Allina Excellian Downtime Preparedness and Awareness 2018

This course is designed to give the learner an overview of Excellian Downtime and their responsibilities before, during and after a downtime.  Additional drilling and hands on education should be made available by department leaders. 

Learners must complete all three sections of the course to receive credit.

Downtime Defined

What is Excellian Downtime?

Excellian is Allina's version of a comprehensive electronic medical record.  


Excellian Downtime occurs when  the Excellian system is not available or operating as expected.

What does this mean for you?


Staff that use Excellian or it's interfacing systems, must have a good understanding of what they would do should Excellian ever NOT be available to them.   

After all, patient care does not stop, just because the system is not available.

Allina Excellian Downtime Preparedness and Awareness Program


Allina's Excellian Downtime Preparedness and Awareness Program addresses the issues that might arise and ensures staff readiness in the event of an unexpected downtime.


As an Allina employee, you are expected to be aware of, to understand and to utilize the plans and processes in place to continue safe and effective patient care in the event of such a downtime.


Objectives of the Course

When you finish this course, we'd like you to be able to:

  1. Identify the two types of downtimes
  2. Identify the 4 most common causes for unplanned Excellian downtime 
  3. Describe when "Read Only" environment will be available
  4. Identify where on your unit you can find your downtime materials
  5. Identify the location of your downtime PC(s), printer (s) and the designee that is responsible for printing your downtime reports
  6. Describe how to use the Downtime Label Application and where to place the labels on downtime forms
  7. Describe the importance of the Downtime Event Form (DEF) and when to send it to Registration/Patient Access
  8. Verbalize the difference between downtime reports and downtime forms
  9. Identify how to obtain a Medical Record number during a downtime
  10. Describe the sequence of recovery (back loading)

Before we start...

1. Indicate your work environment, your job role and your use of Excellian. 

This is so we can make sure you are receiving the information pertinent to your job role. Although the basics of downtime are the same across the system, different operational units have some special procedures they undergo when downtime occurs.  

2. Follow the course material taking special note of anything underlined or in bold (hint, hint:)

Remember, the intent of this learning is to help you do your job and to ensure safe care for our patients.  Though we want you to know the material, we won't penalize you for needing extra help.  

3. Complete all of the questions within the course AND the assessment at the end. 

We'll quiz you a bit throughout the course to make sure it's making sense. Then at the end, you'll be asked to take a short assessment.  

Choose the job level that best describes your role:

  • I am a Director, VP or member of the C Suite
  • I am a Manager
  • I am a Provider
  • I am a Student or Intern
  • I am a Supervisor or Lead
  • I am none of the above

Select the area that BEST describes your work environment:

  • A freestanding clinic, or hospital based clinic, ambulatory setting
  • A hospital, acute care setting
  • A hospital pharmacy
  • A hospital medical imaging, radiology or ultrasound department
  • A hospital laboratory or centralized laboratory department
  • A hospital registration or patient access department
  • Courage Kenny Rehabilitation Institute at any location
  • Home Care Services (Home Care, Hospice, Palliative Care)
  • Any other clinical area not included above
  • A corporate department not included above

Choose the answer that best describes your role.

If Excellian unexpectedly went down: 

  • I would still be able to do my job without it. (limited or no Excellian use)
  • I would not be able to do my job, but could wait until the system becomes available again. (Excellian user with non-critical patient care role)
  • I would not be able to do my job without it and would need an alternative work process to continue to provide appropriate patient care (Excellian user with direct patient care/flow responsibility)

The Basics

There are 2 types of Downtime Occurrences: Scheduled and Unscheduled

Scheduled

Scheduled Downtime happens when the system is intentionally taken down, usually for system maintenance, updates or upgrades.  In the case of a scheduled downtime, staff and leaders are informed well in advance of the downtime.

This advance notice allows staff to make sure they have the necessary materials on hand to function during the time the system is unavailable to them.  These downtimes happen at least quarterly. You can find a list of scheduled downtimes on Excellian.net under the link called Downtime/release schedule

Unscheduled

Unscheduled Downtime happens when the system goes down without warning.  This type may have many different causes.

