Downtime Policy and Procedures for Unavailability of Electronic Clinical Systems

Department of Clinical Research Informatics (DCRI)

Clinical Center, NIH

Subject: Downtime Policy and Procedure for Unavailability of Electronic Clinical Systems

Purpose:

The purpose of the policy is to maintain the integrity of clinical and research information and processes, and

to insure the continuation of clinical care and research studies during the absence of available

electronic/automated clinical systems.

Background:

The prevention, early detection, and effective management of a scheduled or unscheduled Clinical Research

Information System (CRIS) downtime event are critical to assuring quality patient care at the Clinical Center

(CC). To manage these events effectively, the Department of Clinical Research Informatics (DCRI) must identify

the various roles and responsibilities of DCRI in maintaining CRIS and Clinical Information Systems. DCRI’s

Technical Operations is responsible for providing the hardware and network infrastructure, while Clinical

Operations is responsible for maintaining the CRIS Systems. Scheduled System downtimes require

coordination between multiple departments and people. Provided in the guidelines below are: A checklist for

planning scheduled system downs, description of the systems that define CRIS and the description of the

systems affected by CRIS Downtimes.

Policy:

Clinical and research information management will be maintained with a downtime manual process when

electronic systems and information are not available. Defined procedures and guidelines will be followed.

Involved informatics and technical staff will coordinate communications with each other, with clinical users

and with administrators as required.

Appendices:

ferences:

Policy Guidelines

Appendix A Organizational Roles, Assigned Responsibilities and Contact Information

Appendix B Unpl

anned Downtime- Executive Leadership Communication Plan

Appendix C Unpl

anned Downtime/ System Interruption Checklist

Appendix D Nursing Department Related Guidelines for Scheduled Downtimes/CRIS Downtime

Processes

Appendix E Example of System Downtime Communication Process

Appendix F Sys

tem Descriptions, Impact During CRIS Downtimes, and Assigned Responsibilities

Appendix G Clinical Information System Descriptions, Impact During CRIS Downtimes, Assigned

Responsibilities

Appendix H Types

of Labels

Appendix I Examp

le of Downtime Templates

Appendix J Examp

le of Standard Terminology to send in Email and Message for Downtime

Appendix K Pa

tient Access Downtime Guidelines

Appendix L CRIS D

owntime In House Support Checklist for DCRI Nurse Analyst

Appendix M NIH Emerge

ncy Backup Telephone System

Disaster Recovery P

lan: located in the Data Center Operations Department, room B25750.

Approved: _____________________________________

Jon McKeeby, D.Sc.

Chief, Dept. of Clinical Research Informatics

Implemented: 6/01: Revised:11/08, 5/09, 7/09, 2/10, 6/10, 3/11, 6/11, 12/11, 3/12, 7/12, 9/12, 10/12, 11/12,

12/12, 1/13, 2/13, 5/13, 8/13, 11/13, 7/14, 2/15, 8/15, 7/17, 10/17, 12/17, 3/18, 7/18, 2/19, 11/19, 6/20

Procedures: Downtime Processes for Unavailability of Electronic Clinical Systems

1.0 Scheduled System Downs

There are no routine downtimes for systems. System downtimes are related to maintenance upgrades and/ or

system problem solving as needed. All Scheduled CRIS and non-CRIS downtimes must go through the

Technical Review Board (TRB). As part of the TRB process they must be added to the Change Management

calendar used to track and schedule system downtimes. Notification will occur if a system down is planned for

more than 15 minutes or as soon as interruption is found for an unplanned down. DCRI will internally monitor

all system downtime(s) and record all systems disruption, for users. The downtime procedures are defined in

the following section according to roles.

The procedure is also defined in section 3.0.

1.1 Do

wn Preparation- Clarification of Roles

A. The Deputy Chief Informatics Officer (CIO) or the Clinical or Technical Architect utilizing DCRI staff

will coordinate system down time with the following, noted below: (See Appendix A for

organizational assignments) based on the reason for the system down.

The Deputy CIO and Chief, Server Support or other DCRI Executive staff will decide whether to

send an e-mail (blind copy - Bcc) to the CC Systems Notifications DL and CC-ISD IE Notice DL

informing users of system down. If email notification is needed to all CRIS users then the "CC CRIS

Users Master Dist List - A- K" and “CC CRIS Users Master Dist List - L- Z” DL will be utilized (send

blind carbon copy and expand list). These DLs are for emergent / CRIS critical purposes. Also the

CRIS Status screen (Hello Screen) will be updated with applications status (type of down, date and

time).

DCRI

 CIO

 Deputy CIO Clinical Informatics

 Deputy CIO Director of IT Operations

 Chief Portfolio Officer

 Project Manager

 Chief, Clinical Applications

 Clinical Information System Administrator

 Clinical Database Lead

 Systems Monitoring, Team Lead

 DCRI Liaison Team, Member

 Clinical Architect

 Technical Architect

 DPM System Administrator

Diagnostic Radiology Department- Imaging Science Division

 Radiology Information System Administrator

Department of Laboratory Medicine (DLM)

 Lab Information Manager

 Back-up Administrator

Department of Transfusion Medicine (DTM)

 Lab Information System Administrator

 Quality Assurance Specialist

 Transfusion Services Supervisor

Clinical Center Nursing Department (CCND)

(Entire nursing department is notified of downs)

 CCND Chief

 CCND Deputy of Clinical Operations

 CCND Service Chiefs

 Administrative Coordinator (AC) – on call

 For ADT System downtime - notify the Deputy Chief, or designee and Admissions

Nutrition

 Chief Nutrition Department

 Chief of Clinical Nutrition Services

 Assistant Chief of Food Services

 Registered Dietician Informaticist

Note: May need to call Nutrition Kitchen Supervisor on site weekdays beginning at 6:00 am

Patient Support Services Department

 Chief, Patient Support Services Department

 For ADT System Down – notify the Chief or designee and Admissions

Pharmacy

 Chief

 Pharmacy Administrative Officer of the Day

 Pharmacy Informatics Team

Refer to Appendix A.1 for individual’s name for the roles listed above.

Please include CC-DCRI External CRIS Down Notifications when opening conference line for any

CRIS, Printing, CRIS interface, Network Downs, or Training database. Systems Monitoring will add

this DL to the Open Conference Call email.

B. Chief, Clinical Application, Interface Supervisor or Clinical Information System Administrator will

notify the Clinical Information Departments that utilize interfaces of the proposed time by phone

call and then send an e-mail (Bcc) from the CC DCRI Notifications (DO NOT REPLY) DL to the CC-ISD

IE Notice and CC-Systems Notification DLs identifying the date, time and reason for the scheduled

down.

C. DCRI Liaison Team, Member has the role for communicating the planned downtime during regular

working week hours. Communication as to what service is down and the duration of the

downtime needs to be relayed. If there will be three or more downtimes in a week, the DCRI

Liaison Team, Member will send notification included in a table listing the various types of

downtimes with date and times.

The procedures for system users during the downtime are the same whether or not there is less

than or greater than 24 hour notification; however, the communication role of the DCRI Liaison

Team, Member differs.

Email Notification – DLs:

The DCRI Liaison Team, Member will notify users of the downtime utilizing e-mail.

All email will be sent from the CC DCRI Notifications (DO NOT REPLY) DL.

All notifications will be sent blind copy (Bcc) to the CC-ISD IE Notice and CC Systems Notification

DLs.

There may be additional distribution lists added to the notification besides the routine CC-ISD IE

Notice and CC Systems Notification DLs.

Additional distribution lists include: Prescribers and Affiliate staff: Notification to Prescribers and

affiliate staff will be sent (Bcc) if CRIS is to be down for > 2hours and/ or another system goes

down more than once during the day. The prescribers and affiliate staff distribution list is as

follows:

 CCMEDSTAFF-[email protected] and

 CCAFFSTAFF-[email protected]IH.GOV

All Clinical Center Staff: CC Staff DL

Notification (Bcc) to “CC Staff” is used when the message needs to get to a larger group of

stakeholders (e.g. Unplanned Network Downtimes).

All CRIS Users: If email notification is needed to all CRIS users then the "CC CRIS Users Master Dist

List - A-K and CC CRIS Users Master Dist List - L-Z" distribution lists (Bcc) will be utilized.

The following DLs are for emergent / CRIS critical purposes. The DCRI Liaison Team, Member or

Executive leadership will determine when to send to these DLs. Special security rights are required

to send (Bcc) to the "CC CRIS Users Master Dist List - A-K and CC CRIS Users Master Dist List - L-Z".

Reference Appendix A for the following information:

 Departmental staff listed above in section 1.1A (reference Appendix A.1 for staff’s role and

name)

 Clinical Center Nursing Staff reference Appendix A.2 for DL E-mail addresses

 Clinical Center Department of Transfusion Medicine

 Clinical Center DCRI Government Staff

1. 24 hour Advanced Notice (Planned CRIS Downtime):

If the planned downtime has more than a 24 hour notice, during a regular working week, it will

be communicated by having the DCRI Liaison Team, Member distribute flyers to the Nurse

Manager mailboxes, update the CRIS Status Screen (Hello Screen) about the future CRIS

downtime and e-mail CC nursing staff via the CC System Notification DL. A sufficient quantity

of flyers must be provided to the Nurse Managers, as the Managers may cover more than one

inpatient unit and/ or clinic (see Appendix I for sample flyers, and communication of down

Department of Laboratory Medicine Downtime Process for Nursing).

2. Less than 24 hour Advanced Notice (Planned CRIS Downtime):

For planned downtimes, during a regular working week, where there is less than 24 hour

advanced notice, the DCRI Liaison Team, Member will e-mail (Bcc) the CC nursing staff and

departmental staff listed above in section 1.1A.via the CC-ISD IE Notice and CC- Systems

Notification DL, and update the CRIS Status screen about application status. In addition, the

DCRI Liaison Team, Member or designee may call units and clinics.

3. Nur

se Manager Mailboxes are located in the following locations:

 10/2B01 in work area room 2B04

Flyers will be distributed to the Clinics and Day Hospitals only if the downtime will affect them

during their hours of operation. Refer to the Nursing Department (CCND) Organizational Chart as a

resource when distributing flyers to the nurse managers. It can be found at the following URL link:

http://www.cc.nih.gov/nursing/about/orgchart.html

D. Systems Monitoring assumes the responsibilities of the DCRI Liaison Team, Member during

evenings, nights, holidays and weekends. The CRIS Analyst On–Call will follow the same

notification instructions as the DCRI Liaison Team, Member in Section 1.1 C if assistance is needed

from the Systems Monitoring team. In addition, the CRIS Analyst On-Call will contact the Nursing

Administrative Coordinator, via page operator to communicate status of downtime (if applicable).

Clinical Information Departments will be informed if significant changes occur from the downtime

that impact their resources.

2.0 Scheduled System Downs- Communication

There are no set scheduled maintenance downtimes. They occur as needed. The best times to

perform these needed maintenance activities requiring downtime are negotiated with the affected

departments. This is defined in section 2.2. Planned system downs are identified as providing

notification 24 hours in advanced.

2.1 Communication of Downtime (Planned)

The DCRI Liaison Team, Member or designee is responsible for communicating downtime information

when the system is down. Team Leader of Systems Monitoring or designee is responsible for

communicating when the system is back up and operational. All downtime communication to the user

community will be sent from the CC DCRI Notifications (DO NOT REPLY) DL.

A. The DCRI Liaison Team, Member:

 Directs the NIH Page Operator via email to overhead page of CRIS down or affected system 30

minutes before, at the time of downtime and the subsequent repeat announcements.

Announcements can be made hourly unless the down is >2 hrs, then refer to extended

planned downtime.

 Sends email notification (Bcc) to CC Systems Notification and CC-ISD IE Notice DLs identifying

the reason for the downtime.

 Updates/ places announcement on CRIS Status screen (Hello Screen) on the type of downtime:

application type, date and time.

B. The team leader of Systems Monitoring or designee :

 Prior to the downtime:

 Sends 2

reminder email notification (Bcc) to CC Systems Notification and CC-ISD IE

Notice DLs identifying system 30-60 minutes before the down.

 When the system is operational:

 Directs the NIH Page Operator to overhead page CRIS or affected system is

operational.

 Notifies the CC Service Center at 301-496-8400, during regular working hours.

 Notifies the CRIS Analyst on–call via the Page Operator (during evenings, nights,

holidays and weekends only) if necessary.

 Sends email (Bcc) notification to CC Systems Notification and CC-ISD IE Notice DLs

identifying the system is operational.

 Updates/ removes downtime message on CRIS Status screen (Hello Screen) (if any).

Planned downtime

and

tification (Bcc) to Prescribers and affiliate staff will be sent if CRIS is to be down for > 2hours. The

prescribers and affiliate staff distribution list is as follows:

CCMEDSTAFF-[email protected]

CCAFFSTAFF-L@

LIST.NIH.GOV

Upgrades (30,000+ People Distribution list)

URL: http://list.nih.gov

Select NIH Staff Email List – NIH Only

It takes you to https://list.nih.gov/LISTSERV_WEB/NIH-STAFF/

Select “Submit a Message to the NIH Staff List”

Complete fields with information including message.

Selects Yes for NIH staff only and it goes to the DC, MD and VA areas.

Notification Determination/ Frequency

Based on the type of application /system down, the impact to the NIH community is minimal, System

Owners can identify if email or overhead notification is required. Email and overhead notification may

vary at the systems owner’s discretion (e.g. CBORD Down for 24 hours only announce at the beginning

and the end of the down period; NIH email service down at the beginning, repeated in 15 minutes and

at the end of the down period).

If the start of a downtime is delayed more than two hours from the initial time identified in the

communication, an email will be sent out to users by the team leader of Systems Monitoring or

designee.

If the system is not operational at the designated time, continue with downtime overhead

announcement and email notification that the system remains down.

2.2 Time Coordination

Communication between the DCRI appropriate roles will occur when selecting/coordinating the

scheduled downtime.

Best times for downtime:

 All Departments= Primarily CRIS

8:00 pm – 10:00 pm if downtime <90 minutes (Wednesday)

6:35 pm – 10:35 pm on Saturday if downtime > 90 minutes.

Note: Downtimes greater than 90 minutes during the workweek need CIO approval.

 CIT= to follow All Departments best time for downtime.

 DPM = 8:00 pm – 10:00 pm

 DLM= 8:00 pm – 10:00 pm

 DTM= 8:00 pm – 10:00 pm

 DRD= prefers after 4:00 pm

 Nursing= prefers 1:00 am; however, during business hours weekdays and weekends,

the least disruptive time would be after 5:00 pm. Nursing requests the following as

preferred times:

 ADT scheduled downtime - 10:00 pm – 12:00 am.

 ATV scheduled downtime- Thursday after 6:00 pm

 Scheduled downtime < 24 hour notice - at 5:00 pm.

 Times to Avoid- 11:00 am and 4:00 pm.

 Nutrition= 8:00 pm – 5:00 am

 Messenger and Escort= to follow All Departments best time for downtime.

 Patient Support Services Department =

 ADT scheduled downtime - 10:00 pm – 12:00 am.

 ATV scheduled downtime- Thursday after 6:00 pm

 Pharmacy= need to address each downtime on a case-by-case basis

(8:00 pm – 10:00 pm)

 Respiratory Therapy =1:00 am – 5:00 am

*Tim

es to Avoid- During Power Testing

2.3 Notification to Clinical Information Departments of Proposed Downtime

A. DCRI appropriate role and Clinical Information system Administrator will notify the Clinical

Information Departments that utilize interfaces of the proposed time through the following

means:

1. Phone call

2. E-mail (Bcc) to the CC-ISD IE Notice DL identifying the date, time and reason for the scheduled

down.

B. Individual Departments determine if they need to call stat results and if they need to follow their

own Interface down procedures and use manual procedures.

C. Refer to Appendix D & I for the effects of downtime on clinical departments interactions with

patient care units.

