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Townsville Hospital & Health Service

ieMR

Business Continuity Plan

12 July 2016

V1.0

THHS ieMR BCP V1.0 i

Authority and planning responsibility

The Townsville Hospital integrated electronic Medical Record (ieMR) Business Continuity Plan (BCP) is authorised by the Chief Operating Officer, Townsville Hospital and Health Service (THHS) in accordance with the requirements of the Disaster Management Act 2003.

This plan applies to all services and business units utilising the ieMR within THHS.

Amendment List

Proposed amendments to the THHS ieMR BCP are to be forwarded to:

Title: Chief Information Officer

Organisation: Townsville Hospital and Health Service

Phone: (07) 4433 1492

Email: [email protected]

Any amendment to the Townsville Hospital and Health Service (THHS) ieMR BCP will be inserted into the plan as distributed, with the responsible officer certifying the amendments inclusion. All proposed changes will be subject to recommendation, approval and endorsement of the Townsville HHS Executive Team.

The Townsville HHS ieMR BCP will be updated electronically and available via the

Townsville intranet site.

The electronic copy is the master copy and as such is the only copy that is recognised as

being current.

Version Date By Description

0.1 23/06/16 Amie Raymond Draft

0.2 30/06/16 Amie Raymond New template and

amendments

0.3 06/07/16 ieMR Digital Release Team

in Consultation with CIS

Update of Downtime

Business Continuity

Procedures

1.0 12/07/16 Robyn Copley & Paul

Sullivan

Content Verification

Review and Finalisation

Distribution

The Townsville HHS ieMR BCP is available to all Townsville HHS staff via the Townsville HHS website.

Plan Review and Testing

The Townsville HHS ieMR BCP will be reviewed annually or following any significant event. The Chief Operating Officer is responsible for ensuring the review of this plan. The plan will be tested following the initial completion of the plan and after any major revisions of the plan.

THHS ieMR BCP V1.0 iii

CONTENTS

Introduction ..................................................................................................................................................... 1

1.1 General .................................................................................................................................................. 1

1.2 Aim ........................................................................................................................................................ 1

1.3 Purpose .................................................................................................................................................. 1

1.4 Intent ..................................................................................................................................................... 1

1.5 Scope ..................................................................................................................................................... 1

1.6 Governance ............................................................................................................................................ 2

1.7 Planning assumptions ............................................................................................................................ 2

1.8 Supporting plans .................................................................................................................................... 2

2.0 Notification Process ................................................................................................................................... 3

2.1 External Notification .............................................................................................................................. 3

2.1.1 Scheduled Notification iAppS ieMR ..................................................................................................... 3

2.1.2 Unscheduled Notification Application Management Support (AMS)& iAppS ieMR ............................. 3

2.3 THHS Internal Notification ..................................................................................................................... 3

2.3.1 Scheduled Notification ........................................................................................................................ 3

3.0 Concept of operations ................................................................................................................................ 5

3.1 Incident Assessment .............................................................................................................................. 5

3.2 Response Management ......................................................................................................................... 5

3.3 Roles and Responsibilities ...................................................................................................................... 6

3.4 Townsville Hospital and Health Service Emergency Operations Centre (HEOC) ...................................... 8

3.5 Operational Debriefing .......................................................................................................................... 8

4.0 Risk Mitigation ........................................................................................................................................... 9

4.1 Hosted Solution...................................................................................................................................... 9

4.2 Downtime viewer (DTV) ......................................................................................................................... 9

4.3 Emergency Power .................................................................................................................................. 9

5.0 Routine Management .............................................................................................................................. 11

5.1 System Management Activities ............................................................................................................ 11

5.2 Preparedness Activities ........................................................................................................................ 11

5.2.1 Keeping Plans and Procedures Current .............................................................................................. 11

5.2.2 Checking Resource Availability.......................................................................................................... 11

5.2.3 Training ............................................................................................................................................ 12

6.0 Continuity Procedures.............................................................................................................................. 13

6.1 Paper based functions .......................................................................................................................... 13

6.2 Downtime ............................................................................................................................................ 13

6.2.1 General continuity procedures .......................................................................................................... 13

THHS ieMR BCP V1.0 iv

6.3 Business Continuity Plan Scenarios ...................................................................................................... 14

6.3.1 ieMR Unplanned Downtime .............................................................................................................. 14

6.3.2 ieMR Planned Downtime .................................................................................................................. 17

6.3.3 HBCIS and ieMR Delayed HL7 Messages ........................................................................................... 20

6.3.4 HBCIS Downtime ............................................................................................................................... 23

6.3.5 ieMR and HBCIS Planned Downtime ................................................................................................. 25

6.3.6 KOFAX Downtime ............................................................................................................................. 25

6.3.7 Unplanned Power outage ................................................................................................................. 26

6.3.8 Emergency Department PASLink Downtime ...................................................................................... 28

6.4 Testing ................................................................................................................................................. 29

7.0 Power failure ........................................................................................................................................... 30

8.0 Loss of Network ....................................................................................................................................... 31

9.0 Device Failure .......................................................................................................................................... 31

10.0 Recovery Plan ........................................................................................................................................ 31

Appendix 1 - Definitions, Acronyms and Abbreviations ................................................................................. 36

Appendix 2 - Unit Downtime Monthly Checklist ............................................................................................ 38

Appendix 3 – Downtime Viewer (DTV) Locations ........................................................................................... 40

Appendix 4 – Downtime Viewer Location Maps............................................................................................. 41

THHS ieMR BCP V1.0 1

Introduction

1.1 General

Townsville Hospital and Health Service (THHS) ieMR Business Continuity Plan (BCP) (this

plan) provides for an all-hazards comprehensive approach to business continuity. It has

been prepared to enable the efficient coordination of HHS and other resources to flexibly

meet the demands of a disruptive event at the operational level through to the organisational

level.

This plan is supported by the Townsville HHS Emergency and Disaster Management Plan

which provide detailed guides to assist management decision-making and staff response to

various emergency situations.

1.2 Aim

The aim of this plan is to reduce the impact of a disruptive ieMR event on THHS critical

business functions and staff, patient and visitor safety.

1.3 Purpose

The purpose of this plan is to clearly outline the procedures that need to be undertaken in

the lead up to, during and after the unplanned loss of access to the ieMR, including

supporting systems and medical devices as they directly impact the ieMR.

This plan will include:

Authority to activate the BCP, including triggers leading to this decision

Notification processes

Roles and responsibilities

Communication channels to be utilised

Business Continuity Procedures for planned and unplanned downtime

1.4 Intent

This plan is not a single unified plan – it is a set of specialised ‘action-orientated’ response

plans detailing the continuity strategies and the actions required for their effective

implementation.

1.5 Scope

The Townsville HHS ieMR critical business function categories are as detailed:

Critical Business Function

Scope of services

Information Communication & Technology Systems

ieMR and the individual modules that make up the ieMR & supporting systems where the ieMR is affected. The Queensland Health Network (Wi-Fi and Ethernet) and the Local Area Networks where the ieMR is affected.

Disaster Management/

Emergency

Preparedness

Power Outages where the ieMR is affected. Services or key resources that underpin organisational preparedness to respond to incidents/events and activation of DM plans and sub-plans.

Table 1 THHS ieMR critical business function categories


1.6 Governance

The ieMR BCP is a contributory sub-plan designed to specifically detail ieMR downtime

procedures. The ieMR BCP is managed and governed through the Emergency Planning and

Continuity Management Committee.

The Executive Compliance and Risk Committee are responsible for the effective oversight of

the Townsville HHS Business Continuity Management (BCM) program.

The Townsville HHS Emergency Planning and Continuity Management Governance

Committee are responsible for the effective management of the Townsville BCM program

and to ensure that BCM is embedded across all facilities in the Townsville HHS.

