When all systems go down

One of the touted advantages of electronic medical records is that there are no more lost paper charts. We don't waste time looking for the ever-elusive record.

But, what happens when the whole system goes down?

When a medical record is gone, it is an annoyance trying to recall specific medical facts of a particular patient. But multiply that by all the patients in a practice, and you can imagine the chaos that ensues.

We recently had the misfortune of experiencing exactly that scenario. Not only did our EHR go down, but so did the practice management system. We were working without a schedule in front of us and had no idea which patients were coming. We were also unable to look up their insurance coverage and could not to collect any payments because we did not know what was owed.

But that was a minor annoyance compared to having no medical records at all. We continued to see the patients but were unable to check their medical problems, medications or allergies. We also were unable to send their prescriptions electronically and had to resort to calling them into the pharmacy. This additional time on the phone — and waiting on hold — caused a massive backlog of angry patients.

When patients came in for follow-up visits for their diabetes, we could not tell them how they were doing because we had no access to their labs. Typically, we have interfaces with the major labs in our area and the lab results get downloaded directly into patients' electronic charts. Some children arrived for their vaccinations but of course we had to reschedule them without having their records handy. Additionally, we were unable to process any medication refill requests. Usually, our pharmacies send us the renewal requests electronically so that was out as well.

Many people proclaim the great advantages of digital data and I tend to agree. However, a Wi-Fi outage or a limited connection period can cause mass disruption. We store our server in house, which prevents some of these issues as opposed to be being cloud-based. However, during Hurricane Sandy, we had to take heroic measures to protect our server — our whole practice was on there. The advantages of cloud-based server vs. in-house server can be debated endlessly. We learned our lesson from that near-miss and now back up our server daily into the cloud.

For the most part, electronic records have many benefits compared to paper-based ones. But, a system outage is disastrous. In the past, we could keep working with a lost chart. When the whole system is down, it becomes nearly impossible. Thankfully these happenings are rare, but they do occur. I think that the software vendors, rather than using the lost-chart scenario as a selling point, should step up and devise methods to protect against the system going down. As data goes digital, it is becoming more valuable and we need to make accommodations for it.

Linda Girgis MD, FAAFP, is a family physician in South River, N.J. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter's University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions.  Dr. Girgis earned her medical degree from St. George's University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University and she was recognized as intern of the year.  She has been a guest columnist and contributor to many media outlets. She authored the book “Inside Our Broken Healthcare System” and has been interviewed in US News and on NBC Nightly News. Dr. Girgis’ primary goal as a physician remains ensuring that each of her patients receives the highest available standard of medical care.