{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T03:01:44Z","timestamp":1774321304811,"version":"3.50.1"},"reference-count":0,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:p>\n            Introduction\u2003Electronic health record (EHR) downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared.<\/jats:p><jats:p>\n            Objective\u2003The objective of this study was to assess the operational implications of downtime with a focus on the clinical laboratory, and to derive recommendations for improved downtime contingency planning.<\/jats:p><jats:p>\n            Methods\u2003A hybrid qualitative\u2013quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several downtime events, including a hospital-wide EHR shutdown.<\/jats:p><jats:p>\n            Results\u2003During downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of downtime, and how to best address them. Based on these insights, recommendations for improved downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides.<\/jats:p><jats:p>\n            Conclusion\u2003This study documents the extent to which downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their downtime contingency plans need to find more effective methods to collect data during these times.<\/jats:p>","DOI":"10.1055\/s-0039-1692678","type":"journal-article","created":{"date-parts":[[2019,7,10]],"date-time":"2019-07-10T23:26:00Z","timestamp":1562801160000},"page":"495-504","source":"Crossref","is-referenced-by-count":19,"title":["Continuing Patient Care during Electronic Health Record Downtime"],"prefix":"10.1055","volume":"10","author":[{"given":"Ethan","family":"Larsen","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Hoffman","sequence":"additional","affiliation":[{"name":"National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Rivera","sequence":"additional","affiliation":[{"name":"Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian M.","family":"Kleiner","sequence":"additional","affiliation":[{"name":"Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Wernz","sequence":"additional","affiliation":[{"name":"Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raj M.","family":"Ratwani","sequence":"additional","affiliation":[{"name":"National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, United States"},{"name":"Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2019,7,10]]},"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0039-1692678.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,7,10]],"date-time":"2019-07-10T23:26:00Z","timestamp":1562801160000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0039-1692678"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5]]},"references-count":0,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2019,5,29]]},"published-print":{"date-parts":[[2019,5]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0039-1692678","relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5]]}}}