Authors (including presenting author) :
Chan BY, Lily Yip KY, Leung Kwong Hung, Leung SH
Affiliation :
Department of Family Medicine and General Outpatient Clinics, Kowloon Central Cluster
Introduction :
The Hospital Authority (HA) has taken over the 75 public general out-patient clinics (GOPCs) in Hong Kong (HK) since 2003. Information Technology (IT) system was gradually replaced the manual record system, including registration and booking services at Shroff - Out-patient Appointment System (OPAS), clinical documentation for different professionals (doctors, nurses and allied healthcare workers) - Clinical Management System (CMS), and patient queuing – Corporate Queuing Management System (CQMS), in order to enhance the data quality and privacy aspects. These IT systems have become essential tools to make our daily operations running smooth and we are inevitable to work with them to provide quality clinical care.
As the IT system is crucial to us nowadays, the system failure has made them either unavailable or unrecoverable for a period of time deemed sufficient to interrupt critical institute operations. Our department recognizes this important, some strategies are implemented for staff engagement, well prepared and working in team approach in facing the system failure.
Objectives :
1) Maintain smooth operation of clinic services without jeopardizing clinical service, internal communication and documentation during system failure
2) Enhance the staff readiness to face the IT breakdown contingency
3) Increase the staff confidence to face the IT breakdown contingency
Methodology :
Sharing by Expert
Invite the responsible staff from OPAS team in HA Head Office to give two briefing sessions (identical at two different clinics, on 26/7/2019 and 31/7/2019) to clinic Nurse in-charges and Shroff in-charges in order to have a chance to get more familiar and understanding to the “Downtime Version” (for Patient Registration, Appointment Booking, Attendance taking and payment collection)
Departmental “Peer Visit Round”
“IT breakdown contingency workflow” has been chosen as one of the main theme in the department regular Peer visit round (carried out in Aug & Sep among 10 community based clinics):
Present the“IT breakdown contingency workflow” by doctor in-charges for their respective clinic
Perform site visit round for actualization checking of the availability of hardware and staff understanding to support the contingency workflow
Review and align the“IT breakdown contingency workflow” for frontlines reference
Align the IT breakdown log sheet for all community based GOPCs (one sheet for logging IT breakdown issues related to OPAS / CMS / CQMS for follow up action)
Standardize and update “CMS Downtime Kit”
Prepare a “Communication Sheet” for re-input after system resumption and nursing arrangement for routine laboratory requests during downtime
Regular drill
Conduct IT breakdown drill in every two years in order to make frontlines, no matter doctors, nurses, pharmacy staff, Shroff and supporting staff, to participate and get familiar with the IT breakdown contingency workflow.
Result & Outcome :
The unpreventable thing to happen happened last month!
At around 09:25 on 20/11/2019, OPAS failure was found in 5 community based clinics (under QEH server), After the system still failure for 15 minutes, the OPAS downtime contingency plan was activated by using the OPAS downtime version in these clinics. Then OPAS resumed normal at 10:40 (the OPAS failure for over 75 minutes!!!).
Luckily, it was solved by our good teamwork, effective communication and best preparation. All involved clinics operated well and every patient can receive services and treatments unaffected during the breakdown period. No manual medication prescription was issued and no complaint was received. It is appreciated to our in-depth and well preparations, no matter staff or hardware, in the peacetime. Our team has confidence in facing the unforeseeable crisis afterwards.