Figure 1 THHS BCM Governance Structure

1.7 Planning assumptions

The following planning assumptions have been made:

This plan does not replace the requirement for detailed BCP at the

department/business unit level

All disruptive events requiring Townsville HHS-wide coordination will be managed in

accordance with the Townsville HHS Emergency and Disaster Management Plan

1.8 Supporting plans

The following plans support this BCP:

THHS Disaster Management Plan

THHS Business Continuity Plan

TTH Local Support Model

Health Services Information Agency (HSIA), Support Model and System Management Guide (SMSMG).


2.0 Notification Process

2.1 External Notification

2.1.1 Scheduled Notification iAppS ieMR

iAppS (previously SIM) ieMR are the Service Owners and are responsible for the end to end

service of the system. Along with other iAppS and technical operations groups in eHealth

Queensland, they are responsible for providing technical support for the ieMR solution and

enterprise infrastructure (ie. Data centres, wide area network, local area networks etc.) and

manage the relationship with the system and support vendor, Cerner.

Planned downtime will be approved by the Townsville Hospital however; the downtime will

be undertaken and managed by eHealth Queensland, specifically iAppS ieMR.

Notification of planned downtime will occur a minimum of two weeks prior to the date and

time of the downtime. This notification will be conducted via email to the DL-ieMR Change

Notification distribution list. Membership of this distribution list will include key

representatives within the business including, but not limited to:

THHS Medical Records Team Leader, CIS (PH: 07 4433 1334)

THHS Medical Records Scanning Unit (PH: 07 4433 1360)

THHS Data Quality Manager, CIS (PH: 07 4433 4133)

THHS Information Technology Services (ITS), Technical Operations Manager

(PH: 4433 1389)

THHS Emergency Department (ED) Business Practice Improvement Officer

(BPIO) (PH: 07 4433 4235)

After Hours Nurse Manager, AHNM (PH: 4433 3485)

2.1.2 Unscheduled Notification Application Management Support (AMS)& iAppS ieMR

Cerner are the system vendor who will provide specialist application support from AMS

division, including system and technical incident and problem support.

In the event of unplanned downtime recorded by Cerner AMS, iAppS ieMR will be notified in

the first instance for commencement of notification and communication with the THHS.

Notification and communication will commence as soon as possible and iAppS ieMR will be

responsible for monitoring the system.

2.3 THHS Internal Notification

2.3.1 Scheduled Notification

Notification of planned downtime throughout THHS will be provided by CIS via email to ieMR

users across the HHS. Planned notification advice will include the date and time of

scheduled outage, proposed duration of outage, the services and systems that will be

impacted if known and when normal service will be restored.


2.3.2 Unscheduled Notification

Notification of unplanned downtime will occur as soon as an issue is detected by CIS via

email to ieMR users across the HHS. Notification advice will provide any information in

relation to the outage that is available at the time. The Chief Information Officer (CIO) at their

discretion will notify the Health Service Chief Executive (HSCE), Chief Operating Officer

(COO), Executive Director of Medical Services (EDMS) and the After Hours Nurse Manager

(AHNM) based on the severity of the outage (See section 3.0).

Notification process or flow of information for both scheduled and unscheduled outages will

follow the below flow diagram.

iApps Notify Site

of Issues raised external to HHS

iApps notified if

escalation required

Issue Raised InternallyIssue Raised Externally

Site Updated via

email

Site User Calls 1800 198 175, or

logs job through self-service centre

Site Distributes Information

throughout HHS via distribution list emails

Unplanned Downtime Only

AMS notify iAppS


3.0 Concept of operations

3.1 Incident Assessment

The Townsville HHS will use the following incident classification system for ieMR downtime:

Incident type Description

Planned Downtime Planned or Scheduled Downtime occurs with provision of notice of time of outage and length of outage.

Planned Downtime with Unplanned Extension of Downtime

Planned or Scheduled Downtime occurs with provision of notice of time of outage and length of outage however downtime occurs beyond planned length of outage.

Unplanned Downtime Unplanned or Unscheduled Downtime includes any downtime with no prior notice of outage available.

Major Unplanned Downtime

Major Unplanned Downtime is any unplanned or unscheduled Downtime lasting 2 hours or more with no known resolution time or a resolution time of greater than 2 hours. This will be managed as a Code Yellow, internal emergency.

3.2 Response Management

The following guidance informs incident response management responsibilities and actions:

Incident Length of Downtime

Managed by Actions

Planned Downtime

0-6 hrs CIS Provide Notice to ieMR users via email across HHS

Activate Unit Downtime Procedures

DTV devices remain unused unless clinically necessary

Planned Downtime with unplanned extension of downtime

6 – 10 hrs

NB. >10hrs = Major Unplanned Downtime

AHNM AHNM Notifies ND on call

Continue Unit Downtime Procedures

Activate THHS ieMR BCP Plan


Minor Unplanned Downtime

0-2 hrs CIS/AHNM Activate THHS ieMR BCP Plan

Active Unit Downtime Procedures


Notify COO and ND on call at discretion

Major Unplanned Downtime, Code Yellow

>2 hrs

with no known resolution time

OR

Resolution time > 2 hrs

CIS/AHNM Notify COO

HEOC Stand-Up

Continue Unit Downtime Procedures

Continue THHS ieMR BCP Plan

DTV devices accessed by all units

Table 3 THHS BCM incident classification


3.3 Roles and Responsibilities

A number of key roles will be essential for the success of the ieMR BCP and its use during

downtimes, they are:

Role Responsible

After Hours Nurse Manager (AHNM)

Notification of unplanned downtime to ND on call and COO at discretion as per section 3.2 of this plan.

Maintaining access to DTV drawer key in the event that a unit/s misplaces theirs.

Ensure all units have activated their unit downtime procedures

Nursing Director (ND) on call

Will respond to correspondence from AHNM of unplanned downtime in accordance with section 3.2 of this plan.

Shift Coordinator (Emergency Officer (EO) & downtime Coordinator)

The shift coordinator is the identified EO and Downtime Coordinator in each clinical/operational unit. In the event of a downtime this role will ensure:

Downtime Kits are replenished and easily accessible

724 Downtime viewer passwords and key are accessed and used by the area if a Code Yellow is activated or if clinically required.

Hospital Incident Controller Under Code Yellow once the Incident Management Team (IMT) is formed, the Health Incident Controller is responsible for:

The co-ordination and implementation of the Incident Action Plan and the return to normal operations once the emergency is resolved.

Chief Information Officer The ieMR Business Continuity and Disaster Recovery Plan.

Coordinating the initial communication of a major unplanned outage to HHS Executive and Emergency Management Coordinator.

Liaising with various ICT support teams on resolution activities – ie. iAppS ieMR, local DH project team, local SDU, local IT Services.

Updating HEOC/HIC/CIO as required on progress and status based on information provided by iAppS ieMR.

Manager, Clinical Information Services

Determining extent of clinical impacts and subsequent communication to CIO and HIC.

Dissemination of restoration communications and status updates to HHS staff.

Enacting local medical record downtime procedures.

Providing support to clinical areas regarding use and access of 724 downtime processes if required during a major unplanned outage.


Role Responsible

eHealth Qld iAppS ieMR The end to end service supporting the ieMR systems.

Managing the relationship with the various sections of Cerner such as the Application Managed Service (AMS), Hosting and Managed Service (HMS).

Managing the major incident and resolution activities across all parties – vendors, other eHealth teams.

The coordination and support where there is integration or interfacing with systems managed by other technical support teams (e.g. HBCIS, Auslab etc.).

Townsville HHS IT Services Supporting and managing the 724 Downtime viewer service for the HHS including liaising and co-ordination of stakeholders

Validating the synchronisation of ieMR with the data pumps and downtime viewers – this does not include confirming validation of clinical data

Installation services for Downtime viewer client to designated and licensed laptops.

