Health Information Management departments are responsible for the integrity, completeness, and accessibility of the patient health record across its entire lifecycle. During normal operations, that responsibility is complex enough. During an EHR downtime event, it becomes significantly more so. The HIM team is managing a situation where documentation is being created outside the EHR, in formats and through workflows that differ from normal operations, while simultaneously being responsible for ensuring that the permanent patient record reflects everything that happened during the outage period when the EHR is restored.
The post-outage period is when HIM’s downtime burden is most visible, but the during-outage period is when the decisions that determine HIM’s post-outage workload are made. Organizations that support HIM with the right tools during a downtime event significantly reduce the record completion challenge that follows.
dbtech’s eFolders solution plays a specific and important role in both phases: providing HIM with accessible document storage and retrieval during the outage, and supporting the record completion and reconciliation process after the EHR is restored.
What HIM Needs During an EHR Downtime Event
The HIM department’s specific needs during a downtime event differ from those of clinical departments, but they are no less urgent. HIM staff and the functions that depend on the complete health record need:
- Access to existing patient records and documents that were in the EHR before the outage began, including prior visit documentation, consent forms, advance directives, and any documents that may be needed to support active patient care decisions during the outage period
- A reliable mechanism for receiving and storing documents being generated by clinical and administrative departments during the outage, so that all downtime-period documentation is captured in a single, organized location rather than being scattered across paper files, department-level storage, and individual workstations
- The ability to respond to requests for record information from clinical staff, referring providers, and payers during the outage, since record access requests do not stop because the EHR is down
- Documentation of any record release activity that occurs during the outage period for audit and HIPAA compliance purposes
dbtech’s eFolders provides HIM with a searchable document repository that is accessible through the downtime workstations independently of the EHR. Documents stored in eFolders before the outage remain retrievable during the event. Documents scanned or created during the outage through dbtech’s eForms are automatically routed to the appropriate patient eFolder as they are completed, creating a centralized downtime-period document repository that HIM can manage and monitor throughout the event.
The Specific Documents HIM Needs Available During Downtime
Not all documents in the health record have equal urgency during a downtime event. HIM should work with clinical leadership before an outage to identify the specific document types that are most likely to be requested during an outage and ensure they are accessible through the eFolders system. The highest-priority document categories typically include:
- Advance directives and POLST forms, which may be needed to guide clinical decision-making for seriously ill patients during an extended outage
- Consent forms for procedures that are ongoing or scheduled during the outage period, which clinical and surgical staff may need to verify before proceeding
- Prior authorization documentation for services that may be delivered during the outage, which payers may require for claim processing after recovery
- External records received from referring providers that have been incorporated into the patient record and may be needed for clinical reference during the outage
- Any legal or regulatory holds placed on specific patient records, which must be honored during the outage period regardless of system status
eFolders organized by patient and document type allow HIM staff to locate these documents quickly during an outage rather than attempting to access the EHR’s native document module or searching through physical files.
The Post-Outage Record Completion Challenge
The period immediately following an EHR restoration is one of the most challenging for HIM. Every patient encounter that occurred during the downtime period needs to be reviewed to ensure that the permanent record is complete and accurate. Documents created in dbtech eForms during the outage need to be attached to the correct patient record. Scanned documents collected at the point of care need to be reviewed, indexed, and filed. Any verbal orders or clinical decisions made during the outage that were not captured electronically need to be identified and addressed.
Without an organized approach, this record completion process can stretch over days and produce an incomplete record for the downtime period that creates billing, compliance, and continuity-of-care problems.
eFolders supports the post-outage record completion process in several specific ways:
- The centralized downtime-period document repository in eFolders gives HIM a single organized location to start the completion process rather than collecting documents from multiple sources across multiple departments
- The indexing metadata captured when documents are filed during the outage, including patient MRN, document type, and timestamp, allows HIM to systematically work through the downtime period record by record rather than managing an unorganized backlog
- Documents stored in eFolders that need to be attached to the EHR record can be exported through a structured process that links them to the correct encounter rather than requiring manual attachment by HIM staff for each individual document
- The audit log maintained by the eFolders system for the downtime period supports HIM’s obligation to document who accessed what records and when, which is relevant to both HIPAA compliance and any legal or regulatory review that touches the downtime period
Building HIM Into the Downtime Preparedness Program
HIM is frequently absent from downtime preparedness planning conversations, which are dominated by IT, clinical nursing leadership, and registration. This is a structural gap that most organizations should address. HIM’s expertise in record integrity, documentation requirements, and regulatory compliance is directly relevant to the design of downtime procedures, the configuration of the eForms library, and the post-outage reconciliation process.
Practical ways to integrate HIM into the downtime program include making the HIM director a standing member of the downtime preparedness governance committee, including HIM review in the annual evaluation of the eForms library to confirm that all document types meet regulatory and accreditation documentation standards, and assigning HIM ownership of the post-outage record completion protocol so that the process is defined before an event occurs rather than designed under pressure after one.
To discuss how dbtech’s eFolders solution would be configured to support HIM workflows during and after a downtime event, contact our team or request a demo.