During an unscheduled downtime, your department will follow procedures outlined in their Business Continuity Plan.  




The most common causes of an unplanned downtime are:

1. Hardware failure

Hardware failure is any failure of the hardware components that support the Excellian system.  These hardware components include, servers, databases, peripherals and interfaces.

2. Software Failure

Software failure may include a failure with the Epic software itself, or one of its interfacing systems.  



3. Network Failure

A network failure occurs when something disrupts the flow of information through the Allina network.  In the case of a network failure, other systems like eMail or the Internet would also be unavailable.

4. Electrical Failure (Power Outage)

A electrical failure or power outage to the main power source is another possible cause of Excellian downtime.  Downtime PCs are set up to run on backup power that utilizes generators or other secondary power sources.  We will talk more about downtime PCs and reports as the course progresses.

First response

Remember...

In the event of any unscheduled  downtime, your first response should be to call the Technology Support Center at 612-262-1900 to report the incident.

Downtime Readiness Components

Before we dive in, there are a few terms you need to know.  These are the 8 main components of the downtime process.  Just get familiar with the terms for now, we'll go into more detail as we move through the course.

Excellian Read-Only Environment

A back up version of Excellian only available during a scheduled downtime AND within approximately 30-60 minutes if activated during an unscheduled downtime AND if network access is available.

Downtime Reports

Downtime reports are available to staff if either a scheduled or unscheduled downtime of Excellian occurs.  These reports contain pertinent information that can be used to continue patient care even if Excellian is down.

Downtime Binder

A Downtime Binder is a special binder that contains paper copies of downtime materials that might be necessary should Excellian be unavailable.  Each unit or service area should have at least one downtime binder that is reviewed annually to ensure the materials are up to date.

Site Procedures

Site Procedures are Downtime Procedures specific to a particular location or department. A paper copy of Site Procedures should be kept in your area's Downtime Binder.

Downtime PC(s)

Patient care units and clinics throughout Allina have designated PCs to serve as Downtime PCs.

Downtime Labels.mde

Downtime Labels.mde is a special application loaded on Downtime PCs that allows the user to print patient labels even if Excellian is down. 

Downtime Printer(s)

Patient care units and clinics throughout Allina have designated printers to serve as Downtime Printers.

Downtime Forms

paper forms are used to record patient care information when Excellian is not available.  A stock of downtime forms appropriate for your area should be maintained in your department's Downtime Binder.  

Excellian Read-Only Environment


You may have noticed an icon on your PC desktop called Epic 2015 Read Only. 

This icon is to be used when a downtime is initiated.  When double-clicked, this icon brings you into the Read-Only version of Excellian. 


This back up version of Excellian is only available during a scheduled downtime AND within approximately 30-60 minutes if activated during an unscheduled downtime AND if network access is available.

You will know you are going into Read-Only because of the yellow background on the Hyperspace login screen.

Excellian Read-Only Environment Key Points

keypoints

Key Points about the Read-Only Environment

  1. Read-Only is intended to be used as a supplement to the printed Downtime Reports.
  2. Information in Read Only will be current as of the time the Production downtime began
  3. End users will be able to view certain demographic and clinical information in this environment.  
  4. No user preferences of patient data may be created, modified or saved in the Read-Only environment.
  5. No changes of any type will carry over to the actual Production environment.
  6. Read-Only is only available during downtimes ONLY if network access is available.
  7. Read-Only will only be enabled if Excellian Production is unavailable, such as during scheduled downtimes that are expected to take more than 30 minutes.
  8. Read-Only takes 30-60 minutes to activate. In an unscheduled Excellian downtime, IF Read-Only is activated, it will not be available immediately.

Downtime PCs and Printers

Downtime PCs

Patient care units and clinics throughout Allina have designated PCs and printers to serve as downtime PCs/printers.  In many hospital locations, each department or nursing unit may have a downtime PC and/or printer.  In other settings, there may be a central hub of PCs that are designated for this purpose.  In all cases, these downtime PCs and printers should NEVER be turned off. 