Backup and restoration services for the 724 Downtime Viewer data pumps (servers)

eHealth Qld Technical Operations (e.g. NOC, EOC)

Managing and maintaining the enterprise infrastructure that supports the delivery and access to ieMR applications (networks, data centres, firewalls).

eHealth Qld Townsville SDU

the support of local enterprise infrastructure within Townsville HHS and end user computing environment including local area network (wired and wireless), desktops laptops, All-In-One devices, printers.

The appointments listed above are the default appointments for key roles. Other Executive Directors and senior staff may also be called upon to support the IMT in the event of a Code Yellow, subject to the nature of the disruptive event.

The primary appointment listed above is responsible for identifying at least two other staff members within their management structure to provide continuity for the role.


3.4 Townsville Hospital and Health Service Emergency Operations Centre (HEOC)

In the event that a THHS Emergency Operations Centre needs to be activated the primary

location shall be:

THHS North Block, Executive Board Room

Phone: (07) 4433 3385

Email address: [email protected]

In the event that an alternate HEOC Command Room is required, this will be located at the

following site:

THHS Level 2 Acute Block, Surgical Meeting Room

Phone: (07) 4433 3385

Email address: THHS-EOC-MGR @health.qld.gov.au

Please refer to the TTH Emergency and Disaster Management Plan for the full list of

resources available at each location.

3.5 Operational Debriefing

Recovery helps to bring closure to an event and includes debriefing of personnel involved to

ensure learning can be captured and processes refined to improve the health response

emergency and disaster events.

Key Recovery Activities are:

Retrospective Documentation

Scanning

Documentation of the event

Replenishing stock in unit downtime kits

Ensuring passwords for the downtime 724 viewer is reset (if required) and distributed

to all relevant units

Ensure Downtime Viewer (DTV) keys remain with the Shift Coordinator

Document lessons learnt

Recommendations

Procedure & BCP review

It is the responsibility of the Hospital Incident Controller to ensure a timely debriefing of all

involved staff in the THHS response. Outcomes from the debrief will be used to inform further

revisions to the Plan. Key staff from THHS may participate in other debriefings as required.

mailto:[email protected]

mailto:[email protected]


4.0 Risk Mitigation

A number of risk mitigation strategies have been put in place as part of the Digital Hospital

Program and ieMR implementation. The items included below are specifically called out.

4.1 Hosted Solution

Cerner is contracted to provide hosting services covering three aspects of system

management:

Hosting Management Services

Operational Management Services, and

Application Management Services.

Having the hosted solution means that the data and system configuration is held at the Cerner

data centre. Therefore, any incident which impacts the THHS data centre or the THHS site

may result in loss of access to ieMR data however the data itself should not be

compromised.

Cerner operates a highly secure and fully redundant environment and has contractual

commitments regarding service levels. This means that there is full failover of hardware and

full replication of the solution to an alternate location in real time to cover any failure in their

environment. Cerner is also responsible for ensuring standard operational processes such as

backup, system management and monitoring and security are of the highest standard.

4.2 Downtime viewer (DTV)

THHS will be using Cerner’s 724 Access Downtime Viewer (724 DTV) which provides 7x24

hour access to clinical data currently available in the ieMR when access is not available.

The 724 DTV provides access to 30 days of historical clinical data up until the point of loss of

access to the ieMR and/or network. Summary patient information can be viewed and/or,

allowing clinical staff to continue to provide care.

It is important to note that the 724 DTV will not provide a view of any prior scanned

documents or CTG and ECG results. Printing from the 724 DTV devices is only

possible when the network remains available. The use of 724Access is described

below in the contingency procedures however THHS recommends that priority is

placed firstly on patient care and that 724 DTV is only accessed in the case of a Code

Yellow, unless it is clinically necessary to do so.

The 724 Access Downtime Viewer application runs on secure, dedicated laptops which are

strategically located in 10 locations across the hospital, providing easy access for clinical

areas (See Appendix 3 for detailed list of locations, see Appendix 4 for DTV location maps).

Although careful consideration has been given to clinical priority areas for the placement of

the 724 DTV laptops their portability allows extra contingency in the event that some areas

may be experiencing a greater clinical urgency for the 724 DTV.

DTV laptops are not to be used for any purpose other than to view medical information during

system downtime

4.3 Emergency Power

Uninterrupted Power Supplies (UPS) and generators are used to provide emergency power

at THHS across a wide range of relevant functions/equipment. This includes the 724Access

Downtime Viewer laptops (battery operated and can be recharged at emergency power

points), the wireless network, bedside medical devices (battery operated and can be


recharged at emergency power points), workstations on wheels (battery operated and can

be recharged at emergency power points) and the telephone systems.


5.0 Routine Management

The primary components of routine management of the BCP and associated

procedures are shown below.

5.1 System Management Activities

Please refer to the TTH Local Support Model for Routine System Management Activities.

5.2 Preparedness Activities

5.2.1 Keeping Plans and Procedures Current

The ieMR BCP and supporting documentation will be kept up-to-date to ensure it

remains valid to the business activities currently undertaken at the sites.

Consideration of the ieMR BCP and supporting documentation will be included within

each project undertaken with THHS. As part of the planning of each project, an

assessment of the impact on the ieMR, the ieMR BCP, the downtime procedures and

other supporting documentation will be completed.

Following any downtime test or actual downtime, the learning from the downtime review

process will be incorporated into the BCP and supporting documentation as required.

Each time the ieMR BCP or supporting documentation is updated, it will be provided

to the relevant parties, and incorporated into downtime packs and training and testing

materials.

5.2.2 Checking Resource Availability

An important part of preparedness is making sure that the required resources are

available during downtime. Each month the Unit Downtime Coordinator in each unit

will check the following:

The downtime pack is accessible and contains the correct and a sufficient amount of

forms, up- to-date instructions, a valid 724Access Downtime Viewer application

username and password, pens, additional paper and toner for the downtime printer

The downtime computer can be accessed via the key and the computer is turned on

The downtime printer has sufficient paper and toner in it

Should any of these elements be missing the Unit Downtime Coordinator will immediately

replenish the resources. The Unit Downtime Coordinator will need to report any technical

issues to the Info Service Centre on 1800 198 175.

A monthly checklist for the Downtime Kit and 724Access Downtime Viewer in each

unit has been provided in Appendix 2.


5.2.3 Training

Training in the ieMR BCP and supporting procedures will occur in a number of contexts;

As part of the testing processes described above and as part of Disaster Management

training and exercises. To assist with staff knowledge of the downtime systems/processes

and ease of use during downtimes, quick reference guides are included in the downtime

pack.

Annual dry-run training will occur in order to maintain staff training and knowledge on

downtime procedures.


6.0 Continuity Procedures

6.1 Paper based functions

A number of functions will still be managed using paper forms. These include (but are not

limited to):

• Medication Management

• Acute Resuscitation Plan (ARP)

• Consent Forms

These functions are not included in the continuity procedures below and these forms will not

be included within the Downtime Kits.

6.2 Downtime

6.2.1 General continuity procedures

During the event of a downtime a number of continuity procedures will need to be completed

to ensure that patient care and safety is maintained for the duration of the event. These

procedures are shown below.

Please note these procedures do not include supporting system downtime except where the

downtime directly impacts the ieMR.

These procedures are focussed on access to and the recording of information within a

patient’s chart, patient safety and care should take priority. All paper forms completed during

downtime are to be stored with the patient’s Current Encounter Chart (CEC).


6.3 Business Continuity Plan Scenarios

The following information relating to the Utilisation and Preparation of 724 Access Downtime Viewers (724 DTV’s)and Downtime Kits, relates to all

Business Continuity Plan Scenarios:

THHS recommends that the 724 DTV is accessed only in the event of a Code Yellow, if however the clinical requirement for DTV’s is

necessary as a last contingency, the Shift Coordinator will access the DTV at their discretion.

