department Print Information from BCA Web When viewing any of the reports available in BCA Web, click Print if you need to print a hard copy of the report 16

17 3. Outpatient BCA REPORTS During a network downtime when users are unable to log into the fast log in computers, users will use the BCA Printing Application to view and print critical patient information from designated BCA workstations. These workstations have a Downtime BCA Device sign on the top of the monitor. Using BCA Printing Application View/Print Reports Log Into BCA PC 4. Contact the Comand Center to receive the password for the local user 5. At the Windows log in screen, enter the username EPIC-BCA and the password provided 6. At the Log on to prompt, select the computer name and click Ok Log Into the BCA Printing Application 3. Double-click the icon for BCA Printing on your desktop 17

18 4. Enter the same information you use to log into Hyperspace. Click Ok Print All Available BCA Reports 3. Click Print and choose to print all reports in the table or on the PC at once 4. In the Print window that appears, select the printer to use in the Name field and click Print View and Print Specific BCA Reports 4. To view all reports in a specific Department, select the department 5. To view all specific report types, select the report type 6. To view/print specific reports a. To preview a report, select the report that you want to view and click View b. To print one or more reports, select the reports and click Print You can select multiple reports by using CTRL + click c. Use the tag filters on the left side to choose groups of reports that you want to view and print 18

19 4. BCA WEB DATA ENTRY ED Patient Access You can still access patient information during downtimes that can occur either as a planned part of an upgrade or as a result of an unexpected event like a power outage. Epic provides a business continuity access (BCA) system that contains multiple tools for use in different downtime scenarios Supports Ready Only (SRO), BCA Web and BCA PC. Using Supports Read Only (SRO) During a Level III downtime, you can access a view-only version of Epic by clicking on the SRO button on the desktop. This allows you to view all patient information accurate to approximately when the system went down, but will not allow you to do any in-system documentation. Accessing SRO 7. Click the SRO icon on the desktop 8. Log in with your Epic hyperspace credentials 9. View information as normal in a view-only mode a. Notice READ-ONLY MODE at top right of the screen b. Last Refresh Time displays the time the data was last refreshed Using BCA Web Data Entry During a Level III and Level II downtime, you can use BCA Web to enter new Admissions, Transfers, or Discharges that occur during the downtime. This data will file back into Hyperspace when the system comes back up. Log into BCA Web 5. Double-click on the icon for BCA Web on your desktop 19

20 6. Enter the same information you use to log into Hyperspace; press Enter or click Log In Search for Patients 7. Click Patient Search in the BCA Web toolbar 8. Enter the patient name, MRN, and any additional information you have to search for the patient 9. In the search results, click the row for the patient to view additional information such as admission date and current location Patient Search/Creation 1. Search for existing patient in Support Read Only (SRO) 2. In BCA Web Data Entry, click Patient Search and enter patient s Name, Birth Date, and/or Sex. 3. If correct patient is found, in BCA Web Data Entry, click patient s name and write MRN on the blank facesheet 4. If correct patient is not found in BCA Web Data Entry, perform the following steps a. If patient is found in SRO, obtain a downtime facesheet and write down existing patient MRN i. Click Add Patient and enter existing demographic information including MRN b. If patient is not found in SRO, obtain a downtime facesheet and downtime MRN. 20

21 i. Click Add Patient and enter demographic information (populate fields that are followed by an * and additional demographic elements); enter downtime MRN; click Add Patient to continue workflow 5. In parallel to the above steps, populate patient s demographic information on downtime facesheet 6. Once patient is found/created, you are brought to a screen that provides options to create new ED Arrival Create New ED Arrival 1. Using the patient you just added, click Create New ED Arrival and populate fields to arrive the patient 2. Downtime CSN will be auto-generated by BCA Web Data Entry a. Every visit newly created via VCA Web Data Entry will have a downtime CSN auto-assigned from a pre-determined downtime number range b. Write ato-assigned CSN on downtime facesheet c. Click Room/Admit to room patient Discharge 1. Select a patient from a unit census or using Patient Search 2. Click Discharge 21

22 3. Enter the information required to discharge the patient and click Discharge 4. Click Census and select the unit that you just discharged the patient from. Confirm patient does not appear on the unit census. Undo ED Arrival, Transfer, or Discharge created in BCA Web Data Entry 1. Select the patient who was just erroneously arrived, transferred and/or discharged using Patient Search or a unit census 2. Click Undo Last Event 3. Click Ok 4. Open the patient s home page and confirm that the transfer or discharge is undone. 22

23 Using BCA Web to View Reports View Department Information 7. Click Folder List in the BCA Web toolbar to view a list of departments 8. Click the appropriate department link 9. From the list of reports that appears, click the report that you want to view to open it List of available folders may look different search for your department Print Information from BCA Web When viewing any of the reports available in BCA Web, click Print if you need to print a hard copy of the report 23