Downtime PCs function as a real-time repository for downtime reports.

When a downtime occurs, designated staff will print downtime reports from these downtime PCs to the downtime printers allowing for the most current report of patient information available to staff at that time.

Downtime PCs and Printers Key Points

Key Points about the Downtime PCs and Printers

  1. NEVER turn them off.
  2. There may be one or more Downtime PCs on a unit. (check with your supervisor to make sure you know which PCs are designated Downtime PCs)
  3. Downtime PCs and printers should be tested weekly to ensure they are functioning appropriately. 

Downtime Reports

Downtime Reports

Downtime reports are available to staff if either a scheduled or unscheduled downtime of Excellian occurs.  These reports contain pertinent information that can be used to continue patient care even if Excellian is down.

Downtime Reports are pulled to downtime PCs every five minutes.  There are several different types of reports specific to the unit that is using them.  

For example, if you work on the cardiology unit, you may have a cardiology specific report for your patients.  If you work on an OB unit, you may have a report that contains information specific to caring for an OB patient. 

Most units will have at minimum:

1. A census report

2. Last medication administration record (MARNext)

3. Clinical summary report (CLINSUM)

If you are unsure which reports you should have on your downtime PC(s), check with your leader. 


Downtime Reports Key Points

Key Points about Downtime Reports

  1. Downtime reports are NOT automatically printed.
  2. A pre-determined staff member is responsible for printing a units' Downtime Reports from the designated Downtime PC.
  3. Report information will be current as of the last data pull which is typically every 5 minutes

TF Question DT reports

  • Downtime reports print automatically when a downtime occurs.

Downtime Binder

Downtime Binder

A Downtime Binder is a special binder that contains paper copies of downtime materials that might be necessary should Excellian be unavailable.  Each unit or service area should have at least one downtime binder that is reviewed annually to ensure the materials are up to date.

These materials include Downtime Forms, Downtime Procedures, Contact Lists and other pertinent information that might be necessary if you do not have access to Excellian or the Allina network.  

Where is your downtime binder?

If you are unsure, make a note to ask your leader after you finish this course.   

Downtime Binder Key Points

Key Points About Downtime Binders

1. Contain paper forms, procedures and instructions on how to function during a downtime.

2. Must be reviewed annually to make sure information is current.

TF Downtime Binder Question

  • We don't need a downtime binder on our unit if we have our downtime forms stored on the akn.

Downtime Site Procedures

Site Procedures

Although there is a lot of similarity in Downtime Procedures across units, each business unit and/or department may have their own procedures specific to their work process.  

Make sure you know what you need to do by reviewing the site procedures ahead of a downtime.  A paper copy of site downtime procedures in in the Downtime Binder on your unit/department.

Downtime Labels

Downtime Labels

Since labels usually come from Excellian, we need another option to print labels if Excellian is unavailable.  

To print a label during a downtime, you should use the Downtime Labels application.  This application can be located by clicking the icon on the desktop of all Downtime PCs called "Downtime Labels.mde".

When downtime is scheduled, labels should be printed ahead of time. 

Place the labels in the lower right corner of the front page and label on the lower right corner of the back page only if there is documentation on the back, otherwise the scanner will scan a blank page. 


Downtime Forms

Downtime Forms

There are several different paper forms that need to be used if Excellian is not available.  These forms apply to different service areas throughout Allina.  A stock of downtime forms appropriate for your area should be maintained in your department's Downtime Binder.  

One of the most common forms used in the hospital setting is the Downtime Event Form (DEF).

All departments must use the DEF to track events as they occur during a downtime.  

Events include admissions, discharges, births and deaths.

The DEF is sent to Registration immediately when the event occurs and should not be held until after the Downtime is over.