If DTV’s are activated, staff will be able to access them using the Quick Reference Guide located within the downtime kit.

DTV keys and password are available within the Downtime Kit, accessible via the Shift Coordinator.

Paper order forms, clinical documentation forms, spare wrist band labels, specimen labels and CEC labels are available in the downtime kit within

their ward/area

Re-familiarise staff with Downtime procedures and quick reference guides

Implement local unit plans for downtime as required

Printing from DTV’s is only possible if the network is still available, if the network is not available the DTV is a view only device.

NB. Scanned documentation, ECG and CTG results are not viewable on the 724 DTV.

6.3.1 ieMR Unplanned Downtime

Overview of Downtime Procedure: ieMR PowerChart Unplanned Downtime

Task

During ieMR Downtime After ieMR Downtime

Document Scanning No scanning activities can be conducted

Continue preparation of documents Scanning Unit staff to commence scanning. Any batches that did

not reach the ieMR during the 30 minute pre downtime window will need to be rescanned.

Patient registration and updating patient demographics

Continue to register in HBCIS.

Continue to view and update patient information in HBCIS.

Registrations and data updated in HBCIS will not be viewable in the ieMR.

HBCIS remains the ‘source of truth’ for patient demographics and updates to occur in HBCIS as soon as possible

Verify any registration / patient information (e.g. demographics) updated in HBCIS have flowed through to ieMR.



Generating ieMR Encounters & Printing labels & Wrist Bands

Patients ‘admitted’ or ‘arrived’ patients in HBCIS will not generate a viewable encounter in the ieMR.

It will not be possible to manually create an ED encounter in the ieMR

It will not be possible to print ieMR labels, including pathology specimen labels.

It will not be possible to print Patient Wrist Band labels.

Staff will hand write on spare blank labels located within the Downtime Kit.

Verify that patients ‘arrived’ or ‘admitted’ into HBCIS duringdowntime have had a corresponding encounter generated in theieMR. Once the encounters have appeared in the ieMR, ieMRlabels can be printed for those encounters.

Patient Wrist Band labels can be printed to replace any handwritten wrist band labels during downtime.

Direct Entry Documentation within the ieMR

It will not be possible to view and enter clinical information in theieMR.

Complete documentation on paper using the ieMR downtimeforms available in the downtime kit, templates are available onQHEPS or the Digital Hospital website. Store all forms in thepatient’s CEC or EW.

Please note: Risk assessment and allergies & alerts downtimeforms are printed and completed by hand; Progress notedowntime templates can be typed into then printed.

Ensure the five (5) points of identification are recorded on alldocumentation (i.e. first name, last name, DOB, gender, URN).

Resume direct entry of documentation against the currentencounter within the ieMR.

Documentation completed during downtime may remain in the CECor EW for scanning on discharge. However, critical notes should besent for priority scan in order to minimise the disruption of chronologywithin the ieMR.

Orders It will not be possible to view and make orders in the ieMR Complete Pathology and Radiology order requests on the paper

order forms available in the downtime kit. Results can still be viewed in Auslab, The Viewer and

IMPAX/XERO, provided these systems are not affected by the downtime.

If Pathology results are reported over the phone a Pathology Report (Verbal) form should be used to record the results provided.

If the DTV has been accessed active and past radiology tests and procedures may be viewed and/ printed from the DTV.

Upon request radiology result reports will be manually created and

provided to the treating clinician. provided to the treating clinician.

Resume direct entry of orders within the ieMR

Orders complete on paper during downtime will be processedand results will feed into the ieMR when system available.



Device Integration Integrated device results such as CTG and ECG will not feeddirectly into the ieMR.

Results are to be printed direct from each machine with paperprint-outs placed in the CEC for scanning.

Additional paper is available in the Unit Downtime Kit. Previous results may not be viewable and if clinically required

subsequent tests should be conducted.

ECG and CTG’s completed during downtime may remain in theCEC or EW for scanning or filing on discharge. However,critical results should be sent for priority scan in order tominimise the disruption of chronology within the ieMR.

Community In addition to above; Clinicians will create an ephemeral (temporary) record in Microsoft

Word to record clinical information at the point of care. This temporary record must be recorded on a Word template that

includes 3 key points of identification: Name, DOB, URN.

Further downtime forms will be available in the travel downtimekit specific for community clinicians. Store all forms in thepatient’s CEC or EW.

NB: Community staff will not have access to the 724 DTV’s, however historical charts may be accessed if available/required.

Copy and paste ephemeral record created in Microsoft Wordinto the ieMR.

The temporary record is to be deleted following finalisation ofthe ieMR progress note (and not saved to any network drives).

Documentation completed on manual forms during downtimemay remain in the CEC for scanning. However, critical notesshould be sent for priority scan in order to minimise thedisruption of chronology within the ieMR.

Emergency In addition to above

Quick Registration & Subsequent Triage of new patients inFirstnet will not be available. Triage Nurses will utilise theTriage Downtime forms located within the EmergencyDepartment Downtime Kit.

Nursing Staff will retrospectively triage all patients triaged onpaper forms during the downtime in order to maintain reportingdata.


6.3.2 ieMR Planned Downtime

Overview of Downtime Procedure: ieMR PowerChart Planned Downtime

Prior to Downtime

Recommendation: Continue to document within the ieMR until downtime commences. Prior to downtime commencing, cliniciansshould print any documentation recorded within ieMR that is required to remain available during the ieMR downtime period.

Add relevant clinical information to Patient Flow Manager and incorporate into clinical handover and ensure clinical handover adequatelyprepares the on-coming shift to take accountability and responsibility for provision of clinical care throughout downtime period.

Ensure allergies recorded in the ieMR are also recorded on the medication chart.

Verify functionality of ieMR downtime templates on the QHEPS Ensure all scanning ceases at least 30 minutes prior to scheduled downtime Clear all scanning queues and ensure validation queue has been cleared and the documents appear in the ieMR (minimum 30 mins before

downtime to ensure documents are not lost) Service Groups to replenish stocks of all forms for downtime kits in their respective units Ensure paper is available and loaded ready for printing in integrated devices Print latest clinical information and latest ECG and CTG images for patients where it is clinically relevant.

Task Prior to ieMR Downtime During ieMR Downtime After ieMR Downtime

Document Scanning Ensure all scanning ceases at

least 30 minutes prior to

scheduled downtime

No scanning activities can be conducted

Continue preparation of documents Scanning Unit staff to commence scanning. Any

batches that did not reach the ieMR during the 30minute pre downtime window will need to berescanned.



Continue to view and updatepatient information in HBCIS.

Ensure that all data entry iscomplete and up to date


Continue to view and update patient information in HBCIS.

Registrations and data updated in HBCIS willnot be viewable in the ieMR.

HBCIS remains the ‘source of truth’ for patientdemographics and updates to occur in HBCIS assoon as possible

Verify any registration / patient information (e.g.demographics) updated in HBCIS have flowed throughto ieMR.

Generating ieMR Encounters & Printing labels, Wrist Bands

Ensure all ieMR Encounters arecompleted prior to planneddowntime

Ensure that there are adequatestocks of ieMR Patient Labelsand blank wrist bands located inthe CEC

Print Patient Lists from ieMR

Ensure all patient wrist bandsare printed prior to downtime

Patients ‘admitted’ or ‘arrived’ patientsin HBCIS will not generate a viewableencounter in the ieMR.

It will not be possible to manually create an EDencounter in the ieMR

It will not be possible to print ieMR labels.

Verify that patients ‘arrived’ or ‘admitted’ into HBCISduring downtime have had a corresponding encountergenerated in the ieMR. Once the encounters haveappeared in the ieMR, ieMR labels can be printed forthose encounters.



Direct EntryDocumentation within the ieMR

Ensure adequate CEC’s or EWare available

Ensure Downtime Kits arereplenished with up to dateresources

Pre-Print any relevantdocuments- Patient tracking list- Patient Summary (Diagnosis,Allergies, Alerts, Problem List,Admission Details)- Vital Signs, Progress Notes,recent ECG etc.