24 5. BCA Web Data Entry Patient Access You can still access patient information during downtimes that can occur either as a planned part of an upgrade or as a result of an unexpected event like a power outage. Epic provides a business continuity access (BCA) system that contains multiple tools for use in different downtime scenarios Supports Ready Only (SRO), BCA Web and BCA PC. Using Supports Read Only (SRO) During a Level III downtime, you can access a view-only version of Epic by clicking on the SRO button on the desktop. This allows you to view all patient information accurate to approximately when the system went down, but will not allow you to do any in-system documentation. Accessing SRO 1. Click the SRO icon on the desktop 2. Log in with your Epic hyperspace credentials 3. View information as normal in a view-only mode a. Notice READ-ONLY MODE at top right of the screen b. Last Refresh Time displays the time the data was last refreshed Using BCA Web Data Entry During a Level III and Level II downtime, you can use BCA Web to enter new Admissions, Transfers, and Discharges that occur during the downtime. This data will file back into Hyperspace when the system comes back up. Log into BCA Web 1. Double-click on the icon for BCA Web on your desktop 24

25 2. Enter the same information you use to log into Hyperspace; press Enter or click Log In. Search for Patients 1. Click Patient Search in the BCA Web toolbar 2. Enter the patient name, MRN, and any additional information you have to search for the patient 3. In the search results, click the row for the patient to view additional information such as admission date and current location Patient Search/Creation 1. Search for existing patient in Support Read Only (SRO) 2. In BCA Web Data Entry, click Patient Search and enter patient s Name, Birth Date, and/or Sex. 3. If correct patient is found, in BCA Web Data Entry, click patient s name and write MRN on the blank facesheet 4. If correct patient is not found in BCA Web Data Entry, perform the following steps a. If patient is found in SRO, obtain a downtime facesheet and write down existing patient MRN i. Click Add Patient and enter existing demographic information including MRN 25

26 b. If patient is not found in SRO, obtain a downtime facesheet and downtime MRN. i. Click Add Patient and enter demographic information (populate fields that are followed by an * and additional demographic elements); enter downtime MRN; click Add Patient to continue workflow 5. In parallel to the above steps, populate patient s demographic information on downtime facesheet 6. Once patient is found/created, you are brought to a screen that provides options to create new Admission Admit a Patient 1. Search for and select the patient s record 2. Click Create New Admission 3. Complete information about the patient s admission and click Admit. The patient is admitted. Every visit newly created via BCA Web Data Entry will have a downtime CSN autoassigned from a pre-determined downtime number range. 4. Click Census and select the unit to which you just admitted the patient to confirm patient appears on unit census as expected Arrive Existing Pre-Admission 1. Search for and select the patient who had a pending admission prior to downtime. 2. Complete information about the patient s admission and click Admit 26

27 3. Click Census and select the unit to which you just admitted the patient to confirm patient appears on unit census as expected. Transfer a Patient 1. Select patient from a unit census or using Patient Search 2. Click Transfer under the patient s current encounter heading 3. Enter information required to transfer the patient and click Transfer 4. Click Census and select the unit to where you just transferred the patient. Confirm the patient appears on the unit census as expected. Discharge a Patient 1. Select patient from a unit census or using Patient Search. 2. Click Discharge. 3. Enter the information required to discharge the patient and click Discharge. 4. Click Census and select the unit that you just discharged the patient from. Confirm that the patient does not appear on the unit census. 27

28 Undo an Admission/Transfer/Discharge If an admission, transfer or discharge was completed by mistake within BCA Web Data Entry, use the Undo Last Event to undo the action. 1. Select the patient who was erroneously admitted, transferred or discharged (using Patient Search or a unit census). 2. Click Undo Last Event. 3. Click OK. 4. Open the patient s home page and confirm that the admission no longer appears or the transfer/discharge is undone. 28

29 Labor and Delivery Scenarios If newborn is delivered during downtime but was Pending prior to downtime: 1. Do not enter any information into BCA Web. Take note of time baby was delivered. 2. During recovery, admit existing pending baby with delivery time in Hyperspace If mother presents during downtime, but delivers after downtime: 1. Click Patient Search in BCA Web and input mother s information (use information from SRO if mother is existing patient) 2. Add mother to BCA Web following instructions from the Admit a Patient section above 3. Select L&D unit as department. Select patient class of Outpatient 4. After downtime, verify in Epic that mother came through with L&D Assessment status and update status if necessary in Hyperspace. If mother presents during downtime and delivers during downtime: 1. Click Patient Search in BCA Web and input mother s information (uses information from SRO if mother is existing patient). 2. Add mother to BCA Web following instrucitons from the Admit a Patient section above 3. Select L&D unit as department. Select patient class of Outpatient. 4. Take note of time baby was delivered; do not enter any information for the baby in BCA Web. 5. After downtime, change mother s patient class to Inpatient and set OB status to Yes in Hyperspace. 6. Deliver baby off the mother in Hyperspace. 29

30 Using BCA Web to View Reports View Department Information 1. Click Folder List in the BCA Web toolbar to view a list of departments 2. Click the appropriate department link 3. From the list of reports that appears, click the report that you want to view to open it List of available folders may look different search for your department Print Information from BCA Web When viewing any of the reports available in BCA Web, click Print if you need to print a hard copy of the report 30