2.4 Extended Planned Downtime (greater than 2 hours)

A. The DCRI Liaison Team, Member or designee is responsible for communicating downtime

information when the clinical system is down. When a planned extended down is scheduled the

DCRI Liaison Team, Member will:

1. Send initial email requesting the NIH Page Operator to overhead page as guidelines:

 If Downtime occurs between 7:00 am – 10:00 pm= Overhead page every 2 hours

 If Downtime occurs between 10:00 pm – 6:00 am= Overhead page every 4 hours.

2. Send initial email notification (Bcc) from CC DCRI Notifications (DO NOT REPLY) DL to CC

Systems Notification and CC-ISD IE Notice DLs (Bcc) identifying the reason and details for the

downtime.

3. Update/place announcement on CRIS Status screen (Hello Screen) on the type of down:

application type, date and time.

Note: The overhead notification may vary based on the type of application down for a specific system

that has minimal impact the NIH community. The main users or system owners of the system can

request that extended announcement can be reduced to what the user defines (e.g. CBORD Down for

24 hours only announce at the beginning and the end of the downtime period; NIH email service

down at the beginning, repeated in 15 minutes and at the end of the downtime period).

B. Prior to /During System down the DCRI Team Leader of Systems Monitoring or designee is

responsible for:

1. 30 minutes before the downtime: sending a second reminder email notification to designated

distribution lists identifying system is down.

2. Confirming the hourly or every two hour announcements are being made over head until the

system is operational.

3. Updating/ placing announcement on CRIS Status screen (Hello Screen) on the type of

downtime: application type, date and time using red font color.

4. Sending email notification from CC DCRI Notifications (DO NOT REPLY) that the system remains

down every two hours (unless designated otherwise) from the start of the downtime until they

are notified it is operational. Email notification (Bcc) is sent to CC Systems Notification, CC-ISD

IE Notice, CC MedStaff ListServ, and CC AFFSTAFF ListServ.

5. Sending email notification from CC DCRI Notifications (DO NOT REPLY) when CRIS Sundown is

available for use. Email notification (Bcc) is sent to CC Systems Notification, CC-ISD IE Notice

DL, CC MedStaff ListServ, and CC AFFSTAFF ListServ. Note: more DL may be identified.

6. Directing the NIH Page Operator to overhead page when CRIS is again operational.

7. Sending email notification (Bcc) from CC DCRI Notifications (DO NOT REPLY) to CC Systems

Notification, CC-ISD IE Notice DL, CC MedStaff ListServ, and CC AFFSTAFF ListServ identifying

the system is again operational.

8. Updating/ removing downtime message on CRIS Status screen (Hello Screen).

2.5 Extended Planned or Unplanned Downtime (greater than 2 hours) for

CRIS Sunrise ONLY USING CRIS SUNDOWN

CRIS Sundown will be available to users when CRIS Sunrise is down for a duration greater than 90

minutes. This system is a copy of the current CRIS Sunrise with view only and printing capabilities. The

procedure to activate CRIS Sundown takes approximately 90 minutes.

During an extended CRIS Sunrise downtime, DCRI will activate the CRIS Sundown icon via Citrix

(cccasper.cc.nih.gov) to make it available for users. Once informed, the icon is available users must log

out of Citrix and log back on.

The CRIS Sundown icon will then display and users will be able to log in, view and print patient data.

For a scheduled down of > 2 hours:

 CRIS Sundown will be made available with current data up to1 hour prior to the scheduled

down

For an un-scheduled down:

 The procedure to activate CRIS Sundown will begin within 30 minutes of the announced

down

CRIS Sundown Highlights:

 Users will click the CRIS Sundown icon in Citrix to access the application once they have

been informed it is available.

 Users will log in using their NIH domain user name and password.

 Users can View and Print ONLY.

 Users can not add, edit, or modify any data.

 Users will not have access to the Task Manager (MAR), only to the Task Viewer.

 Users will not have access to the Flowsheet tab, data can be viewed from the Documents

tab

 CRIS Sundown will not be available except during these extended downtimes. After CRIS

Sunrise is taken offline, DCRI will make CRIS Sundown available to users approximately 60-

90 minutes after CRIS is unavailable.

 CRIS Sundown will be taken offline when CRIS Sunrise (CRIS SCM) is available.

An announcement by the (NIH Operator Services) Clinical Center operator and email by DCRI Systems

Monitoring will let users know that “CRIS Sunrise is down and CRIS Sundown is available for use by

CRIS users.”

1. Sending email notification from CC DCRI Notifications (DO NOT REPLY) that the CRIS system

remains down every two hours (unless designated otherwise) from the start of the down until

they are notified it is operational. Email should identify if Sundown is available. Email

notification is sent (Bcc) to CC Systems Notification, CC-ISD IE Notice, CCMEDSTAFF-

[email protected] and CCAFFSTAFF-L@LIST.NIH.GOV.

2. Directing the NIH Page Operator to overhead page when CRIS is again operational.

3. Sending email notification (Bcc) from CC DCRI Notifications (DO NOT REPLY) to CC Systems

Notification, CC-ISD IE Notice, CCMEDSTAFF-[email protected].GOV and CCAFFSTAFF-

[email protected] identifying the system is again operational.

4. Updating/ removing downtime message on CRIS Status screen (Hello Screen).

3.0 Unscheduled System Downs

planned downtime

and

3.1 Do

wn Initiation

Systems Monitoring follows the defined Disaster Recovery Plan, which can be found in the Data Center

Systems Monitoring Department located in room B25750 for emergency and/or unexpected downs.

The main DCRI contact is the Team Leader of Systems Monitoring.

3.2 Communication of Downtime (Unplanned)

Refer to Appendix E for specific procedures related to individual systems being down.

A. Initiation of Unplanned Downtime Process:

Depending on the source that identifies the problem, communication of a system downtime is

initiated either through users or DCRI staff contacting Tier 1 CC Service Center / DCRI Systems

Monitoring or vice versa. Send an email to DCRI staff and open conference line.

If the system has a known issue affecting service as soon as DCRI is aware of the interruption

initiate notification as soon as possible, do not wait 15 minutes.

The DCRI Team Leader of Systems Monitoring or designee will:

1. Direct the NIH Page Operators to make an initial overhead page concerning system down. This

will be repeated every 15 minutes for the first hour and then every 30 minutes for the second

hour and then hourly until the system becomes operational.

 Refer to extended planned downtime if CRIS down will be > 90 minutes.

 Refer to Appendix J for exceptions when announcement is not as frequent.

2. Send an e-mail from CC DCRI Notifications (DO NOT REPLY) to CC Systems Notification and CC-

ISD IE Notice DLs identifying system down (see Appendix J).

If issue needs further analysis, email to state “System interruption unknown impact. Further

information to follow.” USE GENERIC TEMPLATE IF FURTHER ANALYSIS IS NEEDED.

tification to Prescribers and affiliate staff will be sent if CRIS or systems affecting CRIS are

down for 1 hour or experience more than one down per day.

The prescribers and affiliate staff distribution list is as follows:

CCMEDSTAFF-[email protected]

CCAFFSTAFF-L@

LIST.NIH.GOV

3. Notify the CC Service Center staff covering Tier 1 support, during regular working hours.

4. If CRIS system has been down for 30 minutes, provide printout to ICU of Clinical Data Viewer

report (refer to ICU downtime process).

5. Notify the CRIS Analyst On– Call via Systems Monitoring (during evenings, nights, holidays and

weekends only) if necessary.

6. Update/ place announcement on CRIS Status screen (Hello Screen) on the type of downtime:

application type, date and time (e.g. CRIS Status: CRIS is unavailable for use).

B. Involved Departments Notification

Affected departments are notified specifically by DCRI. Judgment is used in contacting others,

based on the situation of the downtime. The DCRI Team Leader of Systems Monitoring or designee

will:

1. The following areas are called if the system is expected to be down more than 15 minutes,

during regular working hours.

1. Admissions

2. DLM

3. DPM- Surgery (if open)

4. DTM

5. Messenger/Escort

6. Nursing

7. Nutrition

8. Pharmacy

9. Radiology

10.Special Clinical Studies Unit

11. HIMD (Consents tab, 3M-ESA)

2. Call individual patient care units, clinics and day hospitals notifying them if the downtime

status is going to be greater than 30 minutes, during regular working hours. Note: During

evening, nights, holidays and weekends the Administrative Coordinator’s assistance may be

needed to communicate the downtime status.

3. Sends email notification that the system remains down every two hours from the start of the

downtime to CC Systems Notification and CC-ISD IE Notice DLs.

 CRIS Sundown Use: Please refer to section 2.5 Extended Planned or

Unplanned Downtime (greater than 2 hours) for CRIS Sunrise ONLY

Use of CRIS SUNDOWN

4. Ongoing Status of downtime:

Clinical Information team leads are encouraged to call DCRI to obtain updated information on

the status of the downtime or system interruption.

 Weekdays during business hours (7:00 am- 5:00 pm): Departments may call CC Service

Center (301) 496-8400 and request feedback on the status of all downtimes. The DCRI

Liaison Team, Member or the CRIS Analyst will contact the person responsible for the

downtime and get an update. The update will be provided back to the department

requesting the feedback.

 Weekends, Evenings Nights and Holidays: Departments may call Systems Monitoring

(301) 496-7525 and request feedback on the status of all downtimes. Systems

Monitoring staff will contact the person responsible for resolution of the downtime for

an update. The update will be provided back to the department requesting the

feedback.

C. When the system (e.g. CRIS, Network) is operational, the Team Leader of Systems Monitoring or

designee will notify the NIH Page Operators to overhead page that the system is available for use.

D. Team Leader of Systems Monitoring or designee sends an e-mail (blind copy) to the CC Systems

Notification and CC-ISD IE Notice DLs identifying the reason for the unscheduled downtime, the

time the system went down and when it came back. A team of DCRI Operation staff will call the

patient care units to confirm that the workstations (i.e. WOW,Thin-Clients) are operational.

E. Update/ remove downtime message on CRIS Status screen (Hello Screen) and state system is

operational.

3.3 Conversion to Use of Manual Documentation and Communication Forms For Prolonged CRIS Down

A. Re

fer to Section 4.0 for use of manual documentation and communication forms, as the same

interventions will occur for an unplanned prolonged downtime.

B. Extended unscheduled downtimes require initiation of the defined Disaster Recovery Plan, which

can be found in the Data Center Systems Monitoring Department, located in room B25750.

4.0 Conversion to Use of Manual Documentation and Communication Forms for Prolonged CRIS Downtime

If CRIS is down for a prolonged period of time, 30 minutes or greater, DCRI will communicate this information

to the affected departments. Each department shall define their appropriate downtime procedure for using

manual documentation.

Downtime procedures can be initiated for all CRIS activity or specific functionalities such as order entry, result

retrieval, medication administration documentation, lab/specimen collection and/or clinical documentation.

The extent of what activities are working and what needs to be converted to downtime must be

communicated.

4.1 Forms

Guidelines and manual forms for ordering and documenting, are available on every inpatient unit and

clinic. The nurse managers for the inpatient units, day hospitals and clinics are responsible for keeping

the forms updated and in stock. DLM and DTM will be notified by downtime announcement, the

Clinical Information System Administrator and/ or the Interface Administrator to accept paper

requests and call stat results.

Manual ordering and documentation forms can be obtained from HIMD

Monday- Friday 7:00 am- 5:00 pm or accessed online.

All of the CRIS Downtime forms can be found at the following URL:

http://intranet.cc.nih.gov/medicalrecords/forms/forms-crisdowntime.html

4.2

The following forms (HIMD) are to be used for manual ordering and documentation:

Form Number

Form Name

SF-509 (7-91) Progress Notes

SF-510 (10-75) Nursing Notes

NIH-509 (8-00) Inpatient Progress Notes

NIH-2797 (10-00) Nursing Reports Manual

NIH-54 (12-09) Request for Admission/Travel/Voucher/Location Transportation

NIH-2955 (11-14) Electronic Appointment Request Downtime Form

NIH-513-1 (3-02) Consultation Report

NIH-526 (5-93) Vital Signs-Special Graph Sheet

NIH-532-1 (7-87) Outpatient Progress Notes

NIH-532-10 (8-00) Outpatient Progress Notes (computer template)

NIH-532-11 (2-08) Outpatient First Registration Progress Notes

NIH-532-13 (8-01) Outpatient Progress Notes: Medicine Branch

NIH-2435-3 (2-88) On-Treatment Progress Note: Radiation Therapy

NIH-2795 (5-11) Orders Manual

NIH-2849 (1-06) Inpatient Medication Reconciliation

NIH-2874 (8-08) DLM Information Required for Specific Tests

NIH-2880 (1-10) Rapid Response Note

NIH-2891 (8-15) DPM POIS SISWEB Downtime Case Request Form (formerly Operating Room Case

Request Form)

NIH-2900 (4-11) CRIS Downtime: Medication Orders

NIH-2901 (6-16) Department of Laboratory Medicine Ordering Record – Chemistry

NIH-2902 (6-16) Department of Laboratory Medicine Ordering Record – Hematology

NIH-2903 (6-16) Department of Laboratory Medicine Ordering Record – Microbiology

NIH-2904 (2-11) CRIS Downtime: Medical Surgical Nursing Assessment

NIH-2905 (2-11) CRIS Downtime: Medication Administration Record

NIH-2906 (2-11) Transfusion Medicine Ordering Record

NIH-2907 (2-11) Diagnostic Radiology Exams/Procedures (Ultrasound – CT)

NIH-2907-2 (2-11) Radiology Exams/Procedures (MRI-Nuclear Medicine)

NIH-2907-3 (2-11) Radiology Exams/Procedures (Interventional Radiology)

NIH-2909 (2-11) CRIS Downtime: Total Parental Nutrition TPN

NIH-2911 (4-11) CRIS Downtime: I & O Form

NIH-2912-1 (4-11)

CRIS Downtime – Outpatient Documentation: Screening New Patient Visit Nursing

Assessment

NIH-2912-2 (4-11)

CRIS Downtime – Outpatient Documentation: Follow up - Return

Visit Nursing Assessment

NIH-2912-3 (4-11) CRIS Downtime – Outpatient Documentation: Consult Visit Nursing Assessment

NIH-2912-4 (4-11) CRIS Downtime – Outpatient Documentation: Lab/Test Visit Nursing Assessment

NIH-2912-5 (4-11) CRIS Downtime – Outpatient Documentation: Procedure/Treatment

Visit Nursing Assessment

NIH-2912-6 (4-11)

CRIS Downtime – Outpatient Documentation: Walk-In/Emergency Visit Nursing

Assessment

NIH-2913 (5-11) Patient Transfer of Care Note

NIH-2924 (1-12) Discharge Care Order – Outside Medical Services

NIH-2925 (1-12) Language Interpreter – Social Work Order

NIH-2960 (5-15) CRIS Downtime Nutrition Department Orders

NIH-2955 (11-14) Electronic Appointment Request Downtime Form

1. Other

forms can be found: http://intranet.cc.nih.gov/medicalrecords/forms/forms-crisdowntime.html

2. Request for Admission/Travel/Voucher/Local Transportation (NIH- 54)

are to be used for admission, travel

and vouchers

3. DLM Information Required for Specific Tests (NIH-2874).

Non-Medical Record Forms for the Department of Laboratory Medicine can be found at the following URL:

http://intranet.cc.nih.gov/dlm/downtimeguidelines/stat_result_worksheets.html

1. Heme

Stat Report

2. Chem Stat Report for Serum & CSF Report

3. Chem Stat Report for Whole Blood

4.3 Specimen Labels

abels used during the downtime mus

t include the patient’s name, medical record number and date of

birth and patient location. There are various types of labels (see Appendix H- Glossary: Labels):

1. SoftID labels (if available) are to be used to label any specimens being sent to the lab. These labels print

from the SoftID system, and as a result during CRIS downtimes may continue to print if the SoftID system is

operational. These labels include bar coding specific to a unique identifier of what test needs to be done

and is read by the lab system.