It will not be possible to view and enter clinicalinformation in the ieMR.

Complete documentation on paper using theieMR downtime templates available onQHEPS. Print forms and store in the patient’sCEC or EW.

Please note: Risk assessment and allergies &alerts downtime forms are printed andcompleted by hand; Progress note downtimetemplates can be typed into then printed.

Ensure the five (5) points of identification arerecorded on all documentation (i.e. first name,last name, DOB, gender, URN).

Resume direct entry of documentation against thecurrent encounter within the ieMR.

Documentation completed during downtime may remainin the CEC or EW for scanning on discharge. However,critical notes should be sent for priority scan in order tominimise the disruption of chronology within the ieMR.

Orders Where possible complete allrequired orders in the ieMRprior to downtime.

Ensure adequate manual orderforms are available in theDowntime Kit

Print a list of Orders completedand pending

Print required specimen labelsprior to downtime

It will not be possible to view and make orders in the ieMR

Complete Pathology and Radiology order requests on the paper order forms available in the downtime kit.

Results can still be viewed in Auslab, The Viewer and IMPAX/XERO, provided these systems are not affected by the downtime.

If Pathology results are reported over the phone a Pathology Report (Verbal) form should be used to record the results provided.

If the DTV has been accessed active and past radiology tests and procedures may be viewed and/ printed from the DTV.

Upon request radiology result reports will be manually created and provided to the treating clinician.


Orders complete on paper during downtime will beprocessed and results will feed into the ieMR whensystem available.



Device Integration Print the most recent ECGwhere clinically relevant.

Print the most recent CTGwhere clinically relevant.

Ensure adequate memoryspace available on unitdevices

Ensure thermal paper isloaded into machines and thatthe Downtime Kit containsfurther stock

Integrated device results such as CTG and ECGwill not feed directly into the ieMR.

Results are to be printed direct from eachmachine with paper print-outs placed in the CECfor scanning.

Additional paper is available in the UnitDowntime Kit.

Previous results may not be viewable and ifclinically required subsequent tests should beconducted.

ECG and CTG’s completed during downtime mayremain in the CEC or EW for scanning or filing ondischarge. However, critical results should be sentfor priority scan in order to minimise the disruptionof chronology within the ieMR.

Staff are to resume normal use of deviceintegration within the ieMR.

Emergency As Above In addition to above

Triage of new patients in Firstnet will not beavailable. Triage Nurses will utilise the TriageDowntime forms located within theEmergency Department Downtime Kit.

Nursing Staff will retrospectively triage all patientstriaged on paper forms during the downtime inorder to maintain reporting data.


6.3.3 HBCIS and ieMR Delayed HL7 Messages

Overview of Downtime Procedure: Delayed HL7 Messages Between HBCIS and ieMR

Identification of a HL7 message delay

Patient ‘admitted’ or ‘arrived’ on HBCIS by staff. Staff checks the ieMR and a corresponding current inpatient / outpatient encounter has not appeared. This is due to a HL7 messaging delay between HBCIS and the ieMR. During a HL7 message delay, both HBCIS and the ieMR will continue to be available for viewing, but there will be limitations for direct data entry into ieMR.

Task During Downtime After Downtime


Continue to register, update and view patient information inHBCIS.

HBCIS remains the ‘source of truth’ for patient demographics

Upon resolution of the HL7 messaging delay, real-time HBCISAdmission. Transfer and Discharge messaging will be restored andautomatic encounter generation from HBCIS admissions and arrivalswill resume.

Continue to register, update and view patient information in HBCIS.

Generating ieMR Encounters & Printing labels

The ieMR current encounter will not be automatically created.

Continue to ‘admit’ and ‘arrive’ patients in HBCIS

It will not be possible to print ieMR labels for current encountersthat have not yet appeared in the ieMR. Staff are to ensure thatthe five (5) points of identification are recorded on alldocumentation (e.g first name, last name, DOB, gender, URN).

Staffs to identify patients affected by the message delay androutinely check if the relevant information has arrived in thispatient’s ieMR encounter.

Continue to ‘admit’ and ‘arrive’ patients on HBCIS – automatic ieMRencounter generation has been restored.

Resume printing of labels from the corresponding ieMR encounter.


It will not be possible to document against the currentencounter in the ieMR for Outpatients and Emergency.

Inpatients admitted prior to downtime will have an encounterwhich can be documented against.

Where there is no encounter available completedocumentation on paper using the ieMR downtime templatesavailable on QHEPS. Print forms and store in the patient’sCEC or EW.

Ensure the five (5) points of identification are recorded on alldocumentation (i.e. first name, last name, DOB, gender,URN).

Resume direct entry of documentation against the correctinpatient / outpatient encounter within the ieMR.

Paper documentation completed during the HL7 messaging delayshould be checked to ensure the appropriate ieMR label has beenaffixed.



Orders During a HL7 message delay, both HBCIS and the ieMR willcontinue to be available for viewing, but it will not be possibleto view and enter clinical information in the ieMR.

It will not be possible to view and make orders in the ieMR forOutpatients and Emergency.

Inpatients admitted prior to downtime will have an encounterwhich can be ordered against.

Complete Pathology and Radiology order requests on the paperorder forms available in the downtime kit.

Results can still be viewed in Auslab, The Viewer andIMPAX/XERO, provided these systems are not affected by thedowntime.

If Pathology results are reported over the phone a PathologyReport (Verbal) form should be used to record the resultsprovided.

If the DTV has been accessed active and past radiology testsand procedures may be viewed and/ printed from the DTV.

Upon request radiology result reports will be manually createdand provided to the treating clinician.


Orders complete on paper during downtime will be processed andresults will feed into the ieMR when system available.

Device Integration During a HL7 message delay, both HBCIS and the ieMR willcontinue to be available for viewing, but it will not be possibleto view and enter clinical information in the ieMR.

Device integration will still be available for encounters createdprior to the Downtime.

Where there is no current encounter available, ECG’s andCTG’s are to be printed and stored within the CEC or EW asper the manual process described in ieMRPlanned/Unplanned Downtime plans.

ECG and CTG’s completed during downtime may remain in theCEC or EW for scanning or filing on discharge. However, criticalresults should be sent for priority scan in order to minimise thedisruption of chronology within the ieMR.

Staff are to resume normal use of device integration within theieMR.

Community During a HL7 message delay, both HBCIS and the ieMR willcontinue to be available for viewing, but it will not be possibleto view and enter clinical information in the ieMR.

Encounters created prior to downtime may still be documentedagainst.

Where an encounter cannot be created, an ephemeral(temporary) record in Microsoft Word will be created to recordclinical information at the point of care.

Resume direct entry of documentation against the correctoutpatient encounter within the ieMR.

Any manual documentation completed during the HL7 messagingdelay should be checked to ensure the appropriate ieMR labelhas been affixed.



This temporary record must be recorded on a Word templatethat includes 3 key points of identification: Name, DOB, URN.

Further downtime forms will be available in the traveldowntime kit specific for community clinicians. Store all formsin the patient’s CEC or EW.

NB: Community staff will not have access to the 724 DTV’s, however historical charts may be accessed if available/required.


Quick Registration functionality of FirstNet will becompromised.

Manual Search of HBCIS to locate URN

Quick Registration of patient using the HBCIS URN or if anew patient, continue through Quick Registration and assigna FirstNet URN.

Register patient in HBCIS as normal, assigning to theFirstNet URN is applicable.

Triage to occur as normal once quick registration hasoccurred.

As above

Advise CIS of FirstNet URN’s used during the delay so that recordmerging can occur if necessary.


