Patient Registration in Downtime or Disaster
— Developing an Effective Response

As healthcare providers automate more of their processes and reduce their reliance on paper, the opportunities to reduce cost, improve efficiencies and enhance patient safety grow.  However, every roadmap to electronic medical records must give careful consideration to how facilities will register and care for patients when the network and/or the HIS are down.  Be it a planned maintenance or system update, or a full-blown disaster that takes everything down, your people and processes must be ready to swiftly shift to “Plan B” without hesitation.

Guiding Lights
What should be your chief considerations for patient registration?   “Keep it simple. Focus on those activities that are absolutely critical,” says James Van Wassenhoven, a project manager who has been on both sides of an implementation – for a Wisconsin health system and as part of Standard Register’s technology team.

“In planning your downtime workarounds, you want to look for opportunities to simplify processes, so your staff can concentrate on the essentials of patient safety and care.  And, you want your application to mirror the HIS, so your staff isn’t faced with learning new workflows and will quickly respond without much forethought,” he explained. 

When HIS Goes Down
When the HIS is unavailable but you have network access, you still need to admit and identify patients in order to treat them and assure their safety.  Even your pre-registered patients will need to be re-registered.

So often today, facilities revert back to handwriting patient demographic data onto preprinted forms. However, you don’t need to be reminded how error-prone manual processes can be.  They pose a real risk to safety and a host of compliance issues. Moreover, they offer no efficient means of updating and reconciling records once the HIS is back up.

Van Wassenhoven recommends tailoring your backup system or systems to your expected needs.  During a “normal” downtime, a more robust system may be called for in an effort to gather information that is usually part of the registration process.  During a large scale catastrophe, a simple stand-alone system may be in order to provide the kind of the flexibility that is needed during this type of downtime. A simple PC and printer can operate whether the network is up or down to produce bar-coded wristbands, face sheets and chart labels. 

The application for a “normal” downtime should accommodate information for the existing patient population and those discharged within the last six months.  Ideally, Van Wassenhoven says, the facility would want to have patient data for the last three to five years, so those patients who might be re-admitted can be treated more safely and efficiently. 

“With the history of patient data available for registration -- insurance information and emergency contacts, etc. – a hospital’s staff need only verify the data and make necessary changes rather than going through the full registration process,” Van Wassenhoven explains.

Finally, he reiterates, “Look for every opportunity to streamline the process.  Integrate functionality to facilitate more accurate, complete documentation.  Make registration and care as easy as possible by auto-populating fields, designating required fields such as date of birth, and providing drop-down fields to minimize data entry errors.

“I can’t stress enough the need to keep this downtime application aligned with the intake flow process of the HIS,” Van Wassenhoven says. “If the staff is familiar with the process, it will help them use the application more efficiently.  You want people to move swiftly and make the right choices to assure patient safety.”

He also suggests that hospitals may want to create a downtime recovery report which can be used to aid in the recovery after a downtime has occurred.  This report would list all the information verified and gathered during the downtime registration to be populated back into the HIS for this patient visit.

Back-Up for CPOE
Van Wassenhoven notes that the same technology could also be used to back up applications such as Computerized Physician Order Entry (CPOE).  “As hospitals become more and more automated, more provisions need to be made to back up those applications which could go down independent of the HIS,” he observes.

In the case of CPOE, he recommends the stand-alone downtime system also includes an electronic library of forms that duplicate what is being used in CPOE.  The application could easily be configured to produce form kits, specific to medical conditions, be it appendicitis or a renal dysfunction.  Patient care can then proceed uninterrupted. Fully bar-coded, the forms can be easily scanned into the document image repository and automatically indexed, so orders can be readily processed, documentation accessed or printed, and patient accounts can be charged.   

When Disaster Hits
When a hurricane, tornado, earthquake or other disaster strikes, you need a back-up system that is simple and easy to deploy.

According to Van Wassenhoven, hospitals should plan for the worst.  It is likely their staff will be working from a parking lot or a mobile unit with no access to the HIS or the network present.  Multiple registration points will be needed to accommodate the onslaught of injured. And because of the sheer numbers of patients, most likely, only the most essential documents (face sheet, wristband and labels) will need to be created. 

Standalone PCs and printers with battery back-up or connection to a generator will be essential.  The staff will need to establish proper patient identification, gathering only the critical information the hospital needs to function – at least name and date of birth.  In the disaster scenario, it is also useful to be able to produce a report and any documents needed to provide a rudimentary patient chart, such as progress notes or a flow sheet for capturing patient information.

“Simplicity is paramount, particularly in a disaster,” Van Wassenhoven stresses. “You want your clinicians to be focused solely on patient care.”

Configuring appropriate downtime and disaster processes and procedures demands careful consideration.  For guidance and support in tailoring viable plans to meet the demands of your facilities, contact Standard Register.