Matching Downtime Components

  • Excellian Read-Only environment
    Only current as of the time the production downtime began
  • Downtime Reports
    Printed by a pre-determined staff person
  • Downtime Labels
    Printed using a non-Excellian application on the desktop
  • Downtime Event Form
    Used in the hospital setting to track admissions, discharges, births or deaths as they occur
  • Downtime PC
    Used to print Downtime Reports during a downtime
  • Site procedures
    The series of events that should take place during a downtime
  • Downtime Binder
    Contains paper copies of forms and procedures to use during a downtime

Medical Record Numbers

Medical Record Numbers During a Downtime

As we mentioned at the start, patient care does not stop because the system goes down.  Admissions will continue to take place during the downtime. 

That means we need a plan for retrieving existing medical record numbers and assigning new ones to incoming patients. 

Existing Patient

There are two ways to find the medical record number for an existing patient:

1. Look on the downtime reports

2. Look in the Read-Only environment (if available).

New Patient

Registration maintains a list of available medical record numbers for new patients who may arrive during a downtime. 

To obtain a medical record number for a patient that is not already in Excellian, call Registration to request a new number.

Test your knowledge: Scenario patient #1

  • It is Monday afternoon at 1300.
  • A farming combine just hit the fiber cable that connects to our facility.
  • All computers lose connectivity to the network - EXCELLIAN IS DOWN!
  • Downtime reports have been printed.
  • Phoebe Winter was admitted to ICU early this morning.
  • Phoebe wakes up with severe abdominal pain.
  • The physician reviews her MARNext report and writes a paper order for pain medication.  
  • WHAT HAPPENS NEXT?

Use the arrows on the left of each step to drag into the order they should occur.

  • The HUC or RN sends a copy of the paper med order to Pharmacy.
  • The nurse uses override to obtain medication from Omnicell.
  • Pharmacy receives the paper order for Phoebe Winter.
  • Pharmacy receives notification from the Omnicell override report that a pain med was dispensed through Omnicell and records the Omnicell dispensing.
  • The HUC or RN transcribes the new med order onto paper Downtime MAR form (not the MAR report from the Downtime computer)
  • The ICU nurse immediately documents after administering the pain med on Phoebe's Downtime MAR form.

Test your knowledge: Scenario patient #2

Michael Bluth

  • Michael Bluth was just transferred from ICU to Med/Surg.
  • Transfer orders have been written and all of Michael's downtime Reports travel with him from ICU to Med/Surg.


Should these orders have a label?

  • Yes
  • No

Who should complete the Downtime Event Form (DEF)?

  • Med/Surg
  • ICU

Test your knowledge: Scenario patient #3

Samantha Jones

Samantha Jones is admitted to OB as a laboring patient.

What form will the OB unit complete and send to Registration?

  • The Birth Center Downtime Event Form (DEF)
  • The Clinical Summary Form
  • The Request for Medical Record Form
  • The Downtime Recovery Form

Since the admit orders include a CBC, the HUC completes the Downtime Lab requisition form, and places what on the form before sending it to the Lab?

  • A patient label
  • A black X
  • A signature stamp
  • A sticky note

What happens with Lab results?

Results during downtime

  • Critical lab results are called to the Provider/RN per standard policy.
  • Results that Require Action (RTRA) for inpatients are called to the patient's nurse or provider.
  • Paper copies of results will only be delivered for STAT and RTRA.

Samantha delivers the baby!  Since this is considered an OB status change for the mom and an admission for the baby, what should the OB unit do?

  • Complete two Birth Center Downtime Event Forms (DEF)
  • Put both mom and baby names on one Birth Center Downtime Event Form (DEF).
  • Only complete a Downtime Event Form (DEF) for the mom, the baby will be formally admitted once the system comes back up.
  • Complete a Newborn Admission Downtime Form for the baby.

Onto recovery

Great job on those scenarios!

Now we will move onto the final step in the Downtime process, Recovery.

Recovery Process

Recovery Process

Recovery is the process of back-loading all of the information related to the events that happened while the system was down. 

The sequence of recovery is critical to ensure all information is accurately captured when the system becomes available.  