6.3.4 HBCIS Downtime

Overview of Downtime Procedure: HBCIS Down

Prior to Downtime Ensure adequate stocks of HBCIS downtime sheets / forms are available. These are located on QHEPS

Task During HBCIS Downtime After HBCIS Downtime


Unable to register in HBCIS. Utilise pre-registered ‘unknown’

URN’s when necessary

Unable to view or update patient information in HBCIS.

Follow HBCIS downtime processes.

HBCIS remains the ‘source of truth’ for patient demographics andupdates to occur in HBCIS as soon as possible

Enter all downtime information recorded on downtime sheets / forms.

Enter ‘arrive’ and ‘admit’ information into HBCIS to allow the associatedcurrent inpatient and outpatient encounters to be generated in ieMR


Unable to ‘admit’ or ‘arrive’ patients in HBCIS for inpatients oroutpatients.

No new inpatient or outpatient encounters will be generated inieMR as these patients cannot be ‘admitted’ or ‘arrived’ on HBCIS.

It will not be possible to print ieMR labels for new inpatients oroutpatient admissions / arrivals during downtime.

Continue manual creation of ED encounters within ieMR togenerate a current ED encounter and print associated ieMRlabels

Verify that patients ‘arrived’ or ‘admitted’ into HBCIS during downtimehave had a corresponding encounter generated in the ieMR. Once theencounters have appeared in the ieMR, ieMR labels can be printed forthose encounters.


Any patients who are not able to be ‘arrived’ or ‘admitted’ intoHBCIS during downtime will be unable to have documentationdirectly entered into the ieMR against a current inpatient /outpatient encounter. Instead, complete documentation onpaper using the ieMR downtime templates available onQHEPS. Print forms and store in the patient’s CEC.

Continue ‘business as usual’ direct data entry into the ieMR forall ED patients, chronic renal encounter patients and allpatients who were already ‘admitted’ or ‘arrived’ prior

Once the patient who were unable to be ‘admitted’ or ‘arrived’during the downtime have had these functions completed inHBCIS and a corresponding current encounter has beengenerated in the ieMR, staff are to resume direct entry ofdocumentation against the correct inpatient / outpatient encounterwithin the ieMR.

Documentation completed during downtime may remain in the CEC orthe EW for scanning on discharge. However, critical notes should besent for priority scan in order to minimise the disruption of chronologywithin the ieMR.

Tracking of CEC’s It will not be possible to track CEC’s or EW’s on HBCIS. Resume tracking CEC’s and EW’s on HBCIS.


Overview of Downtime Procedure: HBCIS Down

Orders No new inpatient or outpatient encounters will be generated inieMR as these patients cannot be ‘admitted’ or ‘arrived’ onHBCIS.

It will not be possible to order pathology or radiology tests inthe ieMR for those patients without a current encounter.

Encounters already existing in ieMR prior to the downtime willnot be effected and can be ordered against.

Once the patient who were unable to be ‘admitted’ or ‘arrived’during the downtime have had these functions completed inHBCIS and a corresponding current encounter has beengenerated in the ieMR, staff are to resume direct entry of orderingagainst the correct inpatient / outpatient encounter within theieMR.

Orders complete on paper during downtime will be processed andresults will feed into the ieMR when system available.

Device Integration No new inpatient or outpatient encounters will be generated inieMR as these patients cannot be ‘admitted’ or ‘arrived’ onHBCIS.

Device integration will still be available for encounters createdprior to the Downtime.

Where there is no current encounter available, ECG’s andCTG’s are to be printed and stored within the CEC or EW asper the manual process described in ieMRPlanned/Unplanned Downtime plans.

Once the patient who were unable to be ‘admitted’ or ‘arrived’during the downtime have had these functions completed inHBCIS and a corresponding current encounter has beengenerated in the ieMR.

Staff are to resume normal use of device integration within theieMR.

Community No new outpatient encounters will be generated in ieMR asthese patients cannot be ‘arrived’ on HBCIS.

It will not be possible to print ieMR labels for new outpatientduring downtime.

Encounters already existing in ieMR prior to the downtime willnot be effected

Once the patient who were unable to be ‘arrived’ during thedowntime have had these functions completed in HBCIS and acorresponding current encounter has been generated in the ieMR,staff are to resume direct entry of documentation against thecorrect outpatient encounter within the ieMR.

Documentation completed during downtime may remain in theCEC or the EW for scanning on discharge. However, critical notesshould be sent for priority scan in order to minimise the disruptionof chronology within the ieMR.


Quick Registration is to occur with a Firstnet UR to beassigned

Triage and encounter creation can continue as normal

HBCIS downtime forms should be used to capture correctpatient demographic information.

As Above

Advise CIS of FirstNet URN’s used during the Downtime so thatrecord merging can occur


6.3.5 ieMR and HBCIS Planned Downtime

Overview of Downtime Procedure: Both ieMR PowerChart and HBCIS Planned Downtime

Refer to the individual processes listed above relating to planned downtime for both ieMR PowerChart and HBCIS

6.3.6 KOFAX Downtime

Overview of Downtime Procedure: KOFAX Scanning Application Down

Prior to Downtime Medical Records Scanning Unit to have all of the scanning up-to-date prior to the planned downtime

Communicate date, time and duration of planned downtime to appropriate staff

Task During Kofax Downtime After Kofax Downtime

Document Scanning No scanning activities can be conducted

Continue preparation of documents

Analyse the three scanning queues, starting from where thescanning process stopped working.

Check that previous documents in the batch that stopped did arrivein the ieMR

Check all batches completed in QC during the 30 minute periodimmediately prior to the downtime commencing have reached theValidation queue. Any batches missing from the Validation queuewill need to be rescanned.

Batches that have made it into the Validation queue should betaken through the QA process to guarantee completeness

Resume scanning unit duties to scan documents into the ieMR

Viewing of patient

information

The ieMR remains available to view patient information, performdirect data entry and print patient labels for all patients withexisting encounters and scanned documentation.

As the Scanning Unit resumes scanning duties, scanneddocumentation will become available for viewing


6.3.7 Unplanned Power outage

Overview of Downtime Procedure: Unplanned Power Outage Affecting ieMR Workstations not on Uninterrupted Power Supply, Network Still Active

Note: critical areas may be able to access the ieMR and HBCIS by:-

using a desktop PC that is connected to a ‘uninterrupted power supply’

using a notebook that has been charged prior to power outage

Task During Power Outage After Power Outage

Document Scanning Unless staff have access to a devices connected to uninterrupted power

supply there will:-

No scanning activities can be conducted

Continue preparation of documents

Scanning Unit staff to commence scanning. Any batches that didnot reach the ieMR during the 30 minute pre downtime window willneed to be rescanned.

Patient registration, updating patient demographics, admission, transfers, discharges, appointment scheduling functions

Unless staff have access to a devices connected to uninterrupted power

supply:-

It will not be possible to view / update patient information in HBCIS.

It will not be possible to complete Admission, Transfer orDischarges within HBCIS

It will not be possible to perform tasks associated with HBCISAppointment Scheduling

HBCIS remains the ‘source of truth’ for patient demographics andupdates to occur in HBCIS as soon as possible

Verify any registration / patient information (e.g. demographics)updated in HBCIS have flowed through to ieMR.

Resume HBCIS Admission, Transfer and Discharge transactions

Resume HBCIS Appointment Scheduling transactions


Overview of Downtime Procedure: Unplanned Power Outage Affecting ieMR Workstations not on Uninterrupted Power Supply, Network Still Active

Note: critical areas may be able to access the ieMR and HBCIS by:-

using a desktop PC that is connected to a ‘uninterrupted power supply’

using a notebook that has been charged prior to power outage

Task During Power Outage After Power Outage


Unless staff have access to a devices connected to uninterrupted power supply:-

It will not be possible to create an ED encounter in the ieMR

It will not be possible to create an Inpatient, Pre-Arrival,Outpatient or No Visit encounter in the ieMR.

It will not be possible to print ieMR labels.

