What to do when the Power goes Out and you are using an EMR?

The following question is posed by Dr Cameron Ross in Chilliwack, BC as the lead physician for one of the Fraser Health beta test sites that will soon be implementing an EMR.

"As we are completing some design work we’ve been considering what to so when the power goes out.  With our paper charts we simply see patients in the space with the most natural light and muddle along until power is restored.  While slower, at least we can proceed.  With full EMR however our ability to work will be much more curtailed.  One of our associates has suggested getting a generator as a backup.  If we are able to continue working for 1 day per year as a group of 4 we can pay for an expensive setup (i.e. $5000) in <2 years.  I’ve attempted to discover how other clinics have dealt with this but have no answers.  Thoughts?  Thanks for your consideration."

This is an issue that will create a major disruption to services in the event of a power outage or catastrophic power failure. At a time that medical information will be truly needed (e.g. natural disaster) how can one plan to manage if all records are electronic and dependent on power?

If you have worked through this scenario in your clinic or have some ideas on how this could be cost effectively managed, please click on the 'Comments' link below and add your thoughts.

Comments

[Alan Brookstone]

I would like to start the ball rolling with some comments on this issue. I suspect that there is little contingency planning in the majority of clinics (including mine) in the event of a power failure. I can see a number of potential scenarios taking place, however this is also complicated by the physical layout of the building in which one practices. For example, if you are in a standalone facility owned and operated by a group of physicians, the idea of having a dedicated generator is reasonable as it will power the internal operations of the clinic. However, what would happen if you are on the 10th floor of a downtown skyscraper? Does anyone know what the contingency plans might be in the building in which you practice in the event of a major power outage?

I think this issue needs debate and a team of individuals working on the scenarios to develop a contingency strategy. This is like earthquake planning. You know you should do it, but because it requires a great deal of work, thought and ongoing maintenance in order to 'be prepared' for an event that may never occur, it seems to drop to the bottom of the list in terms of priorities. However the massive power outage on the East Coast a couple of years ago points to the potential for this to happen again.

If one has emergency power backup in a medical office, what happens if you are running an ASP based EMR and access your data from a remote location? Do you have a local backup so that you can access your patient data if you are unable to login to a remote server because the power for a large geographic region is out?

Do you need backup power for your whole network or just for a number of critical computers e.g. administrative to book in patients and a shared computer for clinical information and print and work on paper for the duration of the power outage? Are there any best practices relating to these types of situations?

Further thoughts and comments and ideas are much appreciated.

[Scot Mountain]

Our clinic was using an ASP emr when the power went out on the eastern seaboard a couple of years ago. Fortunately, the server company that the ASP provider contracted with had their own generators, which I am told could provide independant power for up to three days if necessary. This meant that we had no downtime, despite our records being hosted on a server in downtown Toronto. I would strongly recommend anyone looking at an ASP solution ensuring that this kind of backup is available.

With respect to power outages in the office, we survived a couple of those as well. For the most part, the biggest issue was not actually the EMR. We were more affected by the lack of light in our offices, the lack of availability of otoscopes and opthalmoscopes, etc. For those of us that had enough natural light in our offices to see patients, we reverted to pen and paper, making notes as we had for many years, then entered them in the EMR later when the power came back on. My personal experience was that the brief loss of access to patient records didn't impact me much; for the most part either myself or the patient could remember the pertinent information. For things like medication dosages, etc., that needed verification, I just made a note and checked when the power came back on, then phoned in the Rx. This was fine, given that our local pharmacy closed during the power outage anyway, as did every other local business who all depend on electricity and computers to function. The longest power outage we had to go through in this manner was probably less than an hour. Clearly we would have had a problem if the power was out any longer than this, but even in our rural community this would be a rare ocurrence.

[Adam Chen]

We went EMR in Mississauga, Ontario 4 months ago, and this is an important issue for us to consider, in case we have an extended power outage (>24 hours) as in August 2003.

Our office uses a local server, and both wired/wireless access. I think probably the easiest solution for us is to have a fully functional version of our EMR software pre-installed on one of the laptops. During an extended power outage (>1 hour, <24 hours), we can load the backup tape onto the laptop, which has about 9 hours of use. We will share it to look up info/book appointments, but will revert to pen and paper for clinical encounters. (I will need to check with our vendor to see if it's workable)

If the power outage will be really extended (>24 hours), we can use a power inverter (converts 12 V from a car's cigarette lighter into 120 V, cost: less than $100) in order to recharge the laptop. Automobiles are probably the most ubiquitous and reliable power generators to invest in, but it's probably futile to convince the tax man it's an important part of your EMR set up.

[Jel Coward]

We run our EMR locally. We would not trust our data to others. Our building has a generator. We used a generator in the rural practices I worked in the UK too.

We could also do a data restore onto my laptop that has as standalone version of our EMR installed on it - so thanks for that thought.

[Dave Sellers]

We have a local EMR and the server and 3 workstations have a UPS. We can stay up long enough to print off a couple of days of appointments before the UPS shuts down the server (30 minutes).
Our phone system will only stay up about 2 hours along with the emergency lights/fire alarms. Because we don't have a generator, by law (I believe) all staff must exit the building when life support systems fail. Installing backup power is not just to keep the equipment going, much more needs to be addressed. Our undocumented practice is to attend to emergencies only during an extended blackout (we have a known emergency number on the Cell network).

[Yves Raymond]

I am solo with an in-house server.

In a power outage, I have two Canadian Tire power boxes that can operate my server, switches and 3 fluorescent light bulbs (7 watts each).

I can continue to operate since my server is in one of my exam rooms. The power box in that room powers my server, a screen, a lamp and my scopes.

The front desk has the other power box and it runs a computer with 2 lamps for the waiting room.

Recently we had a short power outage which tested my setup.

I noticed that it was not the best setup in the world since I had to shut down the equipment and plug the stuff into the power boxes. Luckily the battery packs lasted over 3 hrs and when the power came up, I still had a lot of power in them. I saw as many patients as I usually do on that day.

I hadn't thought of using my lighter socket to recharge my powerboxes, but great idea.

I have also considered setting up a solar powered backup solution. This would cost about $950 for the solar panels (150W), $250 for the inverter, $150 for the charge controller and 4 batteries for 6 hours of power ($650).
Total cost $2000

If you wanted uninterrupted power flow, you would need a switch to sense the power loss. This would cost an estimated 300-600 dollars more. So for around $2,600 you could have a Solar powered backup that would give you about 6 hours of power up front and then a varying amount based on sunlight.

You could likely do the same with a direct plug into the provinces Hydro to keep your batteries charged, however, once your batteries were dead, you'd be out of luck. You'd save half the cost though.