2. Specimen labels printed from Zebra printer (if available) are to be used to label any specimens being sent

to the lab. These labels print from the Lab system, and as a result during CRIS downtimes may continue to

print if the lab system is operational. These labels include bar coding specific to a unique identifier of what

test needs to be done and is read by the lab system.

3. Patient labels (Admission) are to be used if there are no Specimen or SoftID labels. These are preprinted

with the required patient information. If the function to view orders and a lab order exists in the CRIS

system, write the Order ID number on the admission label. This order ID number identifies the specific

test to be performed and resulted on the specimen being sent down to the lab. The admission labels

include a barcode that represents the MRN for the patient, and is different than the barcode on the LIS

specimen label which is the LIS Order number. Please add the patient care unit (PCU) on the label. These

labels may come from the Zebra printer or from the Admissions Department. Remember if CRIS is down,

Admissions will not be able to print labels for patient care units.

4. Handwritten labels are to be used if Patient labels (admission) are not available. Please add the PCU on the

label.

NOTE: Please verify all labs are collected based on available information (medical care plan, lab form etc.).

5.0 Admission Discharge Transfer (ADT)

Admission Discharge Transfer (ADT) will not occur when the CRIS System is down.

5.1 ADT Impact when the CRIS System is down

A. Any Patient Admission

CRIS will not send patient admission information to Clinical Information systems. Admissions will not be

able to activate a patient electronic medical record in CRIS. Any orders entered while the patient is in pre-

admit status, cannot be released. This applies to either the admission of an Inpatient or the creation of an

Outpatient visit.

New o

rders and/or documentation entered while CRIS is down need to follow the procedures for manual

entry until the CRIS system is operational (See 4.0 Conversion to Use of Manual Documentation and

Communication Forms for Prolonged CRIS Downtime).

B. Transfer to another location in the hospital

The Patient’s location will not change in CRIS until the system is operational and the transfer order/

process have occurred. The patient can physically transfer to another unit for care when the CRIS system

is down.

C. Visit Type

If the patient is discharged while the CRIS system is down the current inpatient visit will not change to an

outpatient visit until CRIS is operational. If the patient goes on pass while the CRIS system is down the

current inpatient visit will not change to a leave of absence status until CRIS is operational.

6.0 System Descriptions, Responsible Parties and Customer Impact

CRIS Components: Equipment and Network That Comprise CRIS.

when the CRIS

system is not operational:

The following appendices reflect the impact on system components, servers and services

Appendix A – A.1 Lists the designated person and contact information for specific roles and responsibilities. A.2

Lists the Organizational contact information for key players involved in the downtime communication process.

Appendix B– The table reflects the communication plan executive leadership will follow in informing Institutes

and Clinical Center leadership of system status.

Appendix F – The table reflects the impact on the various system components and/ or servers if the CRIS Core

system is not operational. Also included are the Departments and individuals responsible for the various

system components or servers.

Appendix G – The table reflects the impact on the various clinical information systems if the CRIS Core System

is not operational. Also included are the Departments and individuals responsible for the various system

components or servers.

7.0 Perioperative Information System (POIS) Downtime Procedure

Ref

er to the Department of Perioperative Medicine Downtime Procedure for the POIS.

8.0 CRIS Status Screen/ Hello Screen

The CRIS Status screen provides users with information on the status of CRIS as well as any upcoming

application downtimes.

To access the status screen one must have permission to access the following network drive

\\CC0PProfiles1\CRISSTATUS

. The DCRI Liaison Team, Member will send an email to the System Administrator

or Team Leader of Systems Administration requesting DCRI staff permission to access.

Onc

e granted access to add, update or revise status screen messages please take the following steps

1. Go to My Computer. Tools--> Map Network Drive.

Map your drive to \\CC0PProfiles1\CRISSTATUS

2. Click Finish.

3. Select the word document ‘statustext’ (rich text format)

4. Update the message as deemed necessary

• CRIS is Unavailable (Day, Date, Time Frame)

System Monitoring will update the message when CRIS is down or operational as well as remove existing

messages when the downtime is complete.

9.0 ICU Downtime Process

ICU will follow downtime procedure as noted in policy.

A special report printing make take place for both planned and unplanned CRIS downtimes or anytime CRIS is

unavailable (e.g. Network downtime).

Refer to the Accessing and Printing CRIS Down PDF Documents for ICU

O:\CRIS Support Center\ Quick Reference Guide\ICU e-doc and biomed devise

The documents are stored in the following folder.

\\CC0PsxaRepo\RepoShare\DownTime

Planne

d Downtime- ICU report printing

The ICU is responsible for printing the following reports ahead of time directly from CRIS Sunrise:

 Medical Care Plan

 Meds Due Worklist

 Specimen Collection Worksheet

 Clinical Data Viewer report

ICU Staff to print ICU CDV report 1 hour prior for planned CRIS downtimes or

Systems Monitoring to print within 30 minutes of the CRIS being down if unplanned

Unp

lanned Downtime- ICU report printing

Systems Monitoring will print the following reports within 30 minutes of the start of the down (e.g. if the

system goes down unexpectedly)

 Medical Care Plan

 Meds Due Worklist

 Specimen Collection Worksheet

 Clinical Data Viewer report

* Note: Reports from 3SWN are only available if the patient census in the ICU is so high that patients are

admitted into that unit.

ICU- ICU will make the determination of when to plug in the Workstations on Wheels (WOWs) to the network

outside patient rooms. Network Cables are available in the ICU (see Appendix D).

10.0 Extended Wireless Network Downtime (Hardwiring WOW using LAN Drop)

If the Wireless network is down for more than 1 hour, the nurse can use a Local Area Network (LAN) cable to

connect/ hardwire one WOW in each patient care room to an active LAN port. This will provide access to CRIS

and the internet until the wireless network is back on line.

The a

ctive LAN line port is located in patient care rooms of the CRC where a WOW is located and marked with

a yellow plastic insert.

Criteria for hardwiring WOWs:

• Wire

less Network Downtime Greater than 1 hour

LAN Cable Information:

• Cables have been distributed to patient Care unit and Day hospital.

• Nurse Managers will store the LAN cables to use for emergent purpose of an extended wireless

downtime (>1 hour).

• Call CC Service Center 301-496-8400 if extra LAN cables are needed

Important Note: The Active LAN port (marked in yellow) is only to be used for emergent WIRELESS NETWORK

Downtimes > 1 hour.

ICU: The ICU will make the determination of when to plug in the Workstations on Wheels (WOWs) to the

network outside patient rooms. Network Cables are available in the ICU (see Section 9.0 and Appendix D).

Appendix A

Organizational Roles, Assigned Responsibilities and Contact Information

A.1. Organizational Role & Assigned Responsibilities

Clinical Center

NIH Page Operator – (301) 496-1211

Anatomical Pathology

Pathology LIS Administrator NCI/ NIH- Earle Barnes- (301) 496-0551

Department of Perioperative Medicine (DPM)

Chief, DPM- Andrew Mannes- (301) 594-7328

DPM Anesthesiologist- Julia Labovsky (301) 594-7323

DPM Application Administrator – Norma Street (301) 496-4835

POIS Database Administrator – Tadele Yenegeta 301-496-9243/Murali Kumar (301) 402-5808

POIS System Administrator – Barrett Grieb (301)-402-3130

Department of Clinical Research Informatics (DCRI)

ATV Administrator- Frank Mickey – (240) 393-2225 (cell)

CITRIX Administrator– Brad Snakenberg – (301) 594-9298

Chief Informatics Officer – Jon McKeeby, D.Sc. – (301) 496-3826

Deputy CIO Director of IT Operations – James (Jim) Pitts – (301) 496-7436

Deputy CIO Clinical Informatics –

Chief, Server Support and Data Center Operations – John Kocher (301) 594-8389

Chief, Technical and Clinical Customer Support – William Hernandez (301) 451-9728

Chief, Clinical Applications – Tony Barnes – (301) 496-4285

Clinical Architect– Seth Carlson – (301) 594-7491

Clinical Database Lead–Tim Maloney– (301) 496-6976

Chief, Budget and Capital Planning– Jay Yarington – (301) 594-7801

Chief Medical Information Officer – David Herion – (301) 496-7734

CC CISO, CC Information Security Officer– Chris Chern

Interfaces Supervisor – Yenshei Liu – (301) 496-6789

Network Engineer– Jason Chan – (301) 435-4692

Network Engineer– Richard Walker – (301) 496-8652

Network Engineer - Tim Salo-(301) 496-4785

POIS Database Administrator – Tadele Yenegeta 301-496-9243/Murali Kumar 301-402-5808

Chief Project Management Office – Ryan Kennedy – (301) 402-4867

Systems Monitoring Lead – Pam Carter – (301) 496-3844

Systems Administration Team Lead – Dempsey Dunn – (301) 496-4712

DCRI Liaison Team, Supervisor – Minnie Raju – (301) 451-3310

DCRI Liaison Team, Member– Adrienne Barrett – (301) 443-3477

DCRI Liaison Team, Member– Rubi Defensor – (301) 435-8516

Appendix A

Organizational Roles, Assigned Responsibilities and E-mail Addresses

UNIX System Administrator– Chris Klein – (301) 402-0974

DCRI Systems Monitoring On-Call Computer Room – (301) 496-7525

partment of Laboratory Medicine

Laboratory Information Manager– Chung-Hee Row – (301) 402-3420

Laboratory Information System Analyst - Bonnie Aramayo - (301) 402-2959

Department of Transfusion Medicine

Lab Information System Administrator- Boyd Conley – (301) 496-4506 or (301) 594-8382

Quality Assurance Specialist– James (Wade) Atkins – (301) 496-4506

Transfusion Services Supervisor– Traci Paige – (301) 496-8335

Diagnostic Radiology Department- Imaging Sciences Division

Radiology Information System Administrator- David Sanford- (301) 435-2147

After 5:00 pm call the page operator and ask to speak to the PACs/RIS technologist on- call.

Health Information Management Department

Chief, Health Information Management Department-Tricia Coffey (301) 496-2292

Deputy Chief - Michelle Hendery (301) 402-3299

3M System Administrator – Tracy Jacobs (301) 594-1786

Messenger and Escort Service (MES)

Chief, Office of Hospitality Services – Jamillah Bynum (301) 451-9868

Program Manager, Messenger and Escort Service -Bonita Witherspoon – (301) 496-0093

Nursing Department, CC (CCND)

Chief, CCND – Gwen Wallen – (301) 435-3489

Refer to Organizational Chart for individual’s name for the roles listed below:

Service Chief’s for Nursing Department (refer to organizational chart)

Nurse Managers

Nursing Administrative Coordinator - Contact via page operator

Resource with phone list and organizational chart can be found at

http://intranet.cc.nih.gov/nursing/resources/

Nutrition

Chief, Nutrition Department-Annie Cichocki - (301) 496-2554

Chief, Clinical Nutrition Services- Madeline Michael – (301) 496-3312

Chief of Food Services- Anita Bailey – (301) 827-3798

Registered Dietician Informaticist-Melissa Riley (301) 451-7188

Note: If need the Nutrition Kitchen Supervisor’s number is – (301) 771-1961

Patient Support Services

Chief Patient Support Services- Karen Kaczorowski – (301) 496-2341

Note: If ADT System Down call Admission staff – (301) 496-3315

Pharmacy Department

Administrative Officer of the Day: 301-496-1211

Chief - CAPT Richard Decederfelt (acting) (301) 832-1995

Service Chief - Operations – Marilyn Farinre (acting) (240) 802-0137

Outpatient Section Chief – Nadia Guirguis (301) 402-7078

Service Chief - Clinical Services/Investigational Drugs- Marcus Ferrone (acting) (240) 743-1605Section Chief

Informatics - Rilwan Badamas (301) 832-2535

A.2 Clinical Center Organizational E-mail addresses

DCRI Government Staff= cc-dcri-Govt-staff@mail.cc.nih.gov

Department of Transfusion Medicine= cc-DTMstaff@mail.cc.nih.gov

Nursing Staff = nurs@mail.cc.nih.gov

CC-NURS ExtraDept Credentialed Nursing Staff =CC-NURSExtraDeptCVProgra[email protected]

CC-ISD IE Notice = isd_ie_noti[email protected].gov

CC Systems Notification = cc-[email protected]c.nih.gov

CRIS Critical DLs =

• CC CRIS Users Master Dist List - A-K (blind carbon copy and expand list);

• CC CRIS Users Master Dist List - L-Z (blind carbon copy and expand list);

The prescribers and affiliate staff distribution list is as follows:

• CCMEDSTAFF-[email protected] and

• CCAFFSTAFF-[email protected]IH.GOV

Dat

amart users: CC-DCRI DataMart Users = CC-DCRIDataMartU[email protected]h.gov

Appendix B

Unplanned CRIS Downtime- Executive Leadership Communication Plan

Address how and when to communicate DOWN once problem has been notified

CC Exec Team

Core CC Clinical Leadership

IC Leadership

CRIS Application Down

Immediate

Global mail

> 30 minutes

Problem identification

Problem Identification, implement

"down procedures"

Problem Identification, implement "down

procedures"

> 60 minutes

Action Plan; ETA, if

known

Detailed actions to be taken by

staff; continue "down" procedures;

ETA, if known

Update & continue "down" procedures; ETA,

if known

Hourly Updates -

Overhead Announcement

CRIS Down, use "Down

Procedures"

CRIS Down, use "Down Procedures"

Every 2 Hours - Email

notification

Critical issues, HL plans;

ETA, if known

Reinforce down procedures; update

ETA

Reinforce down procedures; update ETA

System Up Notification

Announce application is

up & ready for use;

known issue summary, if

extended down; next

steps

Announce application is up & ready

for use; apologize for

inconvenience; reinforce

procedures for updates of manually

collected data

Announce application is up & ready for use;

apologize for inconvenience; reinforce

procedures for updates of manually

collected data

CC Network Outage

Global mail

Immediate

CIT & DCRI

> 30 minutes

Relay critical issues &

expected resolution, if

known, from comm.

w/CIT

Detailed actions to be taken by

staff; implement "down"

procedures; ETA, if known

Notification to implement "down"

procedures; ETA, if known

> 60 minutes (phone

calls)

CRIS Down, use "Down

Procedures"

CRIS Down, use "Down Procedures"

Hourly Updates -

Overhead Announcement

Critical issues, HL plans;

ETA, if known

Reinforce down procedures; update

ETA

Reinforce down procedures; update ETA

Every 2 hours Updates -

Email (for BB & Citrix use)

Announce network is up

& ready for use; known

issue summary

Announce network is up & ready for

use; apologize for inconvenience;

reinforce procedures for updates of

manually collected data

Announce up & ready for use; apologize for

inconvenience

Appendix C

Unplanned Downtime/ System Interruption Checklist

When to initiate this checklist: As soon as a member of DCRI is aware that there is a system interruption (immediately).

Contact Systems Monitoring (301 496-7525) to run the checklist.

Please clarify whether this is a downtime or performance issue (if known).

System Monitoring or Designee to do the following:

 Initial User communication- System interruption

Send notice to users via email (Bcc) CC Systems Notification, CC-ISD IE Notice, CC-Staff, CCMEDSTAFF-[email protected] and CCAFFSTAFF-L@LIST.NIH.GOV

distribution list.

Time ______

 Send “overhead announcement to Page operator

Time ______

 Contact Executive Leadership on-call (Executive Leader on Call will contact Jim Pitts and Dr. Mckeeby)

 Contact appropriate resources (e.g. DBA, Network team, Citrix team, etc.) using on call schedule.

 Open conference line Dial: 877-985-7842 Passcode: 3256164#

Time ______

 Send email that conference line is open to CC-DCRI Staff. For any CRIS, CRIS Interface, Printing, and/ or Network Downs, please include CC-DCRI External

CRIS Down Notifications DL when opening conference line.

