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The True Cost of EHR Downtime
By Peter Charland

Much of the new adoption of EHR technology is taking place at smaller physician practices and hospitals that often lack sophisticated IT staffs and budgets. Therefore, it’s understandable that too little consideration is being given to system downtime and the impact it has on patient care, reputation, and cost. For the most part, the software selection process gets all the attention. After all, the average person thinks most computers are fairly reliable. If there’s a failure, it may be inconvenient, but you’ll be OK if you’ve backed up files, right?

But what is the impact if that computer is running an EHR application for a busy practice of four or five doctors plus staff? Even if the data are backed up, what are the consequences when the system goes down? Can such an occurrence be quantified in terms of cost?

This was the question Mark Anderson of AC Group tackled in a recent report based on time-and-motion studies at physician practices of various sizes. The study evaluates job functions and costs (eg, salaries, overhead) and factors in the additional time spent performing tasks manually and updating information once the systems are up and running again to determine the actual cost of EHR system downtime.

For every minute an EHR system is up, the report concludes that when it’s down, “The average physician practice spends 2.15 minutes to perform the required tasks manually plus the time required to update the computer systems once the system is back up and operating.” By factoring in the various job functions and the fully loaded costs of each, the actual cost to the average healthcare provider equates to almost $488 per hour per physician.

The report points out that healthcare providers can weigh the costs and risks of EHR system downtime by specifying levels of system availability in their system requirements. For example, a standard computer server will offer 99% availability. That sounds pretty good until you consider what it costs when that EHR system is down. For a practice with five physicians that’s open five days per week and 10 hours per day, 99% availability will cost approximately $58,500 per year. For a two- or three-physician practice, it will cost between $23,000 and $35,000 annually in additional costs.

These figures more than justify an up-front investment in a system configuration that provides higher availability. Besides considering downtime costs, providers should factor in the effects system unavailability has on patient care and practice reputation, not only with patients, but also other providers who might refer clients.

The challenge is gaining more system uptime without requiring sophisticated IT expertise or staff while keeping costs to a minimum. In a data center, server clustering may be considered. However, that is complex, requires both IT expertise as well as considerable costs such as external storage area networks, and is beyond the scope of a smaller practice or hospital. On the other hand, solutions such as high-availability software and fault-tolerant servers along with proactive service monitoring provide even higher availability than clustering yet require little to no IT expertise or costly configuration requirements. This is where solutions that reduce EHR system downtime to minutes or even seconds in a year offer the greatest value.

Minimizing the risk of EHR system downtime requires resilient technologies— redundant hardware components, power, and network—and real-time, proactive system monitoring and maintenance. Clustering and virtualization provide resiliency but aren’t proactive—they don’t see impending problems that lead to a system failure and don’t achieve high availability. An EHR system is still down while clustering or virtual approaches attempt to restart the application, databases, and user access. Any glitch can result in extended downtime.

With proactive monitoring, which is a core attribute of high-availability software or fault-tolerant systems, impending problems are identified and remedied or reconfigured so applications and services continue to run. Practices and hospitals that recognize the importance of keeping their EHR system up all the time should make this a required capability.

— Peter Charland is head of business development and alliances at Stratus Technologies.