Posted on behalf of Bj Rosario, Product Manager
No one wants to think about the disaster scenario. Consequently, trying to convey to stakeholders the importance of disaster contingency and business continuity planning can seem futile at times.
One may be tempted to sidestep the dilemma by solely focusing on mitigating planned EHR downtimes, as the frequency of downtimes caused by routine system upgrades is a predictable cost to forecast for a budget proposal.
Network downtimes, however, must still be accounted for. Your hospital could go over a year without a single unplanned network downtime, but, once it does happen, productivity grinds to a standstill and quality patient care is suddenly at risk.
A prominent example of this was back in 2014, when a three-hospital network in Florida experienced a hardware failure that caused both their network and their $80 million Epic EHR to be down for over two days, as reported by HealthcareITNews.com.(i) In this incident, the EHR downtime occurred even though the EHR wasn’t the direct cause of the failure. Additionally, local on-premise computer systems that did not rely on the network to operate were credited as one of the processes that helped ensure business continuity.
Anecdotal hospital horror stories aside, there are also formal studies that your stakeholders need to be aware of to comprehend the impact of unplanned downtimes. Research by the Ponemon Institute proved that the average total cost of an unplanned data center outage amounted to over $740,000 per year.(ii) These costs include:
– Post-downtime recovery activities
– Disrupted IT productivity
– Disrupted end-user productivity
Furthermore, the total cost of downtime reported in 2016 is a 7% increase from 2013 and is a whopping 46% increase from 2010. The impact of downtime is substantially on the rise.
Now, one may be tempted with other options for business continuity, such as an off-site hosted EHR with a 99.9% guaranteed uptime. However, an article published by the founder of HealthcareScene.com did the math and proved that those numbers aren’t as comforting as they seem(iii):
Suppose there is an EHR that guarantees 99.9% uptime…
99.9% uptime per year equates to…
… 60 seconds/minutes * 60 minutes/hour * 24 hours/day * 365 days * .001 downtime per year
… = 8 hours, 45 minutes, and 57 seconds of downtime per year! 
That is an entire work shift of disrupted patient care with no EHR access unless you have an additional solution for redundancies.
Now, suppose instead that the EHR guarantees 99.99% uptime…
99.99% uptime per year equates to…
… 60 seconds/minutes * 60 minutes/hour * 24 hours/day * 365 days * .0001 downtime per year
… = 52 minutes and 33 seconds of downtime per year. 
Those statistics appear more reasonable, but consider the Emergency Department and other fast-paced floors in a hospital. Would those teams be comfortable with 52 minutes of being in the dark when it comes to quality patient care? Again, having an on-premise solution can help mitigate the workflow uncertainty that your clinical staff encounters in these scenarios.
Finally, you may be tempted with the business continuity option where your EHR vendor will reimburse you for a downtime. This option seems to cover the financial risks of downtime, appear lean and strategic on a budget proposal, and make your CIO happy on the short-term, but does an ROI contingency truly compensate for patient safety?
Will a single reimbursement handle the consequences of a lawsuit if a patient dies during a downtime because he or she was not treated correctly?
Does retroactive compensation justify the lack of preventive measures to save a human life?
There are no clever quotes, mathematical calculations, or high-profile research articles to answer these questions. Rather, they are a reminder of the obligation that we healthcare professionals have to provide quality care. Don’t leave that quality patient care up to chance or in the hands of third parties that you cannot monitor or control.
Be responsible. Be proactive. Be prepared.
Cheers.
i “Network Glitch Brings Down Epic EMR”, Healthcare IT News, January, 2014, http://www.healthcareitnews.com/news/network-glitch-brings-down-epic-emr
ii “The Cost of Data Center Outages”, Ponemon Institute, January 2016, https://www.vertivco.com/globalassets/documents/reports/2016-cost-of-data-center-outages-11-11_51190_1.pdf
iii “When Your EHR Goes Down… And It Will”, Hospital EMR & EHR, March 2015, http://www.hospitalemrandehr.com/tag/epic-downtime/