It will not be possible to view other repositories containing clinicalinformation (e.g. The Viewer)

Consider phoning another ieMR site or area located outside thearea affected by the power outage to view and telephonically reportrequired clinical information if applicable

Verify registration / information updated in HBCIS from downtimesheets / forms have flowed through to ieMR.

Verify patient Admission, Transfer and Discharge data capture entered in HBCIS from downtime sheets / forms has generated acorresponding encounter in the ieMR.

Verify patient Appointment Scheduling data capture entered in HBCISfrom downtime sheets / forms has generated a correspondingencounter in the ieMR.

Resume ED encounters within the ieMR

Resume printing of ieMR labels


Unless staff have access to a devices connected to uninterrupted power supply:- It will not be possible to view and enter clinical information in the

ieMR.

Staffs are to complete documentation on paper using theappropriate Progress note form or pre-printed clinical forms.

Ensure the five (5) points of identification are recorded on alldocumentation (i.e. first name, last name, DOB, gender, URN).

Store completed paper-based forms in the patient’s CEC or EW.

Resume direct entry of documentation against the currentencounter within the ieMR.

Documentation completed during downtime may remain in the CECfor scanning on discharge. However, critical notes should be sent forpriority scan in order to minimise the disruption of chronology withinthe ieMR.

Other Unless staff have access to a devices connected to uninterrupted power supply there will:- It will not be possible to track CEC’s and EW on HBCIS

Resume CEC and EW tracking on HBCIS


6.3.8 Emergency Department PASLink Downtime

Overview of Downtime Procedure: Emergency Department - PASLink

PASLink is an integrated system that allows FirstNet to perform a quick registration and generate a UR for new Emergency Department patients to TTH. This is necessary to allow triage and treatment to proceed without undue delays. The Quick Registration process only collects minimal patient data (name, gender & DOB) and still requires a full HBCIS registration to be complete directly after the Quick Registration.

Task During PASLink Downtime After PASLink Downtime

Patient registration, triage and updating patient demographics

Manual UR search of HBCIS will be undertaken.

Quick Registration for new patient encounters in FirstNet will stillbe able to occur

If UR number cannot be located or the patient is new to thehospital a FirstNet UR should be assigned.

Triage can continue as normal

Continue to register, update and view patient information inHBCIS

Upon resolution of PASLink advise CIS of the FirstNet URN’s usedduring the Downtime.


6.4 Testing

The ieMR BCP and supporting documentation will be tested annually, at a minimum.

Planned downtime provides an opportunity, in a relatively controlled and low risk

environment, to ensure that staff are aware of what to do and that systems and processes

work effectively. However planned downtimes usually occur when volumes and staffing are

low in order to ensure minimum disruption, therefore testing will occur outside of these times.


7.0 Power failure

THHS has back-up generators to ensure that areas are able to continue to function

in the event of power loss. Procedures around this are documented within the

Facility Continuity Plans.

It is important to note that during a power failure scanning is unable to continue. For

information on what to do when the Kofax (scanning) system is not available see

section 6.0 above. The 724 Access Downtime Viewer and supporting medical

devices have their own local back-up batteries. Information relating to this is shown

below.

Device Approximate battery back-up duration

724 Access Downtime Viewer – a standard

Windows 7 MOE laptop is used to access the

724 Access Downtime Viewer application. This

laptop will show the battery power available

before a recharge is required.

4-8 hours

Phillips ECG Carts – the battery power

indicator will indicate time remaining on each

charge

At least 45 minutes of continuous Rhythm

printing


8.0 Loss of Network

The contingency procedures documented above include loss of network causing

loss of connection to the ieMR.

9.0 Device Failure

All faults and issues with medical devices should be managed using the THHS

Local Support Model.

10.0 Recovery Plan

This Recovery Plan is intended as a guide only. Patient safety principles take

precedence. The decision to enter clinical information into the ieMR manually, or

have the information scanned and reconciled upon discharge post a downtime

period will be at the discretion of the Local Line Reporting Manager in consultation

with the Divisional Executive Team.

0 – 2 Hour

Downtime 2 – 4 Hour Downtime 4 - 12 Hour Downtime

> 12 Hour

Downtime

Admission

History

(Admission

clinical

assessment)

Initial manual

process.

Retrospective

documentation by

medical and

nursing staff.

Initial manual process.

Scanned documentation reconciled upon discharge.

Summary documented. Critical elements entered into ieMR, e.g.

including RRT activations, AHD, ARP orders

Admissions

(Registration

of

admissions)

Initial manual process. Retrospective documentation of all admissions and

registration of patients will be required during Recovery.

Implement *HBCIS Downtime Plan as required

Maintain Patient Flow Tracking Log to document Admissions during downtime

Retrospective input and correction of data will be required during Recovery Phase.

*Consider additional AO support in high patient flow areas, e.g. ED, Pre-

admissions.

Admissions

(Patient Flow

Tracking)

Initial manual process. Retrospective documentation of all admissions and






admissions.


0 – 2 Hour


> 12 Hour

Downtime

Allergies &

Alerts

Initial manual process. Allergies to be documented on paper Medication Chart.

Retrospective documentation by medical/ nursing/ pharmacy staff during

Recovery Phase.

Problem list Initial manual

process.

Retrospective

documentation by

medical staff


Retrospective

documentation by

medical staff


Retrospective documentation by

medical staff

*Consider retrospective scanning of

clinical documentation in high patient

flow areas (*will not be entered in the

Problems list for future encounters)

Discharges

(Patient Flow

Tracking)

Initial manual process. Retrospective documentation of all discharges of patients will

be required during Recovery.


Maintain Patient Flow Tracking Log to document Discharges during downtime


*ED: Patient ‘Statement of Attendance’ record to be mailed to patient’s

address

*Consider additional AO support in areas that have experienced high discharge

numbers, e.g. ED

Discharge

Summaries

Retrospective documentation of discharge summaries during Recovery Phase by

medical staff as indicated.

Height and

Weight

Retrospective

documentation by

nursing staff.

*As clinically indicated: Retrospective documentation to be

considered by nursing staff.

During downtime to be documented on Observations chart

or progress notes – to be reconciled in scanning process.

I & O Fluid

Balance

Retrospective

documentation by

nursing staff.

*As clinically indicated: Retrospective documentation to be

considered by nursing staff.

During downtime to be documented on Observations chart

or progress notes – to be reconciled in scanning process.


0 – 2 Hour


> 12 Hour

Downtime

Interdisciplin

ary Plan of

Care

(Progress

Notes)

Documented on

Progress Notes,

entered into ieMR

retrospectively by

health clinician

Documented on Progress Notes – reconciled during scanning

process.

*Consider summary report as clinically indicated

Inter-hospital

Transfers Out

of THHS

The Electronic Medical Record is to be printed from the Downtime 724 Viewer prior to

transfer.

Photocopy paper documents prior to transfer

Maintain Patient Flow Tracking Log to document Inter-hospital Transfers during

downtime

Retrospective input and correction of data will be required during Recovery

Phase.

Medication

History

Printing of

medication history

from 724 Viewer.

Retrospective

documentation by

medical staff

Documented on Progress Notes – reconciled during scanning

process.

*Consider summary report as clinically indicated

Medications Current processes are to document Medication Orders on the paper based

Medication Chart. Future processes once electronic Medications Medication is

implemented: To Be Advised.

Pre-existing

Paper-based

Documents

No change. Reconciled at scanning upon discharge. Paper documents to remain in

CEC.

Pathology

Orders

Manual process during Downtime.

Paper based order forms to be utilised. Existing patient ieMR labels or

handwritten patient information to be utilised on order form as available.

Specimen tubes to be handwritten as no access to specimen label printing.

Refer to AUSLAB Downtime Plan

Pathology

Results

Results made available on AUSLAB.