Other information if known or identified

 Da

te and Time problem was reported _____________________________________________

 Who reported the problem/ issue _________________________________________________

 What was the problem/ issue ____________________________________________________

What System, subsystem or “Other” is impacted ____________________________________

 Date and time problem/ issue resolved ____________________________________________

Resources person name/ Time Contacted/ Phone number:

1. ___________________________________________________________________________

2. ___________________________________________________________________________

3. ___________________________________________________________________________

Systems Monitoring or Designee’s name overseeing checklist _________________________

NOTIFICATIONS:

Policy http://cris.cc.nih.gov/procedures/pdf/Backup_Process_Unavailable_CIS.pdf

Unplanned downtime (template)

otification to Prescribers and affiliate staff will be sent if CRIS or systems affecting CRIS are down. i.e. multiple users ( > 1 call with same/related issue within a

30 minute period) .

E-Mail Message:

Subject: UNPLANNED DOWNTIME/ SYSTEM INTERRUPTION

Event Details:

UNPLANNED DOWNTIME/ SYSTEM INTERRUPTION

Impacted Services/Applications:

All CRIS users

Impacted Users:

Users of the service listed above.

Expected Resolution Time:

“There is no current estimated time of resolution”.

Additional Information:

Presently we are experiencing an unplanned system interruption. Please note that DCRI is aware of the issue and working to resolve.

Please contact CC Service Center (301) 496-8400

Thank you for your support,

The Department of Clinical Research Informatics

(301) 496-8400

Message to Page Operator:

Present tense: UNPLANNED DOWNTIME/ SYSTEM INTERRUPTION. Please note that DCRI engineers are aware of the issue and are working to resolve.

Appendix D

Nursing Department Related Guidelines for Scheduled Downtime

All computer systems (CRIS, Clinical Information systems, internet, and intranet) within the CC Data Center will

experience intermittent downtime periods beginning Date @ : p.m. through Date @ : a.m.

Here are some tips to help you prepare for this planned outage.

Communication During Computer Downtime

Note: All manual documents and order forms need to include the patient’s name, medical record number,

date of birth, patient location, ordering prescriber’s name.

1. Prior to the system going down, the Page Operator will announce the actual time of unavailability, and will

also make an announcement when CRIS has returned back to functioning capacity.

2. All attempts should be made to enter information into CRIS prior to Date @ : p.m. including nursing

assessments and medication administration.

3. Please request physicians to enter new patient orders into CRIS prior to Date @ : p.m

4. All non-pharmacy communication will be conducted using the Pneumatic Tube Stations with a follow up

phone call to the appropriate department for STAT orders.

5. Messenger and Escort will make half hourly (or as designated) rounds to DLM to pick up and deliver lab

results to PCU’s.

6. Medical Record Documentation

ALL required forms will be on each PCU in a designated area (Downtime toolkit). The forms include but are not

limited to the following:

• Various Doctor’s Orders forms

o Orders Manual (NIH-2795)

o CRIS Downtime: Medication Orders (NIH-2900)

o Department of Laboratory Medicine Ordering Record forms (Chemistry NIH-2901, Hematology

NIH-2902 and Microbiology NIH-2903)

o Transfusion Medicine Ordering Record form (NIH-2906)

o Diagnostic Radiology Exams/Procedures (Ultrasound – CT) (NIH-2907)

o Radiology Exams/Procedures (MRI-Nuclear Medicine) (NIH- 2907-2)

o Radiology Exams/Procedures (Interventional Radiology) NIH-2907-3)

o TPN (NIH-2909)

• Documentation forms include but not limited to the following:

o Inpatient Progress Notes (NIH-509 or STANDARD FORM 509)

o Outpatient Progress Notes (NIH 532-1) for outpatients only

o Nursing Notes (Standard Form 510)

o Consultation Report (NIH-513-1)

o Vital Signs-Special Graph Sheet (NIH-526)

o Outpatient First Registration Progress Notes (NIH-532-11)

o PCA flowsheet (manual form NIH 2804)

• Instructions for Manual Input into Pyxis Medstation (not in downtime toolkit)

• Two (2) DLM Report Logs for recording lab results phoned to the PCU

o Clinical Chemistry Service Stat Report Log

o Hematology Service Stat Report Log

• DLM computer downtime forms can be found under DLM Website

http://intranet.cc.nih.gov/dlm/specimenguidelines/orderingtests.html

Instructions: Note all manual documents and order forms need to include the patient’s name, medical record

number, date of birth, patient location, and ordering prescriber’s name.

Wireless network downtime

1. ICU- The ICU will make the determination of when to plug in the Workstations on Wheels (WOWs) to

the network outside patient rooms. Network Cables are available in the ICU.

2. House-wide: If the wireless network is down for >1 hour please attempt to plug in WOWs to available

network. Network Cables should be stocked on your PCUs and if more needed, are available from the

Data Center 301-496-8400

MD Orders

1. After the computer system is shut down, all medical orders will need to be written on various Order forms

and signed and dated by the RN after they are read. Each set of written, verbal or telephone orders will

require a date/time the signature of the Licensed Independent Practitioner (LIP) and the location of the

patient. If transcription is needed, the registered nurse will need to date/time and sign his/her signature

at the bottom of the order set.

2. Each time an LIP writes a new medical order, a new order sheet must be used. The copies of the medical

orders are sent to multiple departments such as sending copies to pharmacy and nutrition.

3. All lab orders requested during the computer shut down will be transcribed onto the Department of

Laboratory Medicine Ordering Records or Transfusion Medicine Ordering Record by a prescriber or his/her

authorized agent. At the bottom of this form, the RN transcribing the order will note under the LIP name

whether this was a written, verbal, or telephone order.

4. Save all Medical Care Plans (MCP) and all Order forms after the MCP has printed.

5. Attach all order forms with the current MCP to facilitate entering orders into CRIS once the system has

returned.

6. When the CRIS system comes back up, check all written lab results with the printed copy to validate

accuracy.

Nursing Documentation

ring the down-time, use the Nursing Progress Report (Standard Form 510) for documenting patient

assessments, and complete information relative to medication administration. For example, be sure to include

the medication name, dose and number of tabs given so that this information can be transcribed into the CRIS

system once it becomes operational. The Patient Controlled Analgesia (PCA) Flowsheet (manual form NIH

2804) is used for downtime documentation.

Nursing Department Related Guidelines for Scheduled Downtime

Return of CRIS

1. When CRIS comes back up:

a. An LIP or authorized agent will enter all written, verbal, and telephone orders into CRIS, except lab

orders that were already sent to DLM and DTM during the downtime as they will be entered by these

departments.

b. A nurse will:

• Request a new MCP to validate the accuracy of all medical orders entered.

• File the original manual copy of all order forms in the unit chart under “MD Orders.”

• Document all nursing admission assessments, medications, blood products and PCA flowsheet

information into the CRIS. If CRIS is down for a short duration of time and the use of manual forms

has not been implemented, then assessments should be entered into the system when it comes

back up. Additionally, all information documented during downtime on the Patient Controlled

Analgesia (PCA) Flowsheet (manual form NIH 2804) for a currently infusing bag will be entered into

CRIS when it comes back up.

2. The oncoming nurse will be responsible for double-checking all medical orders written during the CRIS

downtime period. This process involves comparing for accuracy each manual medical order filed in the

chart against the current MCP. When completed, the nurse will initial, date and time the bottom of each

order set.

Clinical Information Systems Departments Impact with CRIS Downtime (pre, during and post down)

Pharmacy

1. The Omnicell Medstation is available during shut down.

2. Medication orders entered AND verified by Pharmacy PRIOR to the downtime will be accessible from the

Omnicell cabinet and Anesthesia Workstations.

3. Emergency medications may be removed using the override process at the Omnicell cabinet and

Anesthesia Workstations.

4. Any new orders or admissions will need to be manually entered (see attached instructions).

5. A record of patients manually entered into the Omnicell Medstation will be kept in the designated shut

down area. The record is to be sent to pharmacy when the system comes back up (see attached).

6. After CRIS comes back up, all written and verbal orders must be entered into CRIS by the unit RN or MD.

7. A RN cannot enter Chemo/TPN orders. Make sure you request physicians are requested to order

chemo/TPN before 12 Noon.

8. Pharmacy will call the patient care unit and speak with the charge nurse for any emergency results.

9. All written orders will be sent to the Pharmacy during the downtime. A follow-up call to Pharmacy will be

required to assure that pharmacy received STAT orders.

Nutrition

1. Any

transfers, new diet order, nutrition orders, food allergies, special nutrition requests and nutrition

consults or changes to orders will need to be sent via the Pneumatic Tube System to Nutrition Services on

the NIH Form 2960 utilizing the above guideline for MD orders. Diet office personnel are not authorized to

accept verbal orders.

2. All diet orders and transfers will be manually entered into the Nutrition Department Computer system

(CBORD) by Nutrition Department personnel using the information provide on NIH Form 2960.

3. After CRIS comes back up, all nutrition/diet orders must be entered into CRIS by the unit RN, MD or LIP.

Health and Information Management Department

1. All historical medical records can be located in CRIS Sundown or ChartView. For ChartView access contact

301-496-5981 during routine business hours or the CRIS Help Desk at 301-496-8400 after hours.

2. All required documentation forms will be on each unit at the in a designated

“Computer Downtime Area.”

3. The Administrative Coordinator on duty and the Health and Information Management Department will

have an extra supply of forms. Forms are also available electronically at

http://intranet.cc.nih.gov/medicalrecords/forms/forms-crisdowntime.html

4. Admissions will provide a temporary patient wristband with patient name, DOB an

d MRN for new

inpatient admissions, upon restoration of service a permanent wristband will be printed. During a

downtime, Outpatients will not be receiving wristbands. Outpatient areas should use verbal identification

with two approved identifiers (Name and Date of Birth).

Department of Laboratory Medicine (DLM)

1. Please attempt to have physicians put in all requests for labs prior to the system going down in an effort to

obtain a specimen label.

2. Any stat lab orders requested during the down will require you to send the lab specimen with the correct

Department of Laboratory Medicine Ordering Record (Chemistry-NIH-2901, Hematology- NIH-2902,

Microbiology- NIH-2903). No other form will be accepted. At the bottom of the order form under LIP

signature, identify either written or verbal order. Note: These Order forms needs to include the patient’s

name, medical record number, date of birth, patient location, allergies, ordering prescriber’s name and

protocol number.

3. Apply a patient label or Generic Patient Label (include the patient’s full name, medical record number,

patient care unit, date of birth and if available the order number) on the specimen prior to sending it to

the lab with form.

4. STAT lab results will be called to the unit by DLM. The unit RN will document the results on either the

Clinical Chemistry Service Stat Report Log or the Hematology Service Stat Report Log.

5. The Administrative coordinator on duty will have extra forms. DLM downtime forms can be found under

DLM Website http://intranet.cc.nih.gov/dlm/specimenguidelines/orderingtests.html

6. Notify Admissions should you need more patient labels.

7. Co

mmunications with DLM will be via telephone and pneumatic tube system.

8. For specimen pickup you will need to call Messenger and Escort

9. All lab orders will be entered by the DLM. You will need to assure and validate that the orders are entered

into the MCP when the system comes back up. Refer to Appendix B.

CHS

1. The Pyxis Supply Station may not b

e functioning during the downtime. Each unit has a key to the Pyxis

Supply Station. Please note where your key is located as this is your means to obtain supplies.

2. CHS may have someone in house Monday-Friday 6:00 am-8:00 pm, Weekend / Holidays 8:00 am-4:30pm.

Off Hours there is someone on call.

Imaging Sciences

The Radiology, Nuclear Medicine and PET Departments will be available for emergent test as the computer

downtime will not affect their imaging equipment.

Department of Transfusion Medicine (DTM)

1. Or

ders placed during the downtime will require a copy of the manual LIP order sent to the DTM on the

Transfusion Medicine Ordering Record form NIH-2906. At the bottom of the order form under LIP

signature, identify either written or verbal order.

2. Note: order form NIH-2906 needs to include the patient’s name, medical record number, date of birth,

patient location, allergies, ordering prescriber’s name and protocol number.

3. Apply a patient label or Generic Patient Label (include the patient’s full name, medical record number,

patient care unit, date of birth and if available the order number) on the specimen prior to sending it to

the lab with form NIH-2906.

4. Typenex labels will still be required for all Type and Screen and RBC orders.

5. The RN will be required to call DTM to ensure that orders for blood components are received

6. DTM will call the nursing unit when the blood product is ready for distribution. Blood may be distributed

via pneumatic tube system if it is functional and nurses will be expected to provide the patient’s full name,

MRN, Date of Birth, and the component requested prior to distribution.

7. Orders will be entered by DTM once the system is restored.

Department of Perioperative Medicine (DPM)

OR case requests submitted manually to the front desk of the OR for emergency cases during downtime

will be entered into POIS by the OR Scheduler when the system is restored. Any requests for future non-

emergency postings during the downtime will be kept on hold until the SISWEB system is available.

Nursing Department Related Guidelines For Scheduled Down

Adding a New Patient to Omnicell/ Pyxis

the event that a patient’s name does not appear on the Omnicell or Pyxis screen, the user will manually add

the patient’s full name and ID number to Omnicell or Pyxis cabinet.

Omnicell use

From the main Menu, select Patient Care.

If the patient you want is not listed:

a. Press the ADD NEW PATIENT button.

b. Enter the patient’s last name and first name.

c. Enter the patient’s medical record number in the ID field.

d. Press Add New Patient.

Pyxis use

f the patient you want is not listed:

a. Sign onto the console using your ID

b. Under patient care, press/ select the patient icon

c. Press “add patient” located at the bottom

d. A screen will pop up to enter patient information (i.e. name, Pt ID, nursing unit, discharge date, room

number and bed) then press OK to save information

Nursing Department Related Guidelines For Scheduled Down

“Qui

ck” Computer Shut Down Check List

Record of Patients manually added in Omnicell or Pyxis

Please print clearly in all documentation fields.

Please return this record to pharmacy when CRIS is in operation.

Date. Patient Name Unit Medical record No.

□ Identify Computer Shut Down Area in the nurse’s station

□ Assure that you have the required manual forms These forms are located on every patient care

area in the CRIS Downtime Toolkit.

For additional forms please contact Health Information Management Department (301-496-2292)

Monday- Friday 7:00 am- 5:00 pm or go online to the following URL:

http://intranet.cc.nih.gov/medicalrecords/forms/forms-crisdowntime.shtml

Note all manual documents and order forms need to include the patient’s name, medical record

number, date of birth, patient location, allergies, ordering prescriber’s name and protocol number.

□ Check med Omnicell for access during the shutdown (pharmacy for problems)

□ All LIP orders have a date, time and LIP signature and patient location

□ All LIP orders transcribed have RN signature, date and time

□ All lab specimens must be accompanied with the correct Department of Laboratory Medicine Ordering

Record form and/ or Transfusion Medicine Ordering Record form

□ W

hen the computer system comes up, the following are verified, double-checked and entered into

CRIS

□ All written/verbal LIP orders – except for DTM and DLM orders. Note: If a lab order was active in

CRIS prior to the down and DTM/ DLM entered the same lab order; please discontinue the original lab

order as not to have duplicate entry.

□ Meds, blood or blood products and admissions notes

□ All orders entered into CRIS are verified against a new MCP

□ All orders are double checked for accuracy by the night shift, initialed and dated

□ All data documented for the currently infusing PCA bag on the Patient Controlled Analgesia (PCA)

Flowsheet (form NIH 2804)

*** Please read computer shut down packet for details

Important Note: You will need to write the ordering protocol for each order on the manual order forms listed

below (e.g. For labs to DLM/ DTM send on the correct Department of Laboratory Medicine Ordering Record

form or Transfusion Medicine Ordering Record form). Refer to Downtime Toolkit for manual forms.

CRIS Downtime Processes – By Department

Department

How to Handle Routine Orders During

Downtime

How to

Handle STAT

Orders During

Downtime

How to Retrieve

Results

Who will

Enter Orders

into CRIS

post Go-Live

Admissions

301 496-3315

Patients are admitted to Clinical Center

using Request for

Admission/Travel/Voucher/Local

Transportation form (NIH- 54).

