KLAS Arch Collaborative Success Pathway—EHR Reliability & System Speed

Healthcare Delivery Organizations

Optimization Journey: EHR Reliability & System Speed

1. Review self-examination questions
2. Proactively round with clinicians to monitor EHR reliability, EHR speed, and other related issues (e.g., faulty equipment, EHR login issues, Wi-Fi interruptions) that may impede EHR reliability and speed
   1. Include your technical team in your rounding so they understand firsthand the challenges clinicians encounter across all locations and care settings
3. Prioritize EHR reliability and speed by working with your technical team to establish optimal system performance metrics and SLAs for EHR reliability and speed across all locations and care settings; include your login process as part of this effort
   1. Collaborate with your EHR vendor to understand optimal EHR reliability and speed expectations; ensure your organization is meeting or exceeding these expectations
4. Share EHR speed and reliability SLAs with senior leadership and EHR end users; determine the cadence for reporting target versus actual performance to both groups (e.g., monthly, quarterly)
5. Work with your technical team to ensure regular, proactive monitoring and testing of EHR reliability and speed across all locations and care settings to verify optimal performance
   1. As needed, partner with third-party vendors to monitor and ensure optimal EHR system reliability and speed

1. When interruptions to EHR reliability or speed occur, perform a comprehensive root cause analysis to determine the cause and prevent future interruptions; look for patterns in ticket volumes and prior disruptions; investigate process- and technical-related factors, such as adjacent systems (e.g., the login or single sign-on process, VPN issues)
   1. Immediately inform clinicians of all unexpected system interruptions, including service impacts, and provide regular updates; notify users of the timing of system restoration
   2. Work with your EHR vendor to monitor and understand system performance metrics/data collected via the EHR; regularly compare your system performance data with what is reported through the EHR; collaborate with your EHR vendor to diagnose and resolve issues
2. Work with your technical team to stay on top of software and hardware updates for the EHR as well as for adjacent software and hardware; verify that vendor system performance requirements are met
3. Forecast hardware replacement costs to remain compliant with the EHR vendor’s hardware requirements, including costs for laptops desktops, monitors, keyboards, COWs, printers, servers, etc.
   1. Create a hardware inventory maintenance and replacement schedule (i.e., a three-year or five-year refresh cycle); create a budget based on the percentage of equipment replacements each year

1. Schedule regular and well-published downtime events (i.e., every third Wednesday at 2:30 am) for system maintenance and upgrades for clinical and nonclinical applications
   1. Communicate early and often about expected downtime so clinicians are not surprised and can then follow established downtime protocols
   2. Work with clinicians and review patient census data to ensure scheduled downtime occurs on a day and time that minimally impacts end users and patients
   3. Rigorously test upgrades via an offline node to identify and correct issues so that upgrades do not impact the live environment and cause unexpected interruptions; after upgrades, monitor the speed of screen changes, refresh rates, and the single sign-on process to quickly identify and correct issues; include rounding with your technical team in this effort
2. Create and implement downtime protocols to ensure patient safety and continuity of patient care during regularly scheduled and unexpected downtime events
   1. Acknowledge that select clinicians will bear the brunt of regularly scheduled downtime; work to assess their needs during downtime periods and provide alternate methods for them to complete necessary work

1. Measure clinician satisfaction via an Arch Collaborative survey and share your survey results with:
   1. Your technical team to jointly resolve issues and ensure your EHR and adjacent software, systems, and equipment (e.g., single sign-on, Wi-Fi, VPN, network) are up to date
      • Confirm that single sign-on performance metrics are measured and meet vendor SLAs; share SLAs with end users and senior leadership so they understand expectations
   2. Your EHR vendor to jointly resolve issues, review system performance data captured by the EHR, and ensure hardware, EHR reliability, and EHR speed requirements are met

Self-Examination Questions—EHR Reliability & System Speed

On a scale of 1–5, rate your agreement with the following statements (5 means “strongly agree” and 1 means “strongly disagree”):