In the event of a concurrent AUSLAB downtime; critical results to be phoned

to Ordering Medical Officer by Pathology. All other results printed to areas as

required.

Pathology results to be reconciled to the ieMR chart during the

Recovery Phase by Pathology staff.

Refer to AUSLAB Downtime Plan


0 – 2 Hour


> 12 Hour

Downtime

Patient Flow Maintain Patient Flow Tracking Log to document

Admissions/Transfers/Discharges during downtime


Some units may be required to use Whiteboards to maintain an accurate

tracking list map during a Downtime (e.g. ED)

Consider additional strategies for transparency of bed availabilities during

Downtime utilising Patient Flow Manager (PFM).

Patient

identification

wristbands

Existing ieMR armbands to remain on patient.

Hand written armbands to be used on new patients (and patients without an

armband during downtime).

New ieMR armbands printed post downtime.

Patient labels Existing ieMR labels to be used. In the event that there are no ieMR labels

available, all clinical documentation forms are to be handwritten with the

patient’s full name, UR Number, and Date of Birth.

Additional ieMR labels are to printed post downtime. ieMR labels to be

attached to all clinical documentation forms prior to scanning at discharge:

*Refer to ieMR Business Rules – patient labels.

Progress

Notes

*Retrospective

documentation.

Scanned documentation. Summary documented. Critical

elements entered into ieMR, e.g. including RRT activations,

deterioration of patients, AHD, ARP orders

Radiology

Orders

Manual process during Downtime.

Paper based order forms to be utilised. Existing patient ieMR labels or

handwritten patient information to be utilised on order form as available.

Order form to be faxed or hand-delivered to Radiology during Downtime period.

Radiology

Results

Results made available on IMPAX.

In the event of a concurrent IMPAX downtime; critical results to be phoned

to Ordering Medical Officer by Radiologist. All other results printed to areas

as required.

Radiology results to be reconciled to the ieMR chart during the

Recovery Phase by Radiology staff.


0 – 2 Hour


> 12 Hour

Downtime

Registration Initial manual process. Retrospective documentation of all admissions and




Retrospective input and correction of data will be required during Recovery

Phase.


admissions.

Risk

Assessments

Admission Nursing Risk Assessments to be delayed until post Downtime period.

Patient Safety principles to be applied as indicated (e.g. Falls Risk interventions,

Pressure injury preventative strategies, etc).

Specimen

Labels

Patient information on specimen containers to be handwritten during

downtime.

Transfer of

Patients

(internal)

Initial manual process. Retrospective documentation of all internal transfers of

patients will be required during Recovery.


Maintain Patient Flow Tracking Log to document Transfers during downtime


*Consider additional AO support to assist with retrospective

documentation

Vital Signs All vital signs are

documented on

the paper based

observation forms

by the nursing

staff and stored in

the CEC. Vital

signs to be added

to the ieMR

during the

Recovery Phase

(via manual

process)

Enter the last 3 sets of vital signs

Document summary of clinical deterioration into the ieMR

during the Recovery Phase as clinically indicated.


Appendix 1 - Definitions, Acronyms and Abbreviations

Name Definition

AO Administration Officer

ARP Acute Resuscitation Plan

AUSLAB State wide laboratory information management system (LIS) provided by PJAS

BCP Business Continuity Plan

CEC Current Encounter Chart

Cerner Clinical software provider contracted by QH for the ieMR

DDU Day of Discharge Unit

DOH Department of Health

ECG Electrocardiogram

ED Emergency Department

EDS Enterprise Discharge Summary

eHealth The program responsible for implementing electronic health solutions into Queensland Health

eMR Electronic Medical Record

ESI External Systems Inbound Interface (Cerner)

EW Encounter Wallet

HBCIS Hospital Based Corporate Information System – Current Qld Health Patient Admissions System (PAS) – iSoft product.

HEOC Health Emergency Operations Centre

HL7 Health Level Seven messaging standard for healthcare environments

HMS Hosting and Management Services Agreement (ICT2239c) with Cerner Corporation.

iAppS Integrated Application Services

ICT Information and Communications Technology

ICU Intensive Care Unit

ieMR Integrated Electronic Medical Record build on the Cerner Millennium Solution

IMPAX Radiology System used to view images

IMT Incident Management Team

IT Information Technology

Millennium Cerner clinical application suite used for the QH ieMR

OERR Order Entry Results Reporting

OPD Outpatients Department


Name Definition

PASLink

PFM Patient Flow Manager

PJA Solutions AUSLAB software vendor

PowerChart Cerner Millennium Desktop Application

QH Queensland Health

QRIS Queensland Radiology Information System (RIS)

RRT Rapid Response Team

SIM Systems Integration Management Team

SIM ieMR Systems Integration Management Team – integrated electronic Medical Record

THHS Townsville Hospital and Health Service

TTH The Townsville Hospital

UPS Uninterrupted Power Supply

UR


Appendix 2 - Unit Downtime Monthly Checklist

Monthly Downtime Checklist

Unit Ward:

Date Check Completed:

/ /

Completed By:

Name:

Signature:

Task Variance – Action

Required

Action

Completed

(Initial and Date)Downtime Kit

1 Downtime kit is easily accessible

2 Forms: all required forms are in the kit

3 Reference Guides are in the kit

4 Adequate wristbands and pens are in the kit

5 Spare paper is in the kit (including for

6 Spare ieMR labels including Specimen labels are in the kit

7 Spare Pens

724 Downtime Viewer

8 Key to access the secure cabinet can be located and

works

9 The Downtime 724 Viewer computer is turned on (it

should be left on at all times) and plugged into

emergency power10 The Username and Password for the Downtime 724

system can be located and works

11 Patients for that unit can be located in the Downtime

724 system (tracking list)


12 Patient data in the Downtime 724 system is complete

and up to date

13 Patient data for that unit can be printed from the

Downtime 724 system


Appendix 3 – Downtime Viewer (DTV) Locations

No. Server No.

Physical Location of DTV Workstation I.P Address

Port Number Room No.

Printer Connected

1 1 Emergency Department, Acute Fishbowl, (bottom of shelf near med reg computer)

10.208.128.157 TSVHS-NB-N1-AS 568S

NG.920B QH10441701

2 2 Emergency Department, Short Stay Unit (Underneath Telemetry Monitor)

10.208.128.158 TSVHS-NB-NG-AX 359X

NG.933 QH10449828

3 1 Women's & Children's Clinics, Reception Area (Underneath Battery Chargers, R/H side of desk)

10.209.32.102 U6UC-SWG-146 AG.470 QH30733184

4 2 Children's Ward, On shifties desk near printers 10.209.34.89 U6-WD-WG-140 WG.160 QH30726139

5 1 Cardiac Ward & Surgical Clinical Decisions Unit (SCDU) 10.208.129.120 TSVHS-NB-N1-AU-172U

N1.066 QH30582244

6 2 Renal Dialysis, Second Nurses Bay (R/H side underneath bench)

10.209.17.121 U6AC-NE-1079 A1.141 QH10441715 - Need to confirm

7 1 Medical Ward 3, (W1.175, Cupboard in front of nurses bay)

10.209.14.208 UCWD-W1-070 W1.175 QH30735104

8 2 Neonatal Unit (Special Care Nusery), Pinnacles Meeting Room, Underneath top cupboard, Printer located in Neonatal Unit

10.208.130.93 AC-NW-02-019X N2.122 QH30735219

9 1 Maternity Unit, Nurses Station Left handside beneath patient charts, under bench

10.208.69.30 TSVHS-WD-L2A-Y-065

W2.8150 QH10082520

10 2 Surgical Ward 2, Back of Nurses Bay, Underneath top shelf that houses Battery charges

10.209.26.64 U6WD-E2-150 W2.133 QH30735205


Appendix 4 – Downtime Viewer Location Maps

Townsville Hospital & Health Service ieMR Business ... · The Townsville Hospital integrated...

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