NOTE: The patient cannot be admitted

or registered (new outpatients). No

patient labels can be generated.

Admissions will place a temporary

wristband with hand-written patient

identifiers (name and DOB) for all

inpatient and outpatients.

Call

Admissions

Department.

N/A

Admission

staff will

enter

admission

orders and

patient

information

Blood

Bank/DTM

301-496-4506

Transfusion lab

496-8335

Tube copy of Downtime Order form (NIH

2906) to Blood Bank/DTM.

Even if SoftID.Tx is operational, still use

generic labels and apply to specimen

containers to accompany NIH 2906.

Tube copy of

Downtime

Order form

(NIH 2906) to

lab and follow

up with phone

call to

department.

N/A

Lab staff

Department

How to Handle Routine Orders During Downtime

How to Retrieve

Results

Who will

Enter Orders

into CRIS post

Go-Live

Laboratory

Chemistry 496-

3386

Hematology

496-4473

Microbiology

496-4433

Accessioning:

496-5971

Phlebotomy:49

6-5777

Process is the same for Routine and Stat Labs.

Use the various Department of Laboratory Medicine

Ordering Records / forms to identify labs needed. Make

sure to fill out mandatory information on all pages.

Forms are as follows:

1. Chemistry- NIH-2901 (4-11) – 4 carbon copy pages

2. Hematology- NIH-2902 (2-11) – 3 carbon copy pages

3. Microbiology- NIH-2903 (2-11) – 3 carbon copy

pages

Select labs required on the various forms and send to lab

accompanying the specimen through the tube system. If

available add order number to label.

Some tests may require using an additional form

“Information required for specific test” located at

http://intranet.cc.nih.gov/dlm/specimenguidelines/orde

ringtests.html

If SoftID is operational, still use generic labels and apply

to specimen containers to accompany the correct form

based on what is being ordered

Routine - Results

will be delivered

by messenger to

units on routine

rounds.

STAT – Unit will

be called with

result and the

hardcopy will be

delivered by

messenger.

Lab staff

Messenger

and Escort

Service (MES)

301-827-0553

Call orders to 301-496-0094

N/A

Department

How to Handle

Routine Orders

During Downtime

How to Handle

STAT Orders

During Downtime

How to Retrieve Results

Who will Enter

Orders into CRIS

post Go-Live

Nursing –

Medical

Order

Management

Routine orders will be

completed by LIP or

affiliate staff utilizing

NIH approved forms.

Refer to Manual

forms for downtime

http://intranet.cc.nih.

gov/medicalrecords/f

orms/forms-

crisdowntime.html

Note –Emergency or

verbal orders taken

by the RN will also be

documented utilizing

these forms. Copies

of all medical orders

will be filed in the

appropriate patients

chart.

Stat orders and

requests are

followed up with a

phone call to the

receiving

department to

confirm arrival of

the medical order.

Lab results will be delivered hourly

to each PCU by MES and placed in

designated area.

All reports are to be filed in the

patient’s chart immediately.

Critical and STAT results will be

called to the PCU when the LIP

cannot be reached.

LIP or affiliate staff

should enter all

written, verbal and

telephone orders

into CRIS except

Lab and Blood Bank

orders.

Nutrition

301-496-2390

301 496-0241

Tube copy of

downtime order form

(NIH- 2960) to

Nutrition Call Center

(tube station #444).

Tube copy of

Downtime Order

form (NIH- 2960)

to Nutrition Call

Center and follow

up with phone call

to department.

N/A

LIP or RN

Department

How to Handle Routine

Orders During

Downtime

How to Handle

STAT Orders

During Downtime

How to Retrieve Results

Who will Enter Orders

into CRIS post Go-Live

Pharmacy

Unit Dose

496-1914

IV Meds 496-

6551

• Send a copy of

Downtime Order

form (NIH-2900) by

messenger escort to

Pharmacy: include

patient name, MRN,

allergies and unit

location on form.

• Order Inpatient and

Take-home

medication on

separate order forms

(NIH-2900)

• Downtime TPN (NIH-

2909) order form that

will be available on all

units.

• For Medication

Replacement, make a

copy of the order

(whether it is from

your medical care

plan or on a manual

form) and send to

pharmacy.

Send copy of

Downtime Order

form (NIH-2900)

to Pharmacy and

follow up with

phone call to

department.

N/A

LIP or RN

Department

How to Handle

Routine Orders

During Downtime

How to Handle

STAT Orders

During Downtime

How to Retrieve Results

Who will Enter

Orders into CRIS

post Go-Live

Radiology

301-496-7700

Patient to bring a copy

of the correct

Radiology Downtime

Order form with them

from the inpatient

unit or clinic.

1. Diagnostic

Radiology

Exams/Procedure

s (Ultrasound –

CT)- NIH-2907 (2-

11)

2. Radiology

Exams/Procedure

s (MRI-Nuclear

Medicine)- NIH-

2907-2 (2-11)

3. Radiology

Exams/Procedure

s (Interventional

Radiology) NIH-

2907-3 (2-11)

Patient to bring a

copy of order form

to Radiology and

follow up with

phone call to

department.

Routine and STAT – Clinicians can

call the Radiology department or

physically go to the department to

retrieve results.

Radiology

Technologist, RN’s

& Radiologists

Department

How to Handle

Routine Orders

During Downtime

How to Handle STAT

Orders During

Downtime

How to Retrieve Results

Who will Enter

Orders into CRIS

post Go-Live

Respiratory

Therapy/

CCTRCS

301 496-0758

• Page Respiratory

Therapy (RT) via

the page operator

301-496-1211.

• Provide a copy of

Downtime Order

form (NIH-2795)

to the respiratory

therapist.

NOTE: For respiratory

medications pharmacy

will need to provide a

copy of order form to

therapist.

Page RT via page

operator STAT.

Provide a copy of

downtime order form

(NIH-2795) to

therapist.

Clinicians may page the

respiratory therapist

assigned to the individual

unit through the page

operator.

LIP or RT assigned to

the specific areas.

Patient Travel

Office

(Government

Arranged

Travel)

301-496-6676

Patients in need of

government arranged

travel.

• If ATV unavailable,

submit manual

form Request for

Admission/Travel/

Voucher/Local

Transportation

(NIH- 54) to either

the Travel office

or Admissions

depending on the

time of request

(business versus

non business

hours).

Deliver NIH- 54 form

to the Travel office

located at 10/1-4553

(during business

hours) or Admissions

(during non-business

hours)

N/A

Department

How to Handle Routine

Orders During Downtime

How to Handle STAT

Orders During

Downtime

How to Retrieve Results

Who will Enter

Orders into CRIS

post Go-Live

Voucher

Office

301 496-4530

Patients in need ofvoucher

for travel, meal or lodging.

• If ATV unavailable,

submit manual form

Request for

Admission/Travel/Vou

cher/Local

Transportation (NIH-

54) to either Voucher

office or Admissions

depending on the time

of request (business

versus non-business

hours).

Deliver NIH- 54 form

to the Voucher office

10/1SW-5612 (during

business hours) or

Admissions (during

non-business hours)

N/A

Department

Peioperative

Medicine

OR case request during

downtime will be

completed by LIP or

affiliate staff utilizing NIH

approved forms. Refer to

Manual forms for

downtime

http://intranet.cc.nih.gov/

medicalrecords/forms/for

ms-crisdowntime.html

SISWEB Downtime Case

Request Form (formerly

Operating Room Case

Request Form) NIH-2891

(8-15)

Any requests for future

non emergency postings

during the downtime will

be kept on hold until the

SISWEB system is

available.

Emergency OR case

requests and case

documentation will be

done on POIS Intraop

forms kept in the POIS

downtime box at DPM

front desk.

Contact Anesthesia

AOD on call via NIH

operator

OR case requests

submitted manually

to the front desk of

the OR for

emergency cases

during downtime

will be entered into

POIS by the OR

Scheduler when the

system is restored.

 Ord

ers need to be legibly signed on the Downtime MD Order Sheet, co-signed by the nurse, and include

the patient location and allergies.

 Put original Downtime Order on patient’s chart.

 Nursing Documentation Post Go-live: Document all nursing admission assessments, medications given,

and blood products administered into the CRIS.

Appendix E

Exam

ple of System Downtime Communication Process

This is to assist DCRI with maintaining communication during unscheduled downs. Please follow the plan

below:

If SCM interfaces are down:

Tony Barnes, Yenshei Liu or the on-call Interface Team member, Tim Maloney (DBA Team Member), and John

Kocher (NT Administrator on-call during evening, nights, holidays and weekends) must be called to coordinate.

They will call others as needed. An email is sent out to the CC-DCRI IE Prod Admin and CC CRIS DBA Support

Team DL

Call Jim Pitts and DCRI Executive Leader On-Call immediately.

1. Systems Monitoring to call the NIH Page Operator and have them make an overhead announcement that

the CRIS Interfaces are down. This announcement should repeat every 15 minutes for the first hour and

then every 30 minutes for the second hour and then hourly until the system is operational.

• Message: The CRIS Interfaces are down.

• Use message from Appendix J- CRIS Interface Downtime.

2. Systems Monitoring to send e-mail to CC Systems Notification and CC-ISD IE Notice DL identifying that the

interfaces are down as soon as interruption is determined. This gets the message to all other interfaced

groups (EKG, SoftMed, IDMS, POIS etc.).

3. Systems Monitoring to open conference line (reference Appendix J checklist)

• Send email that conference line is open to CC-DCRI Staff. For any CRIS, CRIS Interface, Printing,

and/ or Network Downs, please include CC-DCRI External CRIS Down Notifications DL when

opening conference line.

4. Systems Monitoring updates status screen.

5. For planned downs or assistance call DCRI Liaison Team (during regular working hours). If necessary,

Systems Monitoring can notify the CRIS Analyst On-Call (during evening, nights, holidays, and weekends)

with status.

6. Systems Monitoring sends e-mail to CC Systems Notification and CC-ISD IE Notice DL when operational.

7. Systems Monitoring to call the NIH Page Operator to make an overhead announcement that CRIS

interfaces are operational.

8. Systems Monitoring updates status screen all is operational.

If SCM interfaces are down for more than 2 hours notify: Jon McKeeby

If QDX interfaces are down:

Tony Barnes must be called to coordinate. Call Yenshei Liu or the on-call Interface Team member to check and

make sure when is operational.

Call Jim Pitts and DCRI Executive Leader On Call immediately.

1. Systems Monitoring to call the NIH Page Operator and have them make an overhead announcement that

the CRIS Interfaces are down. This announcement should repeat every 15 minutes for the first hour and

then every 30 minutes for the second hour and then hourly until the system is operational.

• Message: The CRIS Interfaces are down.

• Use message from Appendix J- CRIS Interface Downtime.

2. Systems Monitoring to send e-mail to CC Systems Notification and CC-ISD IE Notice DL, identifying that the

interfaces are down as soon as interruption determined. This gets the message to all other interfaced

groups (ATV, EKG, SoftMed, IDMS, POIS, etc.).

3. Systems Monitoring to open conference line (reference Appendix J checklist)

• Send email that conference line is open to CC-DCRI Staff. For any CRIS, CRIS Interface, Printing,

and/ or Network Downs, please include CC-DCRI External CRIS Down Notifications Distribution List

when opening conference line.

4. Systems Monitoring updates status screen- If necessary

5. For planned downs or assistance call DCRI Liaison Team (during regular working hours). If necessary,

Systems Monitoring can notify the CRIS Analyst On-Call (during evening, nights, holidays and weekends)

with status.

6. Systems Monitoring sends e-mail to CC Systems Notification and CC-ISD IE Notice DL when operational.

7. Systems Monitoring to call the NIH Page Operator to make an overhead announcement that CRIS

interfaces are operational.

8. Systems Monitoring updates status screen all is operational if necessary.

If QDX interfaces are down for more than 2 hours notify: Jon McKeeby.

If SCM is down:

Clinical DBA on call, John Kocher, Tony Barnes must be called to coordinate. They will provide details of others

to be contacted as needed. Call Jim Pitts and DCRI Executive Leader On Call immediately.

1. Systems Monitoring to call the NIH Page Operator and have them make an overhead announcement that

the CRIS system is down. This announcement should repeat every 15 minutes for the first hour and then

every 30 minutes for the second hour and then hourly until CRIS becomes operational.

a. Message: CRIS is down.

b. Use message from Appendix J- CRIS Downtime.

2. Systems Monitoring to send e-mail to CC Systems Notification and CC-ISD IE Notice DL identifying that the

CRIS is down as soon as interruption determined. This gets the message to all other interfaces (EKG,

SoftMed, IDMS, POIS, etc.).

3. Systems Monitoring to open conference line (reference Appendix J checklist)

a. Send email that conference line is open to CC-DCRI Staff. For any CRIS, CRIS Interface, Printing,

and/ or Network Downs, please include CC-DCRI External CRIS Down Notifications DL when

opening conference line.

4. ICU Staff to print ICU CDV report 1 hour prior for planned CRIS downtimes or

Systems Monitoring to print within 30 minutes of the CRIS being down if unplanned.

5. Systems Monitoring updates status screen.

6. For planned downs or assistance call DCRI Liaison Team Member (during regular working hours). If

necessary, Systems Monitoring can notify CRIS Analyst On-Call (during evening, nights, holidays, and

weekends) with status.

7. Systems Monitoring sends e-mail to CC Systems Notification and CC-ISD IE Notice DL when operational.

8. Systems Monitoring to call the NIH Page Operator to make an overhead announcement that CRIS is

operational.

9. Systems Monitoring updates status screen all is operational.

If SCM is down any period of time, notify: Jon McKeeby

If SCM Report Services, Label Printing, Order Generation Services or other SCM Functionality is down:

DBA On-Call, Tony Barnes and John Kocher (NT Administrator on-call during evening, nights, holidays and

weekends) must be called to coordinate. They will direct others to be called as needed.

1. Those involved in the problem will decide if Systems Monitoring needs to call the NIH Page Operator and

have them make an overhead announcement that the CRIS or certain functions of CRIS are down.

• Message: Needs to be individualized based on the type of down.

• If users call Systems Monitoring, the CRIS on-call analyst or CC Service Center: You can state that

there are CRIS Services down and we are working on a resolution.

2. Systems Monitoring to send e-mail to CC Systems Notification and CC-ISD IE Notice DL identifying that the

CRIS is down as soon as interruption determined.

3. Systems Monitoring to open conference line (reference Appendix J checklist) see templates if additional

users need to be included in conference line.

• Send email that conference line is open to CC-DCRI Staff. For any CRIS, CRIS Interface, Printing,

and/ or Network Downs, please include CC-DCRI External CRIS Down Notifications Distribution List

when opening conference line.

4. Systems Monitoring updates status screen.

5. Clinical Information Systems departments will be called if necessary

6. For planned downs or assistance call DCRI Liaison Team Member (during regular working hours). If

necessary, Systems Monitoring can notify CRIS Analyst On-Call (during evening, nights, holidays, and

weekends) with status.

7. If service has not resumed within 30 minutes, call Jim Pitts or DCRI Executive Leader On Call.

8. Systems Monitoring sends e-mail to CC Systems Notification and CC-ISD IE Notice DL when operational.

9. Systems Monitoring to call the NIH Page Operator to make an overhead announcement that all is

operational.

10. Systems Monitoring updates status screen all is operational.

If production or developmental CDR (Clinical Center) database goes down

Chris Klein, or Shi-Feng (Grace) Chen, or Murali Kumar, or Tony Barnes or Yenshei Liu must be called to

coordinate. They will direct others or to be called as needed.

1. No

tify Systems Monitoring (496-7525).

2. Turn off all threads with cdr in name and results from SoftMed.

3. Chris Klein must make sure server is operational.

4. Shi-Feng (Grace) Chen, or Murali Kumar must make sure when is operational.

5. Tony Barnes and Yenshei Liu need to make sure no data is lost before restarting. They may need to reload

data first. Tony or Yenshei should e-mail Murali if occurs in the middle of the night so he can check his

processes.