1. We view our EHR reliability and system speed as critical components of patient safety and effective patient care.
2. We work in partnership with our technical team to ensure that system redundancy eliminates single points of failure in our EHR infrastructure, network, data centers, etc.
3. We prioritize staying on the most current version of our EHR and surrounding software, such as our single sign-on platform.
4. When clinicians express frustration with EHR reliability and speed, we holistically investigate the issue by reviewing adjacent systems, such as the single sign-on platform, the VPN, Wi-Fi, hardware, etc.
5. We have an established process for clinicians to register infrastructure-related complaints (e.g., complaints about laptops, servers, desktops, printers, monitors, keyboards, the login process, COWs).
6. We encourage clinicians to raise urgent issues when they encounter challenges with EHR reliability and speed as well as with laptops, servers, desktops, printers, monitors, keyboards, the login process, COWs, Wi-Fi, etc.
7. We promptly investigate all reported infrastructure concerns.
8. Our technical team and clinical team leadership regularly round together and on-site with clinicians to understand end-user EHR experiences related to system performance metrics, recognizing that infrastructure issues frequently go unreported because clinicians are unsure what is normal and what they should expect (i.e., waiting 60 seconds to log in is unacceptable).
9. We perform a comprehensive root cause analysis when our planned downtime lasts longer than anticipated (i.e., during a system upgrade) to minimize future disruption.
10. We proactively work with our EHR vendor when clinicians encounter unexpected outages or sluggish system speeds to decrease the time to restore the expected service level.
11. We proactively notify our EHR vendor before making changes that may affect EHR reliability and speed and collaborate with them to restore the system to normal as quickly as possible.
12. We have a communication plan when there are interruptions to EHR reliability and speed or when there are issues with printers, desktops, laptops, Wi-Fi, COWs, etc. to create transparency for our end users.
13. Our downtime protocol includes a communication plan, backup systems (such as alternative methods to access critical patient data), prioritization of patient care (i.e., focus on life-saving interventions), staff roles and responsibilities, workflow adjustments (including protocols to manually process and administer medication), documentation procedures (i.e., paper documentation to be entered later), and a system recovery plan.
14. We prioritize updating our EHR and surrounding infrastructure by using a rolling scale for hardware replacement (e.g., a certain percentage of laptops, servers, desktops, printers, monitors, keyboards, COWs, Wi-Fi technology, etc. are replaced each year) that accounts for factors such as user calls for failing devices, device age, and end-of-life and end-of-warranty dates.
15. We proactively notify end users when the equipment they use is approaching end-of-life or end-of-warranty and will be replaced, along with a timeline for replacement.
16. We ensure that clinicians have a consistent EHR experience when they access the system from a remote location by providing infrastructure expectations for equipment, Wi-Fi, etc. at off-site locations.

Total

Scoring

HIT Software Vendors

Self-Examination Questions—EHR Reliability & System Speed

1. Do you provide comprehensive requirements for equipment (e.g., hardware, software) to your customers to ensure a robust EHR end-user experience?
2. Do you provide reliability and speed expectations for the EHR and surrounding systems to your customers, including the expected time for activities such as the speed of loading and refreshing pages, logging into the system, etc.?
   1. Do you recognize that EHR reliability and speed begin with the initial click of the mouse and/or a login to the system?
3. Do you provide recommendations for hardware replacement to ensure that servers, computers, etc. can handle the requirements of EHR upgrades?
4. Do you regularly check to ensure customers meet your infrastructure expectations?
5. Do you proactively monitor EHR reliability and speed with your customers, partner with them to ensure they adhere to expected SLAs, and empower them to promptly raise concerns and issues with you?
6. When EHR interruptions occur, do you collaborate with your customers to complete a root cause analysis and quickly restore service to expected levels?
7. Do you strongly encourage your customers (technical team members, clinician team leads, senior leadership) to round with clinicians to understand firsthand what the EHR experience is like?
   1. Do you round with your customers to understand what their EHR experience is like?
8. Do you provide a hardware road map five years into the future, enabling your customers to appropriately budget for replacement equipment and software?
9. Do you have a communication plan to promptly communicate any infrastructure irregularities (e.g., downtime, lagging system speeds) with your customers?
10. Do you assist your customers in creating downtime protocols as well as a communication plan for expected and unexpected downtime and sluggish system speeds?
11. Do you comprehensively test EHR upgrades and patches to ensure minimal disruption to your customers’ EHR infrastructure?
    1. When an upgrade may cause disruptions to EHR reliability and/or speed, do you proactively notify your customers before releasing the update and help them quickly resolve any issues?
12. Do you encourage your customers to provide a consistent experience with EHR infrastructure across locations and care settings?