Pediatric Informatics: Computer Applications in Child Health (Health ...

16 Prioritizing Pediatric Investment for IT in Smaller Practices 229
Other contingencies that must be planned include prolonged downtime (How does
the practice operate when the system is nonoperational?) and recovery (How is
data from downtime restored to the system? How is data loss or theft handled?).
Practices must have a clear idea about how support will respond either to routine or
urgent requests. Are they fast and dependable? Communication with previous users
is essential because vendor promises might not be reliable.
16.4.5.3 Maintenance
In a paperless pediatric office the electronic data repository will be the life blood of
the practice and it must be maintained. Information must be backed up on a regular
basis. Technologies to automate this process include tapes, redundant hard drives,
optical disks, etc. have been in use for practice management systems and can be
applied to EHRs. This task can also be entrusted to an Application Service Provider
to store data securely off site.
Most systems incorporate regular backup processing to multiple locations to
provide redundancy. Assurance of the restoration (and retrieval) process, while the
responsibility of the practice, requires guidance from vendors and purchasers should
look for guarantees of rapid response in case of an emergencies. No office should be
placed into the position of having to manage a restoration without help available.
Downtime policies for staff should be in place in case of a failure (system failure,
power outage, misplaced record). This includes a mechanism to create a temporary
record until updating the electronic systems can be restored and reincorporating
interim records into the main system. These policies and procedures should be
reviewed periodically by the practice.
System updates and repairs should be considered as part of service contracts for
workstations, servers and other hardware. Upgrades should be considered in terms
of compatibilities with other components of the system (operating system, network
connection, control devices, and any system that cannot be updated easily should
be questioned (as it may incur additional costs and upgrades).
16.4.6 Expenses – Nonmonetary
Important questions to ask about contingency procedures involve how data (or lack
of data) is handled when the system does not function optimally.
16.4.6.1 Confidentiality and Security
What happens if information security is compromised (stolen or lost) due to any
cause (malicious or otherwise)? What are ways of mitigating this compromise
and its effects on care? What are the disclosure requirements and procedures as