No need to call down.

Appendix F

System Descriptions, Impact During CRIS Downtimes, and Assigned Responsibilities

Legend:

Component Name

Name of System Component

Description

Description of the function that the system

component provides in respe

ct to the CRIS Core

system.

Firewall Location

Location of component in relation to the CC

Checkpoint Firewall (Escher). Behind mean that the

system component is protected from access by rules

on the firewall.

Impact On CRIS Core

The affect a down of the System Component on has

to the CRIS Core System.

Responsible Party

The persons whom should be notified when the

system component is down.

Component Name

Description

Firewall Location

When Component is Down

Impact On CRIS Core

Responsible Party

CC CRIS

Firewall

(Protects Clinical

Data)

Maintains

Security

N/A

No User Access to CRIS Core.

No printing from CRIS Core.

No Interface Transactions in or out of

CRIS Core: Orders, ADT, ATV, Results,

Statuses.

Richard Walker

Jason Chan

Tim Salo

CC Domain

Controllers

SCM MSQM

is installed

on the

Domain

Controllers

and is used

by the

interfaces to

send and

receive

messages

In front if CC CRIS

Firewall

No Interface Transactions in or out of

CRIS Core: Orders, ADT, ATV, Results,

Statuses.

Dempsey Dunn

Tony Barnes

CC Network

Firewall

Main CC

Network

N/A

No User Access to CRIS Core.

No printing from CRIS Core.

No Interface Transactions in or out of

CRIS Core: Orders, ADT, ATV, Results,

Statuses.

Jason Chan

Richard Walker

Tim Salo

CCSXAPCONSES

Enterprise

Behind CC CRIS

Firewall

No Administration Configuration changes

to SCM or Installation of New Clients.

Systems

Administration,

DBA On-Call

CCSCMPMUL

SCM

Multum

Server

Behind CC CRIS

Firewall

Loss of drug interaction checking for CRIS

Core users.

Systems

Administration,

DBA On-Call

CCSXAPCONSORD

SCM

CDS/Order

Generation

Behind CC CRIS

Firewall

Repeat orders will not get created for

CRIS Core orders.

Systems

Administration,

DBA On-Call

CCSXAPCONSES

SCM HL7

Executive

Behind CC CRIS

Firewall

No Interface Transactions in or out of

CRIS Core: Orders, ADT, Results, Statuses.

Systems

Administration,

Component Name

Description

Firewall Location

When Component is Down

Impact On CRIS Core

Responsible Party

DBA On-Call,

Tony Barnes

CCSXAPMASQL

Master

Active

Behind CC CRIS

Firewall

No Access To CRIS SCM or ATV

Systems

Administration,

DBA On-Call

CCXAPPRT1

SCM Print

Servers

Behind CC CRIS

Firewall

No printing from CRIS Core.

Systems

Administration,

DBA On-Call

CCXAPPRT2

SCM Print

Servers

Behind CC CRIS

Firewall

No printing from CRIS Core.

Systems

Administration,

DBA On-Call

CCSXAPCONSRPT

SCM Report

Behind CC CRIS

Firewall

No Printing of Reports.

Systems

Administration,

DBA On-Call

CITRIX

Client

access for

CRIS

N/A

No User Access via CITRIX.

Todd Myrick

Brad Snakenberg

CRIS-SAN

SCM

Storage

Behind CC CRIS

Firewall

No patient data available from CRIS Core.

All CRIS Core System Functions and ATV

may be affected.

Systems

Administration On-

Call,

DBA On-Call

Interface

Engine

Server

Behind CC CRIS

Firewall

No Interface Transactions in or out of

CRIS Core: Orders, ADT, ATV, Results,

Statuses.

Interface Team On-

Call, Yenshei Liu or

Tony Barnes

QDX

Interface

Engine

Application

Behind CC CRIS

Firewall

No Interface Transactions in or out of

CRIS Core: Orders, ADT to Clinical

Information Systems, ATV, Results,

Statuses.

Interface Team On-

Call, Yenshei Liu or

Tony Barnes

Monet

Domain

Name

Server used

within CC

In front if CC CRIS

Firewall

No ADT User Access to CRIS for users

using Monet as name server: Majority

ADT users.

Tadele Yenegeta

Chris Klein

SMM

Sunrise

Medication

Manager

N/A

Not able to perform SMM services

Pharmacy orders entered in CRIS would

queue up.

No order verification.

Tina Patel

DBA On-Call,

Pharmacy Contact

Thin Clients and

Server

Client

access for

CRIS

N/A

No CRIS Core User Access via Thin Client.

Possible thru CITRIX.

Citrix team on call

CRIS Sundown

View / Print

only

Behind CC CRIS

Firewall

No CRIS Core impact

CRIS DBA On- Call

Wireless Network

NIH Main

Network

N/A

WOWs and PDA will not work

CIT

Jason Chan

Richard Walker

Tim Salo

Component Name

Description

Firewall Location

When Component is Down

Impact On CRIS Core

Responsible Party

VPN Wireless down

NIH

Wireless

Network

N/A

Wireless down- WOWs and PDA will not

work

Remote access unavailable

CIT

Jason Chan

Richard Walker

Tim Salo

Appendix G

Clinical Information System Descriptions, Impact During CRIS Downtimes, and Assigned Responsibilities

egend:

Clinical Information System

Name of System Component

Description

Description of function that the Clinical Information System

provides.

Impact When CRIS Core is Down

The affect to the Clinical Information System when CRIS Core

is down.

Responsible Party

The persons whom should be notified when the Clinical

Information system is down.

Clinical

Information

System

Description

Impact When CRIS Core is Down

Responsible Party

ATV

Admission Travel

Voucher System

Lists of values (e.g. Attending Physician, Primary

Physician, or Protocols) and Patient Demographics may

not be up to date with information from CRIS Core. If the

CRIS database server is down ATV is down.

Frank Mickey

Tony Barnes

CRIS DBA On-Call

Barcode

(SoftID)

Barcode system

Orders are not sent from CRIS. ADT transactions are not

sent from CRIS to LIS (SoftID).

Interface Team On-

Call, Yenshei Liu or

Tony Barnes

BD Cato (BD IV

Prep)

IV Workflow System

ADT transactions are not sent from CRIS.

Verified IV orders are not sent from SMM

Tina Patel

Interface Team On

Call

Pharmacy AOD

CBORD

Nutrition System

Allergies and Orders are not sent from CRIS to CBORD.

Admission, discharge and transfer (ADT) transactions are

not sent from CRIS to CBORD.

Sys Admin On-Call,

Interface Team On-

Call

CDW

Clinical Data

Warehouse –

databases common,

cllab, cdr_new

Orders from CRIS and results from Clinical Information

Systems are not loaded into CDR.

ADT transactions from CRIS are not loaded into CDR.

Tadele Yenegeta

Chris Klein

Murali Kumar

CRIS Core

Order Entry

Documentation and

Retrieval system

ADT transactions from SCM are not sent to Clinical

Information systems.

Orders from CRIS are not sent to other Clinical

formation Systems.

Results from other Clinical Information Systems are not

displayed in CRIS.

CRIS DBA On-Call

Interface Team On-

Call

Dictaphone

Transcription System

Barrett Grieb

Michelle Hendery

EKG

EKG System

Orders are not sent from CRIS and results are not sent to

CRIS.

Interface Team On-

Call

IDMS

Investigational Drug

Management

System

Orders are not sent from CRIS.

Tina Patel

Interface Team On-

Call

Murali Kumar

Pharmacy AOD

LIS (Micro, Lab,

Laboratory

Orders are not sent from CRIS and results are not sent to

Earle Barnes

Clinical

Information

System

Description

Impact When CRIS Core is Down

Responsible Party

Blood Bank,

Anatomic

Pathology)

Information System

CRIS.

ADT transactions are not sent from CRIS to LIS.

Tony Barnes

Chung-Hee Row

Boyd Conley

Omnicell

Pharmacy

Dispensing System

ADT transactions are not sent from CRIS.

Verified medication orders are not sent from SMM.

Tina Patel

Interface Team On

Call

Pharmacy AOD

Suzanne Castine

Rilwan Badamas

POIS and SISWEB

Perioperative

Information System

(POIS)

ADT transactions are not sent from CRIS.

Barrett Grieb

Norma Street

Tad Yenegeta

Murali Kumar

Julia Labovsky

Interface Team On

Call

PYXIS

Hospital supply

Dispensing System

ADT transactions are not sent from CRIS.

Interface Team On

Call

RIS

Radiology

Information System

Orders are not sent from CRIS and results are not sent to

CRIS.

ADT transactions are not sent from CRIS.

David Sanford

CRIS DBA On Call

ScriptPro

Outpatient

Pharmacy System

Orders are not sent from CRIS and dispenses are not

received by CRIS. ADT transactions are not sent from

CRIS.

Tina Patel

Interface Team On

Call

Pharmacy AOD

Suzanne Castine

Rilwan Badamas

Transcription System

Orders are not sent from CRIS and results are not sent to

CRIS.

ADT transactions are not sent from CRIS.

Tracy Jacobs,

Michelle Hendery,

Barrett Grieb

Enterprise

Scheduling

Appointment

Enterprise Scheduling will be down as it is part of CRIS

CRIS DBA On-Call

Seth Carlson

Appendix H

Types of Labels

Appendix I

Example of Downtime Templates

Figur

e I.1. CRIS Downtime Flyer – Extended (i.e. CU Updates/Upgrades)

Upcoming: 5 HOUR CRIS DOWNTIME (example)

DATE:

TIME:

PURPOSE: CRIS Cumulative Updates

Details: Beginning DATE at TIME (approximately 5 hours), The Department of Clinical Research Informatics

(DCRI) will be doing a CRIS Update.

During the service disruption, the Clinical Research Information System (CRIS) will be UNAVAILBALE. Please

prepare to use downtime procedure during the downtime period.

WHO IS AFFECTED: All CRIS users

WHAT IS IMPACTED: Access to CRIS

CRIS USERS: Starting on DATE at TIME, you will need to log off CRIS.

- Please use CRIS Downtime Procedure.

- The downtime policy can be found on the CRIS website at

http://cris.cc.nih.gov/procedures/pdf/Backup_Process_Unavailable_CIS.pdf

- Please refer to your department’s downtime policy for specific instruction.

- *NURSING: See attachment for unit posting

- P

OIS and SISWEB will NOT be operational for requesting emergency surgical procedures, please use NIH-

2891 manual form. OR case request during downtime will be completed by LIP or affiliate staff utilizing NIH

approved forms. Refer to Manual forms for downtime

http://intranet.cc.nih.gov/medicalrecords/forms/forms-crisdowntime.html

- SISWEB Downtime Case Request Form (formerly Operating Room Case Request Form) NIH-2891. A

requests for future non emergency postings during the downtime will be kept on hold until the SISWEB

system is available.

- Appointment Scheduling: You will not be able to enter, status, or view patient appointments or print

scheduling reports (Appointment Roster by Location, Patient Itinerary, Unstatused Visit Report by

Location).

What you can do to prepare for implementation:

- Restock your downtime toolkits.

- Prepare your area with the necessary manual downtime forms. Electronic versions of these forms can be

found at the following, but please DO NOT PRINT out forms that come in carbon copies.

URL: http://intranet.cc.nih.gov/medicalrecords/forms/forms-crisdowntime.shtml

. Instead please contact

the Health Information Management Department at 301-496-2292.

- Have adequate supply of Patient Labels.

DCRI plans to provide CRIS Sundown approximately at 7:00 PM. CRIS Sundown is a copy of the current CRIS

Sunrise with view only and printing capabilities. Data entered in CRIS prior to 5:00 PM can be viewed by

selecting the CRIS Sundown icon via Citrix (https://cccasper.cc.nih.gov

You will be informed when the CRIS Sundown application is made available.

For more information about CRIS Sundown, see below.

at you can do when CRIS Sundown is available:

You can view and print CRIS data/ information ONLY that was entered in CRIS approximately up to 1 hour prior

to the scheduled downtime.

- For more information about CRIS Sundown please refer to the resource handout found

at http://cris.cc.nih.gov/cristraining/documents/CRIS_Sundown_FAQ.pdf

at you can do when CRIS Sunrise is available:

- Follow the downtime procedure concerning orders and clinical documentation re-entry into CRIS.

What to do if you get a Blank Content “White” Screen when logging into CRIS:

- Please see attached “Gateway White Screen” document.

For assistance during or post the CRIS Downtime call (301) 496-8400

Thank you for your support,

The Department of Clinical Research Informatics

Example of Downtime Templates (i.e. Flyer)

CRIS DOWNTIME

When:

Time:

Why: CRIS Updates/Upgrade

Below are guidelines to make this XX-hour downtime a smooth

process for you and your patients. Remember that you cannot enter

orders or documens when the system is down. Also, please do NOT

log on until notified. If you have any questions, please consult with

your nurse manager and/or supervisor.

Downtime References:

https://cris.cc.nih.gov/procedures/downtime.html

: Downtime

Processes for Unavailability of Electronic Clinical Systems,

Preparing for the Scheduled Down

Downtime Toolkits should be restocked in advance. Since most

downtime forms are completed in duplicate and triplicate, it is

essential these are NO T photocopied. Manual ordering and

documentation forms can be accessed online at:

http://intranet.cc.nih.gov/medicalrecords/forms/forms-

crisdowntime.shtml. Forms that don’t use carbon paper can be

photocopied.

. Forms that don’t use carbon paper can be photocopied.

Orders Management:

• Anticipate and coordinate with LIPs to enter all orders (i.e., take-

home meds, med orders, and routine lab work) prior to

downtime.

WOWs:

• Inpatient Units: place all cleaned WOWs outside patient’s room

prior to TIME. Keep WOWs plugged in and turned on.

• Outpatient Areas: Prior to close of business day DATE. Place all

cleaned WOWs outside of offices in a central location. Keep

WOWs plugged in and turned on throughout the weekend.

CRIS Printouts & Printers:

• Check that you have sufficient paper and toner supplies for

printers.

• Print a supply of Patient Labels for each current patient.

• You will need to print out reports is necessary (Medical Care Plan,

Nursing Worksheet, Meds Due List, Specimen Collection List)

• Validate accuracy of printouts against your current Medical Care

Plan; copy each set for the other shifts to use while CRIS is down.

Retain all copies to support documentation in the post-recovery

period.

CRIS Sundown:

• Will be made available approximately at TIME providing a view-

only image. CRIS data entered before TIME DATE can be viewed

and printed in Citrix by selecting the CRIS Sundown icon.

POIS and SISWEB:

• POIS and SISWEB will not be operational. For requesting

emergency surgical procedures, use NIH-2891 manual form. OR

case request during downtime will be completed by LIP or affiliate

General Guidelines

Manual Ordering and Documentation Processes are used during

all downs.

Patient Labels should include your patient’s room number, LIP’s

name, and protocol number. If you apply a Patient Label to

downtime forms, be sure to label all carbon copies.

Downtime Order Forms

• When using downtime forms, confirm that the original and all

carbon copies

are legible and filled out completely. Review

Downt im e Order Form Guidelines

• For accurate order processing, all downtime forms must include

patient’s name, date of birth, protocol number, and room

number. Orders must be

dated, timed, and signed, and all

signatures must be accompanied by a printed name.

• Original copies are filed in the patient’s chart and carbon copies

are sent to appropriate departments. No new orders should be

added to processed forms.

• STAT orders should be followed up with a phone call to

the receiving

department to confirm receipt of the

medical order.

Pharmacy Orders:

• Drug Orders and Drug Allergies are sent to Inpatient or Outpatient

Pharmacy via messenger escort.

• Requests for a medication replacement is made by copying the

Medical

Care Plan or Medication Orders form, circling the drug

needed, and indicating

the number of doses required and the

priority status. This should be delivered to pharmacy by

messenger escort.

