An Evaluation of the Insidious Consequences of Clinical Computing Infrastructure Failures at a Large Academic Medical Center
Thesis (Master's)--University of Washington, 2019 Electronic Health Records (EHRs) are intended to make healthcare delivery safer, more effective and accountable. They are complex socio-technical systems that are dependent on the proper functioning of many individual components that comprise th...
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ftunivwashington:oai:digital.lib.washington.edu:1773/43989 2023-05-15T17:53:33+02:00 An Evaluation of the Insidious Consequences of Clinical Computing Infrastructure Failures at a Large Academic Medical Center Napa, Sandeep Malleshwar Whipple, Mark E 2019 application/pdf http://hdl.handle.net/1773/43989 en_US eng Napa_washington_0250O_20017.pdf http://hdl.handle.net/1773/43989 none Clinical Computing Infrastructure Failure Clinical Consequences Downtime EHR Event Model Failure Logs Information science Medicine Health sciences Biomedical and health informatics Thesis 2019 ftunivwashington 2023-03-12T18:59:22Z Thesis (Master's)--University of Washington, 2019 Electronic Health Records (EHRs) are intended to make healthcare delivery safer, more effective and accountable. They are complex socio-technical systems that are dependent on the proper functioning of many individual components that comprise the clinical computing infrastructure (CCI), such as networking equipment, message routing systems, departmental clinical computing systems and many others. However, on occasion these CCI components fail or need maintenance, causing clinical workflow and data flow disruptions called downtimes. Considering the inherently disruptive nature of EHR downtimes, organizations typically have mitigating procedures in place. However, many other small hardware or software CCI components also fail, causing loss of EHR functionality, sometimes insidiously. To our knowledge, systematic analysis of CCI failures has not been undertaken. In this work, a dataset of CCI failure logs gathered at one health care system was classified and categorized to shed light on the nature, diversity, frequency and user impact of such failures. ORCA (Online Record of Clinical Activity), Epic and Mindscape are EHR components. By number of records, the top 3 components that had the highest frequency of failure are: Network (393 incidents, 59.5% of which were unscheduled) the inpatient EHR (ORCA) (372 incidents, 49.5% unscheduled) the outpatient EHR (Epic) (228 incidents, 12.3% unscheduled). In terms of user impact, components that accumulated the most failures are: the inpatient EHR (ORCA) (284.8 hours among under 5 users), Cloverleaf (interface engine) (263.5 hours among under 200 users), imaging (205.8 hours among under 50 users), and network (193.9 hours among under 50 users, and 193.4 hours among under 10 users). It is interesting to note that 4 of the 5 aforementioned components affected under 50 users. For the data with user impact estimates, cumulative EHR downtime (687.3 hours) is less than cumulative downtime for small impact non-EHR CCI failures ... Thesis Orca University of Washington, Seattle: ResearchWorks |
institution |
Open Polar |
collection |
University of Washington, Seattle: ResearchWorks |
op_collection_id |
ftunivwashington |
language |
English |
topic |
Clinical Computing Infrastructure Failure Clinical Consequences Downtime EHR Event Model Failure Logs Information science Medicine Health sciences Biomedical and health informatics |
spellingShingle |
Clinical Computing Infrastructure Failure Clinical Consequences Downtime EHR Event Model Failure Logs Information science Medicine Health sciences Biomedical and health informatics Napa, Sandeep Malleshwar An Evaluation of the Insidious Consequences of Clinical Computing Infrastructure Failures at a Large Academic Medical Center |
topic_facet |
Clinical Computing Infrastructure Failure Clinical Consequences Downtime EHR Event Model Failure Logs Information science Medicine Health sciences Biomedical and health informatics |
description |
Thesis (Master's)--University of Washington, 2019 Electronic Health Records (EHRs) are intended to make healthcare delivery safer, more effective and accountable. They are complex socio-technical systems that are dependent on the proper functioning of many individual components that comprise the clinical computing infrastructure (CCI), such as networking equipment, message routing systems, departmental clinical computing systems and many others. However, on occasion these CCI components fail or need maintenance, causing clinical workflow and data flow disruptions called downtimes. Considering the inherently disruptive nature of EHR downtimes, organizations typically have mitigating procedures in place. However, many other small hardware or software CCI components also fail, causing loss of EHR functionality, sometimes insidiously. To our knowledge, systematic analysis of CCI failures has not been undertaken. In this work, a dataset of CCI failure logs gathered at one health care system was classified and categorized to shed light on the nature, diversity, frequency and user impact of such failures. ORCA (Online Record of Clinical Activity), Epic and Mindscape are EHR components. By number of records, the top 3 components that had the highest frequency of failure are: Network (393 incidents, 59.5% of which were unscheduled) the inpatient EHR (ORCA) (372 incidents, 49.5% unscheduled) the outpatient EHR (Epic) (228 incidents, 12.3% unscheduled). In terms of user impact, components that accumulated the most failures are: the inpatient EHR (ORCA) (284.8 hours among under 5 users), Cloverleaf (interface engine) (263.5 hours among under 200 users), imaging (205.8 hours among under 50 users), and network (193.9 hours among under 50 users, and 193.4 hours among under 10 users). It is interesting to note that 4 of the 5 aforementioned components affected under 50 users. For the data with user impact estimates, cumulative EHR downtime (687.3 hours) is less than cumulative downtime for small impact non-EHR CCI failures ... |
author2 |
Whipple, Mark E |
format |
Thesis |
author |
Napa, Sandeep Malleshwar |
author_facet |
Napa, Sandeep Malleshwar |
author_sort |
Napa, Sandeep Malleshwar |
title |
An Evaluation of the Insidious Consequences of Clinical Computing Infrastructure Failures at a Large Academic Medical Center |
title_short |
An Evaluation of the Insidious Consequences of Clinical Computing Infrastructure Failures at a Large Academic Medical Center |
title_full |
An Evaluation of the Insidious Consequences of Clinical Computing Infrastructure Failures at a Large Academic Medical Center |
title_fullStr |
An Evaluation of the Insidious Consequences of Clinical Computing Infrastructure Failures at a Large Academic Medical Center |
title_full_unstemmed |
An Evaluation of the Insidious Consequences of Clinical Computing Infrastructure Failures at a Large Academic Medical Center |
title_sort |
evaluation of the insidious consequences of clinical computing infrastructure failures at a large academic medical center |
publishDate |
2019 |
url |
http://hdl.handle.net/1773/43989 |
genre |
Orca |
genre_facet |
Orca |
op_relation |
Napa_washington_0250O_20017.pdf http://hdl.handle.net/1773/43989 |
op_rights |
none |
_version_ |
1766161246210490368 |