When I selected the topic, Downtime Protocol, for this month’s blog, I wasn’t sure where I was going to begin. But like anytime I am at a loss for an idea, I took a few days to “sleep on it.” I was hoping a flash of genius would hit me, and the words would just pour out.
I was pleasantly surprised when that happened a few days ago. In the spirit of full disclosure… it wasn’t a flash of genius. It was more like a deficiency report a fellow Laboratory Manager received from the CLIA inspector. Any way you slice it, the idea was planted, and the words were ready to pour out.
When I think of downtime, I think of the Laboratory Information System (LIS). That’s the frame of reference I had when working in my early days in hospital laboratories. When we heard the LIS system would be “down”, we had to prepare for a morning of phlebotomy with no pre-printed labels. We had to prepare to print and deliver reports to the floors. And we had to (insert shudder here), FAX reports to the Emergency Department.
In today’s complex world of connectivity, Downtime Protocol means so much more. And as laboratorians, we need to prepare for all of them.
It is true, the LIS sometimes goes down. Sometimes downtime is scheduled, but sometimes it is not. Preparation is very different depending on the scenario. In a scheduled downtime, we alert our offices that they will not be able to transmit or process laboratory orders during that period. We have scheduled these at various times and find that none of them are convenient. When we planned for Friday evening, after office hours, we found the proper resources at our reference labs were not available. When we planned them for late in the day, there were complaints of overtime while playing catch up. When we planned them for early in the day, we received complaints that the LIS was down at the busiest time of the day. Clearly, you cannot please everyone, every time. If you have found the “perfect” time, please let me know. I am open to the suggestion.
In an unscheduled downtime, no one has time to plan. You might think everyone would be on the same footing. But even that is not so. We recently experienced an LIS downtime that was caused by connectivity, not the LIS system itself. In our laboratory, where the LIS hardware is maintained, we still had connectivity. The laboratory itself was fully functional. But none of our off-site locations could connect to the LIS system. In those facilities, the LIS was DOWN. The managers look to me for guidance in these situations, but unless I have an idea when the system will be operational it is difficult.
With I moved from the hospital environment to the physicians’ office laboratory, Practice Management and EHR systems became part of my world, as they are connected to our LIS. With the universal use of systems, many physicians’ offices are now faced with needing a downtime protocol. This may include the scheduling and appointment modules as well as the charting and laboratory modules.
Protocols can vary depending on the source and severity of the downtime. We have experienced a single site downtime, such as one caused by failed connectivity at one doctors’ office. When that happened, the schedule and recent progress notes were printed at a different location and forwarded to the affected location. Fortunately, their email system was not impacted, or they would have had to rely on facsimile.
We have also experienced a system downtime due to the Practice Management/EHR program not available. This is so much more difficult to handle since there is no access to patient information to call and cancel hours. There is no chart information to review prior to seeing the patient. There is also nowhere to document the visit and order laboratory tests and other diagnostic procedures.
Electronic interfacing between LIS programs and reference laboratories adds another layer of communication which can suffer a downtime. My LIS is interfaced with both Quest Diagnostics and Laboratory Corporation of America. When connectivity with either or both laboratories is down, we cannot upload laboratory orders to the Patient Service Centers for blood draws. We cannot upload specimen and test information when submitting specimens collected in the office. The reference lab must hand input the information into their LIS system. Then when the results interface to our LIS, we need to manually match each result with the original order. All these manual steps add in the opportunity for errors to occur and for delayed result filing.
If the result interface is also affected by the downtime, then patient results are held in limbo until the connection is restored. Physicians who need laboratory results are forced to rely on phone calls and faxes to receive their valuable diagnostic information in a somewhat timely manner.
As I sit here listing the numerous types of downtimes in our advanced electronic facility, I realize that my downtime protocol is sorely lacking in detail and direction. I have the basics, but there is much that is left up to the imagination. I know what I will be working on before 2016 comes to close.
How are your procedures? Hopefully, you are further ahead than I am. But if not, you are in good company.