Nutrition Orders:

• Orders for new or updated diets, NPO status, food allergies,

consults, and patient location changes are recorded on the Orders

Manual form (NIH-2960) and tubed to the Nutrition Department

(#444).

• Food Allergies are tubed to the Nutrition Department.

Messenger Escort Services (MES):

• For patient transport requests, please call MES downtime phone

number at 301-496-0094.

Laboratory Medicine:

• There are 3 distinct lab ordering records for chemistry,

hematology, and microbiology. Please use the appropriate

ordering record to request lab tests.

• Messenger & Escort Services (MES) will pick-up clinical

specimens on their hourly rounds but if possible and

appropriate, please deliver by Pneumatic Tube System.

• Lab Results will be delivered every 30 minutes by MES and

dropped into the PCU’s yellow bins. Please file lab results in

your patient’s chart immediately. Call DLM only if you do not

receive lab results within 2 hours or within 1 hour for stats.

• Critical Test results and STAT results will be called to the PCU

when the LIP

cannot be reached. Record results on the DLM

Report Logs. When you have

handed-off results to the LIP,

please document this hand-off in a Progress

Note.

staff utilizing NIH approved forms. Refer to Manual forms for

downtime

http://intranet.cc.nih.gov/medicalrecords/forms/forms-

crisdowntime.shtml

• SISWEB Downtime Case Request Form NIH-2891. Any requests

for future non-emergency postings during the downtime will be

kept on hold until the SISWEB system is available,

Other Applications/Clinical Systems:

• CBORD, Citrix, ECG, IDMS, LIS, Omnicell, OPUS-

RT, PACS, PYXIS, RIS

Dictation/Transcription, etc. will operational but

results will not cross over to CRIS during the downtime. ChartView

be available in Citrix.

General Guidelines (continued)

Critical Test results and STAT results will be called to the PCU when

the LIP

cannot be reached. Record results on the DLM Report logs.

When you have

handed-off results to the LIP, please document this

hand-off in a Progress

Note.

Transfusion Medicine

• Use a Transfusion Medicine Ordering Record to request a type

&screen and to order blood components.

• Please obtain a written infusion order specifying date/time &

infusion rate.

• When requesting delivery of blood components, provide your

patient’s first & last name, DOB, MRN, and requested component

type. DTM will call your PCU

when it is ready. If specimen collection

or transfusion orders display in SoftID/SoftID.TX, you can use the

system as usual; if not displaying, use downtime procedures.

Inpatient Progress Note is used to document all

patient care

activities including assessments,

interventions, given medications

(i.e., drug name,

dose, route, frequency, and time of

administration),

and transfusions.

Medical Care Plan - Please track order changes on the Medical

Care Plan and use all forms to

communicate updates when care is

handed off to

the next care provider. Retain all copies of the

Medical Care plan so they can be used when CRIS has returned

and orders are reconciled.

Admissions Process when CRIS is Down

Please no

te that patients admitted to the CC during this

scheduled down cannot be

admitted into CRIS. This has an

impact on general

admission procedures, when patients can be

registered in CRIS, and how medical orders should be handled

once CRIS is available. ATV will not be operational, use NIH-54

form.

n Admission to the Clinical Center, Admissions

staff will

facilitate the review and signing of all

admission consent

documents with your patient prior to sending them to your PCU.

• If your patient is new to the Clinical Center, a

medical

record will not be sent immediately. Existing patient’s

information can be found in ChartView via Citrix.

• Your patient will arrive with a hand-written ID band.

Carefully validate the accuracy of the

handwritten

information (first/last name, DOB,

and MRN) with your

patient when they arrive.

• Your patient will arrive without Patient Labels and the usual

Transfusion Medicine:

• Use a Transfusion Medicine Ordering Record to request a type

& screen and to order blood components. Please obtain a

written infusion order specifying date/time & infusion rate.

• When requesting delivery of blood components, provide your

patient’s first & last name, DOB, MRN, and requested

component type. DTM will call your PCU when it is ready.

• If specimen collection or transfusion orders display in SoftID

/SoftID.TX, you can use the system as usual; if not displaying,

use downtime procedures.

Page 1

en CRIS Becomes Available

The Page Operator will announce when CRIS is available. Please

take

the following actions in collaboration with LIPs:

Entering Medical Orders in CRIS

• DLM and DTM staff will enter all lab and blood component

orders that arrived in the labs with an appropriate ordering

record. This action will cause LIS labels to print on some PCUs.

Please discard these labels if specimens were collected during

the down.

• LIPs or RNs should enter all other written, verbal, and

telephone

orders into CRIS, i.e., allergies, medications, blood

product infusion,

nutrition, radiology, etc.

• If your patient was admitted during the downtime, you can

enter the

medical orders in CRIS once the patient displays on

your PCU’s patient list. If your admitted patient does not

appear on the PCU

patient list, the visit status has not yet been

updated in CRIS.

• The original copies of all medical order forms are filed in the

unit chart under “MD Orders.”

• Nursing staff who work the shift following CRIS availability should

confirm that all manually handwritten orders were accurately

entered in CRIS. When completed, the nurse reviewer should

record their initials and date/time at the bottom of each order

sheet.

Specimen Labels, Serum Drug Levels, and Lab Results

• To avoid redrawing specimens that were collected during the

downtime, please carefully review any specimen orders that print

and/

or display in SoftID after CRIS is available. Discard all

duplicate

labels.

• If Serum Drug Levels were drawn during the downtime,

please

complete the required documentation on the

Worklist.

• Please keep the

manual copy of all lab results in the unit chart

until the results post in CRIS.

Clinical Care Documentation and Signature Manager

• The following nursing notes: Admission Assessments, Allergy

Assessments, Transfused Blood Components, and administered

medications are to be entered into CRIS once it is available.

• The Charge Nurse is responsible for facilitating

documentation of administered medications in CRIS using

Admission forms.

Admissions Process is completed when CRIS is recovered. The

Admissions staff will register your patient in CRIS and will notify

you by phone when registration in CRIS is completed. Until the

registration process is completed in CRIS, your patient will not

appear on your PCU list or OP Clinic. Once registration is

completed, the Admissions

Record, General Admission Consent,

Patient Labels,

ID Band, and the medical record (for new patients)

will be sent directly to your PCU or clinic.

Entering Orders - Until your newly admitted patient is listed in

CRIS on your PCU or OP Clinic you should not enter or release

CRIS medical orders. Orders entered while the patient is in an

incorrect visit status will auto-complete when the registration

process is completed. If STAT or Priority medical

orders need to

be implemented, please follow downtime procedures until your

patient displays in CRIS.

information written in the

Progress Notes. Clinical

documentation is recorded “on behalf of another.”

• If someone has entered clinical documentation on your behalf

or, signed a medication “Marked as Done by Other”, please

review this documentation and co-sign it using <Signature

Manager> when you next return to work. Here’s how . . .

• When you log into CRIS, a Signature Manager window

opens and lists all the documents entered or medications

signed on your behalf.

• Review these documents and/or medications to validate

their accuracy and make edits as needed.

• Select the <SIGN> button at the bottom right

• Select <Okay> to apply your electronic signature.

**CRIS Support Staff will be in-house to assist users when the system

is down as well as when it becomes operational**

Page 2

Example of Downtime Templates

Figure I.1a. CRIS Downtime Flyer (< 90 minutes)

CRIS Downtime- 60 minutes

Date:

Time:

Purpose: CRIS Maintenance

Event Details:

Tonight, xxxxxxxxxxxxxxx beginning at 8:00 pm for approximately 60 minutes, the CRIS system will be

unavailable for use. Please begin using Downtime (manual) procedures. You will not have access to the CRIS

system.

Impacted Services/Applications: Access to CRIS.

Impacted Users: All CRIS system users.

Expected Resolution:

Additional Information:

• Please begin using Downtime (manual) procedures at 8:00pm.

• You will not have access to CRIS.

• You can NOT enter orders, document, print or retrieve information.

• You cannot admit, transfer or discharge a patient in CRIS until it becomes operational.

• Important Note: SOFTID Transfusion Verification will not be available

o Since CRIS is unavailable, transfusions are documented in a Progress Note according to Nursing

Procedures and Standards of Practice: Blood Product Administration -Appendix F: Downtime

Procedure found at

http://intranet.cc.nih.gov/nursing/practicedocs/procedures_pdf/PRO_Blood_Products_Admin

_App_E.pdf

o Typenex expiration date can be confirmed by calling DTM.

o The Patient Transfusion Record will accompany the product when it is issued to the patient care

area.

• Systems such as: CBORD, CITRIX, ECG, IDMS, LIS, Omnicell, PACS, PYXIS, RIS, Scriptpro, Dictation/

Transcription, & more will be operational but results will not cross over to CRIS. ATV is not operational, use

NIH-54 manual form.

• POIS and SISWEB will NOT be operational for requesting emergency surgical procedures, please use NIH-

2891 manual form. OR case request during downtime will be completed by LIP or affiliate staff utilizing

NIH approved forms. Refer to Manual forms for downtime

http://intranet.cc.nih.gov/medicalrecords/forms/forms-crisdowntime.shtml

• SI

SWEB Downtime Case Request Form (formerly Operating Room Case Request Form) NIH-2891. Any

requests for future non emergency postings during the downtime will be kept on hold until the SISWEB

system is available.

• Omnicell and PYXIS will be functional but ADT information will not be updated. Please admit by hand per

manual procedure. Medication orders manually placed or discontinued during the Downtime will not be

updated at the Omnicell cabinet and Anesthesia Workstations. Medication orders entered and verified by

Pharmacy prior to the Downtime will be accessible from the cabinet. Emergency medications may be

removed using the override process at the cabinet.

• Please do not send non-emergent orders on the manual ordering forms during the Downtime period.

• Please wait and enter non-emergent orders in CRIS after CRIS becomes operational.

• You will need to call Departments to communicate the orders and obtain service.

• For Messenger and Escort, you will need to call all transport requests to the Messenger and Escort’s CRIS

Downtime phone line (301) 496-0094.

Emergent Lab Order, Please Follow This Procedure:

1. Send the specimen to the lab with the appropriate completed (Patient Identifiers, Location, Phone

Number, Protocol Number, Tests Requested, LIP Name and Signature) manual Department of Laboratory

Medicine Ordering Record form or Transfusion Medicine Ordering Record form.

2. Do not enter Emergency Orders into CRIS. The Lab will enter the orders on their end.

3. Do not redraw specimens for orders entered during the down.

4. Keep a written record of the results called back to the unit.

All Other Emergent Orders Follow the Defined Manual Ordering Process by Service (Pharmacy, Imaging

Services, Transfusion Medicine, Respiratory Care, Nutrition and All Other Clinical Services)

During the downtime, please use manual ordering and/ or documentation forms.

Thank you for your support,

The Department of Clinical Research Informatics

(301) 496-8400

Figure I.1b. CRIS Intermittent Service Interruptions Flyer

CRIS - Intermittent Service Interruptions

Date:

Time:

Purpose: CRIS Maintenance

Event Details:

On __________starting at ______ until approximately ______, users may experience intermittent service

interruptions if using the CRIS system (Orders, Printing, Interfaces).

DCRI Engineers will be applying Microsoft updates to address security vulnerabilities.

**This is NOT a CRIS down; CRIS will be available**

Impacted Services/Applications: CRIS system (Orders, Printing, Interfaces).

Impacted Users: All CRIS system users.

Expected Completion:

Thank you for your support, The Department of Clinical Research Informatics

(301) 496-8400

Exa

mple of Downtime Flyers / List of Manual Forms to Use for Documentation

Figure I.2. LIS Downtime Information

Laboratory Information System (LIS) Downtime – 1 Hour

Date:

Time:

Purpose: LIS Upgrade

Event Details:

CRIS will be operational during this time, however Laboratory Information System (LIS) results will not cross

over to CRIS. Enter all desired lab orders in advance if possible to prepare for the downtime.

Orders entered in CRIS during the LIS downtime will not cross to LIS until LIS becomes active and LIS results will

not cross over to CRIS.

SoftID /SoftIDTx will NOT be available.

Impacted Services/Applications:

LIS

Impacted Users:

All users of the service listed above.

nformation during the LIS Downtime:

• During the downtime, Department of Laboratory Medicine (DLM) will call the nursing units with STAT

and Critical results. Keep a written record of the results called back to the unit.

• A hard copy of downtime results will be delivered to PCU every 30 minutes via Messenger & Escort

• All samples with or without the barcode label should be accompanied by the DLM Ordering record that

must be completely filled out (when LIS is down, DLM staff does not know what to run on samples).

• Please call the DLM, the Department of Transfusion Medicine (DTM) and the Laboratory of Anatomic

Pathology to communicate orders and obtain service during the downtime.

• Once LIS is back up, SoftID for specimen collection and blood product transfusion will be active. If you

have issues, trouble shoot with your superuser, if still not resolved call DCRI help desk at 301-496-

8400 to obtain contact with Barcode team.

Expected Completion of upgrade:

Thank you for your support,

The Department of Laboratory Medicine and

The Department of Clinical Research Informatics

(301) 496-8400

Another Example:

Event Details:

This is a Laboratory Information System (LIS) and SoftID Downtime; CRIS will be operational during this time.

Please call the Department of Laboratory Medicine (DLM), the Department of Transfusion Medicine (DTM) and

the Laboratory of Anatomic Pathology to communicate orders and obtain service. Please enter all desired lab

orders for <date> in advance if possible to prepare for this downtime.

Important Note: Lab specimens must be accompanied by the appropriate manual ordering record. Please

complete manual record with Patient Identifiers, Patient Location, Phone Number, Tests Requested, LIP

Name, CRIS order number.

Impacted Services/Applications:

The Laboratory Information System (LIS) & SoftID

Impacted Users:

All users of the service listed above.

Expected Completion of upgrade:

nformation during the LIS Downtime:

• Send the specimen to the lab with the appropriate manual Department of Laboratory Medicine

Ordering Record form or Transfusion Medicine Ordering Record form.

• Specimen Labels may or may not print out. Use patient labels.

• Please verify all labs are collected based on available information (medical care plan, lab form etc.).

• Lab results will not cross over to CRIS until the LIS system is operational.

• You CAN enter orders in CRIS, document and retrieve information, and print during the downtime;

however, LAB orders entered will not cross over to the Laboratory Information System (LIS) which

includes the following: Micro, Lab, Blood Bank, and Anatomic Pathology. The orders will cross to the

LIS and results will queue up into CRIS once the downtime is complete.

• During the downtime, DLM and DTM will call the nursing units with STAT results. Keep a written record

of the results called back to the unit.

• Messenger and Escort will deliver downtime results every 30 minutes to appropriate PCU. Please file

Lab results to central result bin.

SoftID

SoftID labels can be used from to with the accompanying manual order form. After <time>, use only the

manual order form as per downtime procedures

Transfusion Verification/SoftID.Tx

Transfusion verification may be done in SoftID.Tx up until <time>, after <time>, use downtime procedures,

including verification of blood products with second nurse

SoftID/SoftID.Tx –Go live when LIS downtime is completed at <time> on <date>:

Once LIS is back up, SoftID for specimen collection and SoftID.Tx for blood product transfusion will be active,

please begin to use the new system. If you have issues, trouble shoot with your superuser, if still not resolved

call DCRI help desk at 301-496-8400 to obtain contact with Barcode team. The arcode Team from Nursing and

Phlebotomy will make rounds on the units.

Example flyer: Department of Laboratory Medicine Downtime Process for Nursing

Projected Downtime: Date @ : _.m – Date @ : _.m. (insert date)

Prior to Downtime:

1. Please have all routine orders for labs in CRIS prior to the system downtime.

2. Have adequate supply of patient labels and the following forms on the unit and in the downtime

Tool kit:

 Department of Laboratory Medicine Ordering Records (Chemistry, Hematology, Microbiology)

 Transfusion Medicine Ordering Record

 “Information Required for Specific Tests” (dose and draw time for drugs, etc)

 STAT Report Logs for Chemistry (1 form for serum/CSF, and 1 for whole blood) and 1 form for Hematology”

to record STAT lab results and critical lab values called to PCU during computer downtimes.

