Located in Bolivar, Missouri, Citizens Memorial Healthcare is a nationally recognized, rural health care system with 1,500 employees that provides a number of services including: inpatient care, outpatient care, emergency room services, behavioral health services and imaging services. CMH has received many accolades including: the first rural hospital to earn the Nicholas E. Davies Award of Excellence, presented by the Healthcare Information and Management Systems Society (HIMSS) for advanced use and implementation of health IT. We also received the Stage 6 Electronic Medical Record adoption recognition from HIMSS Analytics.


CMH used to operate with disparate systems and databases, no common patient identification, a lack of clinical documentation systems, a lack of continuity of patient care information across the delivery system and minimal IT standards. Nearly four years ago, however, we overhauled the hospital’s IT structure in an effort to operate more efficiently, improve patient care and manage rising costs. Today, a fully integrated, 100 percent paperless health care information system connects the 74-bed hospital with five long-term care facilities, 16 physician clinics and home care services across southwest Missouri.


What Happens if There’s a Power Outage?


When our CMH administration and board decided to implement an integrated health record throughout all our facilities, they envisioned replacing all paper charts with electronic records.


About a week prior to going live with the patient care system (PCS) documentation, my IT staff was removing the paper from the charts at the nurse’s station when a thought crossed their minds: “What are we going to do if the hospital’s systems go down?”


The charts were all going to be electronic and the nurses wouldn’t have the paper to fall back on. We had a little more than a week to decide what we were going to do in that scenario.


My IT staff and I decided to use scripting technology to automate the printing of reports to a portable document format (PDF) file or some other type of file. In the event the hospital’s systems crash, we would be able to create paper charts on the fly from the printed reports, enabling physicians and others who provide patient care to be able to access the data they need without missing a beat.


We quickly found Boston WorkStation from Boston Software Systems.


Boston WorkStation is a workflow automation technology that allows health care organizations to automate common tasks, manage workflow and improve productivity throughout the organization. These tasks include revenue cycle projects, interactions with Web sites, integrating new applications, systems and devices as well as electronically monitoring and managing user activity.


I spoke with Boston Software Systems for an hour over the phone to familiarize myself with Boston WorkStation. In that time, I realized that this tool would be powerful enough to successfully run the scripts unattended. We looked at a couple of other scripting tools, but they weren’t capable of accomplishing the task well enough.


Planned and Unplanned Downtime


In the event of a system failure, a hospital must be able to fully function, because it still needs to continue to care for its patients. Using Boston WorkStation, CMH now has downtime reports for short-term or long-term outages that help transition records from electronic to paper, providing instant access to pertinent patient information.


We now have a dedicated server with Boston WorkStation that gathers and delivers the important patient data to the hard drive once an hour, 24 hours a day, unattended. The reports then get “pushed” to a central location where all departments can pick them up in case of a system failure. The reports are also pushed to each of the long-term care facilities, because they are spread out over five counties. In addition, CMH has a second location where it stores the scripts and pushes other important backup information in case of an extreme disaster.


Every other month, we schedule planned downtime of two and a half hours, allowing staff to perform regular system maintenance, test and implement new systems and test disaster recovery procedures. During this time, each department is encouraged to follow its downtime action plans.


Unfortunately, at CMH, we have also had to deal with unexpected downtime when nature strikes in the form of ice storms and tornadoes. We’ve had power outages due to tornadoes in our area. They didn’t hit our facilities, but they hit a part of our town and zapped our wide area network (WAN) connectivity at one site for a day and a half. The reports that the Boston WorkStation process had produced that day were the only information that site had on hand. Being able to retrieve those documents was a lifesaver.


It’s not always a natural disaster that causes unplanned downtime either. The IT staff members and I recall a Friday afternoon, three years ago, when we were down for 82 straight hours due to hardware failure. We were at the hospital the entire time, and the automated reports allowed us to transition to paper records so we could still tend to patients’ needs. We had to make some adjustments to the downtime process, but we didn’t have to start from scratch. Fortunately, we made good decisions in the beginning as to which reports would be necessary.


We can proudly say that CMH has been paperless for four years, but there have certainly been instances when the system was down and we had to rely on the paper files. Although having systems down is very inconvenient, we feel confident that we can remain fully functional, because our staff is still able to access the critical data they need to deliver exceptional care to patients.

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