The sequence is as follows:

1. Registration

2. Pharmacy

3. Imaging & Lab

4. Nursing and Other

Recovery Communication

Communication

  1. Once Registration, Pharmacy, Imaging and Lab back-loading is complete, they will contact the site designee.
  2. All other departments will be notified that Excellian is available based on site process. (overhead page, HipLink page, administrative supervisor, or designee.
  3. All other departments can then begin their back-loading process.

Nursing and MAR Recovery

Nursing MAR Recovery

Nursing staff enters all of the downtime administered doses into the MAR activity in each patient's Excellian chart.

  • If the nurse who completed the paper downtime MAR is still on duty, he/she must update the Excellian MAR.  
  • If a nurse who has entered the information on the paper MAR has left, use the documenting for another process.

Documenting for Another

The current nurse completes the Excellian MAR using "downtime recovery" as the action on the MAR.  

The nurse uses the paper Downtime MAR for the action date and time and any additional notes.

The current nurse enters the name of the RN who administered the medication in the Comment section: "for [First Name Last Name, Credentials]".

Remember, in order to complete the Excellian MAR for another nurse, the nurse must be licensed to administer the medication(s).

Paper Downtime MAR

The paper downtime MARs are an official/legal document.  The MARnext report, MAR form, Anesthesia form for meds stay in the patient shadow charts and are sent to Health Information Management (HIM) at patient discharge where they will be scanned and retained per state regulation.

You're Almost Done!

Just one more thing...

You're almost done!  You have just one more piece to finish up your annual review of the Allina Health Excellian Downtime Preparedness and Awareness Program.  

Remember, your leader or your site Downtime Champion can help you with any questions you might still have.  


1. Go back to the home page of the course by selecting HOME at the bottom of this slide.

2. Select the Assessment Module and complete all questions.  

Hospital Assessment

A backup version of Excellian named Read-Only is available:

  • All of the time.
  • Only during planned Downtimes.
  • During planned downtimes and within approximately 30-60 minutes if activated during an unplanned downtime and if network access is available.
  • I don't know.

Where are your department specific procedures located?

  • On Excellian.net under the downtime materials.
  • Locked in my manager's office.
  • In the downtime binder/box in my department of designated area.
  • I don't know.

When a planned downtime occurs, Downtime Reports are printed:

  • Manually by a predetermined staff person.
  • Automatically by the system.
  • I don't know.

During an Excellian Downtime, what would you do to obtain a medical record number for a patient that is not in Excellian?

  • Make up a medical record number.
  • Wait until Excellian is available.
  • Call Registration/Admitting to obtain the medical record number.

During an Excellian Downtime, where is the medical record number for an existing Allina Health patient found?

  • In the Read-Only environment. (if available)
  • On the Downtime Reports.
  • By calling the patient's insurance company.
  • Both in the Read-Only environment (if available) and on the Downtime Reports.
  • All of the above.

A Downtime Event From (DEF) is used:

  • Every time a patient has a bed status change.
  • When a patient is born or expires.
  • When a unit receives a patient.
  • All of the above.

Downtime Event Forms are:

  • Sent to Registration when the event occurs.
  • Held until the downtime is completed.
  • Entered in the Read-Only environment as they occur.

TF DT Event Form

  • If Registration does not receive the Downtime Event Form, the recovery process will be delayed.

DD Patient Label

Drag the PATIENT LABEL to the correct location on the downtime form.

  • PATIENT LABEL

During an Excellian Downtime, how are new lab tests ordered?

  • Call the Lab.
  • Lab requires a paper requisition, with patient label, for all orders either sent to lab or sent with specimen.
  • Write the order on a Lab label, affix to specimen and forward to Lab.

Sequence of Recovery

Use the arrows on the left side to put in the correct order

  • Scheduling
  • Registration
  • Pharmacy
  • Lab and Imaging
  • Nursing and Other

TF Backloading

  • Departments performing a service during a downtime (e.g., Pharmacy, Lab, Imaging) are responsible for back-loading orders/results.

TF ClinDoc

  • Clinical Documentation recorded on paper during an Excellian downtime is back-loaded based on your department's requirements when the system is available, and then scanned into Excellian per your department's procedure.

Congrats

You have completed your Annual Review!