3. Review the purpose of these forms and their location with the staff.

4. The Nursing Administrative Coordinator will have additional copies of these Forms.

CRIS Downtime:

ORDERS:

1. Limit manual lab orders during downtime.

2. Complete Department of Laboratory Medicine Ordering Records for lab tests required during downtime:

 Use a separate order form per patient for each DLM Service (Chemistry, Hematology, and

Microbiology).

 Use a separate form for Transfusion Medicine tests

 Important reminder…

Print PHYSICIAN name, enter PCU location, and Protocol Number

DLM must have this information to enter CRIS orders after downtime is over.

3. Send the “Information Required for Specific Tests” if tests require specific information in order to be

processed (e.g. drug levels and 24 hour urines)

4. Label specimens with patient label (barcode labels will not be available)

5. Write PCU location on the label.

Manual RESULTS:

1. DLM will call STATS and Critical Value lab results to the PCU. Record these results on the form “STAT

Report Log for Chemistry and Hematology” to record the lab results called.

2. Test reports will be sent to each PCU for STAT, Priority and Routine orders via Messenger Escort every 30

minutes. All results called to the unit should be recorded on the STAT logs and filed in the front of the

patient’s chart for easy access/retrieval during the downtime.

Important reminder -please do not call the lab for results during the downtime. During the downtime, it

is difficult to retrieve results in the lab when working in the manual mode.

3. DTM will call the PCU when blood is ready for pick up and will continue to tube blood. Please be

prepared to state patient’s complete name, MRN, Date of Birth, and component type requested when

initiating request for blood delivery.

ample flyer: Department of Laboratory Medicine Downtime Process for Nursing

Projected Downtime: Date @ : _.m – Date @ : _.m. (insert date)

CRIS Up:

1. DLM will enter all lab orders that arrive in the labs on the various Department of Laboratory Medicine Ordering

Records (Chemistry, Hematology, and Microbiology) during the downtime period.

Specimen labels for these orders will then print out in the labs.

2. DTM will enter all lab orders that arrive in the labs with a Transfusion Medicine Ordering Record during the

downtime period. Specimen labels for these orders will then print out in the labs.

3. Collaborate with your peers to see what samples were drawn during the downtime and discard the duplicate labels

that may have printed on the units when CRIS is brought up.

Do not redraw specimens that were drawn during the downtime.

4. Lab results from manual orders placed during downtime will not be available in CRIS until

Date @ : a.m. Keep the paper file of lab results on the PCU until all lab results are in CRIS. DLM expects that all

Lab results from downtime will be in CRIS by

Date @ : a.m

Example of Downtime Flyers / List of Manual Forms to Use for Documentation

Figure I.3. Network Downtime:

CC Network Downtime

Date:

Purpose: Network Maintenance

Time:

Event Details:

The Clinical Center (CC) Network will be down from DATE and TIME period. Areas will lose access to CRIS for

approximately XX minutes. Some clinical and non-clinical applications (SoftMed, Theradoc, SIS, CBORD, SOFIE,

etc.) will also be unavailable. You may experience loss of network connectivity to other CC resources during

this period.

During the service disruption, CRIS users are to use downtime procedure.

Impacted Services/Applications: CRIS, SoftID system and CC Network.

Impacted Users: All CRIS, SoftID and CC Network users.

Expected Resolution:

Date and Time

Additional Information:

· Please begin using Downtime (manual) procedures.

· You will not have access to CRIS.

· You can NOT enter orders, document, print or retrieve information in either system.

· You cannot admit, transfer or discharge a patient in CRIS until it becomes operational.

· Barcode Information: SoftID Specimen Labels and generic labels will not print out.

**Prior to the Downtime, please be sure you have an extra set of Patient Labels on hand by ordering

them from Admissions.**

o Units that still receive LIS labels from the Zebra printers can use these labels during the SoftID

downtime.

o Units that no longer receive LIS labels from the Zebra printers, should use standard downtime

procedures for specimen collections. That is, please complete a lab requisition (including

protocol number) and apply a Patient Label to specimen containers.

· SoftID.Tx Transfusion Verification will not be available:

o If CRIS is available, transfusions are documented in the “Blood Component Administration”

structured note. (These notes are entered directly into CRIS)

o If CRIS is unavailable, transfusions are documented in a Progress Note according to Nursing

Procedures and Standards of Practice: Blood Product Administration -Appendix F: Downtime

Procedure found at

http://intranet.cc.nih.gov/nursing/practicedocs/procedures_pdf/PRO_Blood_Products_Admin

_App_E.pdf. (These docs get scanned into CRIS per Nursing process)

o Typenex expiration date can be confirmed in CRIS or by calling DTM.

o The Patient Transfusion Record will accompany the product when it is issued to the patient

care area.

o When the SoftID.Tx system comes back up, blood components that were issued during the

downtime may display in SoftID.Tx. Please contact DTM to verify status

· POIS and SIS Web are not operational. For requesting emergency surgical procedures, please

use NIH-2891 manual form. If clinical documentation from POIS is needed please contact the

DPM Surgical On call team via the page operator.

· Clinical Information Systems such as: CBORD, CITRIX, ECG, IDMS, LIS, Omnicell, PACS, PYXIS, RIS,

Dictation/ Transcription, & more will be operational but results will not cross over to CRIS during the

downtime. ATV is not operational, use NIH-54 manual form. Chart View will be available in Citrix.

· Omnicell and PYXIS will be functional but ADT information will not be updated. Please admit by hand

per manual procedure. Medication orders manually placed or discontinued during the Downtime will

not be updated at the Omnicell cabinet and Anesthesia Workstations. Medication orders entered and

verified by Pharmacy prior to the Downtime will be accessible from the cabinet. Emergency

medications may be removed using the override process at the cabinet.

· Please do not send non-emergent orders on the manual ordering forms during the Downtime period.

· Please wait and enter non-emergent orders in CRIS after CRIS becomes operational.

· You will need to call Departments to communicate the orders and obtain service.

· For Messenger and Escort, you will need to call all transport requests to the Messenger and Escort’s

CRIS Downtime phone line (301) 496-0094.

Emergent Lab Order, Please Follow This Procedure:

1. Send the specimen to the lab with the appropriate completed (Patient Identifiers, Location, Phone

Number, Protocol Number, Tests Requested, LIP Name and Signature) manual Department of

Laboratory Medicine Ordering Record form or Transfusion Medicine Ordering Record form.

2. Do not enter Emergency Orders into CRIS. The Lab will enter the orders on their end.

3. Do not redraw specimens for orders entered during the down.

4. Keep a written record of the results called back to the unit.

All Other Emergent Orders Follow the Defined Manual Ordering Process by Service (Pharmacy, Imaging

Services, Transfusion Medicine, Respiratory Care, Nutrition and All Other Clinical Services)

During the downtime, please use manual ordering and/ or documentation forms.

These forms are located on every patient care area in the CRIS Downtime Toolkit.

For additional forms, contact Medical Record Department (301-496-2292)

Monday- Friday 7:00 am- 5:00 pm or go online to the following URL:

http://intranet.cc.nih.gov/medicalrecords/forms/forms-crisdowntime.shtml

Thank you for your support,

The Department of Clinical Research Informatics

(301) 496-8400

Another Template Example:

CC Network Downtime

Date:

Time:

Purpose:

Event Details: The Clinical Center (CC) Network will be down from _______ starting at _____ until ___. Areas

will lose access to CRIS during this time period.

** CRIS and SUNDOWN WILL BE UNAVAILABLE **

ring the service disruption, CRIS users need to use downtime procedures. The following

clinical and non-

linical applications will also be unavailable in the CRC, Pharmacy, ACRF, DEMII, CCMD and via VPN:

Impacted Clinical

Systems:

Impacted Web-Based CC

Applications:

Impacted Department Applications:

Acuity Plus

Omnicell

Clinical Data

Warehouse (CDW)

MRD

Diagnostic

Discharge

(DDX)

Blood Borne

Diseases

Pharmacotherapy

Registration

ANSOS

PACS

Executive

Information System

(EIS)

MRD Lab

Report

Requests

Bioethics Tracking

Pharmacy Patient

Tracking

ATV

POIS

Hospital Services &

Visual Supply

Catalog

STARS

Building Services

Requests

Phlebotomy

BTRIS

Prosolv

Hospital Statistics

System (HSS)

Pharmacy Drug

Formulary

Catheter Placement

Patient

Recruitment

Tracking

CITRIX

PYXIS

Investigational Drug

Monitoring System

(IDMS)

Protocol

History

Consult Evaluation

System

Volunteer

Tracking

CRIMSON

RIS

Lawson

Pain Management

Tracking

CRIS

ScriptPro

CRIS Mobile

Softmed

(3m)

ECG

Theradoc

IDMS

Viasys (PFT)

LIS

BD Cato

(BD IVPrep)

The following communication systems will NOT be available in certain areas of Building 10 (DLM, DTM, DPM,

MRD, MMD, 2C410, Credentialing, OFM, 5J, 2J, DCRI) complex.

* VoIP Phone * Internet * E-mail

Use the Emergency Back-up Telephone System for communication during this network maintence

period. Refer to the Emergency Back-Up Telephone System attachment for dialing procedures and a list of

emergency numbers.

Impacted Users: All CC Network users

Expected Resolution:

Additional Information:

• Use CRIS Downtime (manual) procedures.

o You can NOT enter orders, document, print or retrieve information in either system

o You cannot admit, transfer or discharge a patient in CRIS until it becomes operational

o Barcode: SoftID Specimen Labels and generic labels will not print out. SoftID.Tx Transfusion

Verification will not be available

o You will need to call Departments to communicate the orders and obtain service

• POIS and SIS Web are not operational. For requesting emergency surgical procedures, please use NIH-

2891 manual form

o If clinical documentation from POIS is needed please contact the DPM Surgical On call team via

the page operator

• The Clinical Information Systems listed above will NOT be operational

• For Messenger and Escort, you will need to call all transport requests to the Messenger and Escort’s

CRIS Downtime phone line (301) 496-0094

• NURSING: see attachment for information and unit posting

Thank you for your support,

The Department of Clinical Research Informatics

(301) 496-8400

H Wireless Network Downtime

Purpose: CIT Wireless Maintenance

Date:

Time:

Location: Building 10 CRC, Old Building 10 and the ACRF

Event Details:

All NIH Wi-Fi access may be intermittent for use on DATE according to the following schedule:

a) Building 10 Magnuson & ACRF: TIME

b) Building 10 CRC-Hatfield: TIME

• This includes NIH-Guest-Network, NIH-Wireless and ALL other wireless networks run by CIT in Building

10. Smart phone, laptop and tablet users may also be impacted and need to reauthenticate when the

wireless networks are up.

• CRIS will be operational and can be accessed only from the Thin Client devices during this network

maintenance period.

• Wireless Computers such as Workstations on Wheels (WOWs) may NOT have wireless access to CRIS

including SoftID (Barcode System including PDAs), Provation Travel Carts or the network.

• WOWs and Provation Travel carts connecting to the network directly via a network drop will continue

to work.

• Patients may not have Wi-FI connections to their entertainment devices (e.g. gaming consoles)

• If you use NIH paging and rely on a mobile device WITHOUT a 102 pager, and you will be on campus

and must be reachable during this window, please ensure your device connects to cellular. If you need

assistance with contacting someone during this maintenance, please call the NIH Page Operator

Supervisor at 301-496-4516

• Patient Call System: RTLS (Real-Time Location Services) and Zebra Phones

Impacted Services/Applications:

The wireless network, including wireless Workstations on Wheels (WOWs).

Impacted Users:

Users of the service listed above.

Expected Resolution Time:

For Building 10 Magnuson & ACRF: date and time

For Building 10 CRC-Hatfield: date and time

dditional Information for Nursing and Phlebotomy:

• If requiring use of SoftID from the WOWs, you can connect to the yellow LAN ports located throughout

your unit.

•

• SoftID Specimen Labels may not print out.

• Units that still receive LIS labels from the Zebra printers can use these labels during the SoftID

Downtime.

• Units that no longer receive LIS labels from the Zebra printers should use standard downtime

ocedures for specimen collections. That is, please complete a lab requisition (Including protocol

number) and apply a Patient Label to specimen containers.

• You CAN enter orders, document, print or retrieve information from Thin Client devices.

• Clinical Information Systems, such as RIS, LIS, ECG, PACS, CITRIX, PYXIS, Dictation/ Transcription, IDMS

& more will be operational and results will cross over to CRIS.

Thank you for your support,

The Department of Clinical Research Informatics

(301)

496

-8400

Example of Downtime Flyers / List of Manual Forms to Use for Documentation

Figure I.4. Clinical Center Database Downtime Flyer

CLINICAL CENTER SQLSERVER DOWN

Date:

Start Time:

End Time:

Purpose: Maintenance/SQL Server Upgrade

Event Details:

The Clinical Center SQL Database Server will be unavailable on

Impacted Services/Applications:

During the downtime, you will not have access to applications on the list below during the down.

Impacted Users:

Any user attempting to access the Clinical Center SQL Database Server and dependent applications (listed

below).

Users of the services listed below.

Expected Resolution Time:

Additional Information:

CRIS will NOT be affected:

This Downtime will primarily affect the following web-based CC applications and Department Applications:

• Bioethics Consult Report, CES

• Bioethics Tracking

• Clinical Data Repository (CDR) (a.k.a Clinical Data Warehouse (CDW))

• Clinical Studies Info - search field only

• Clinical Studies: Protocol Consents Search

• CPT (3M) billing code interfaces will affected

• CRIMSON

• CRIS Usage Analytics

• Executive Information System (EIS)

• HIMD Lab Report Requests

• Hospital Services & Visual Supply Catalog

• Investigational Drug Management System (IDMS) - Orders from CRIS will not cross to IDMS

• Material Safety Datasheet (Pharmacy)

• Medical Staff Dictionary (OCS)

• Pain Management Tracking

• Payment Tracker (OFRM)

• Pharmacy Drug Formulary

• Pharmacy Patient Tracking

• POIS—Lab results will not post to module but is accessible in CRIS

• Research Volunteer System (RVS)

• Researcher Tracking (Rehab)

• SoftMed interfaces –results and report will not cross to CRIS

• LAWSON

• ANSOS

• Clarity

• Institute Feeds - not be affected

Other Applications Interrupted (with shorter downtime):

• AMS, AQI, OFRM, Percussion, PharmRees, Phlebotomy, ProNutra, RegActivity, sacredCES

(SACRED will not be affected), SocialWork (SWAT), Surveys, Universal Precaution, WaitTime

Tracker

*Attn Nursing: For Central Hospital Supply (CHS) orders during this period, please contact CHS at (301) 496-

2243 or contact the page operator to reach the CHS On-Call staff.

Exam

ple of Downtime Flyers / List of Manual Forms to Use for Documentation

Example of updated. CRIS Slowness- Downtime Message

Update- Event Details:

Presently CRIS is experiencing intermittent slowness with entering CRIS Orders, Documentation, and printing.

This will continue until tomorrow morning (DATE and TIME)

A CRIS downtime has been scheduled for DATE from ____ until ____ to work on the issue. No further email will

be sent out about the slowness.

Please contact CC Service Center (301 496-8400) if the delay in entering CRIS orders is greater than 2 minutes.

Impact

ed Application:

CRIS

Impacted Users:

All CRIS Users

Expected Resolution:

Thank you for your support,

NIH CC/ Department of Clinical Research Informatics

-----------------------Previous Information-----------------------

From: CC DCRI Notifications (DO NOT REPLY)

To: CC Systems Notification; CC-ISD IE Notice

Subject: CRIS Slowness -

Event Details:

CRIS Slowness- Delay in entering Orders, documentation, printing

Presently CRIS is slower than normal. Please note that DCRI is aware of the issue and working to resolve.

Please contact CC Service Center (301) 496-8400 if the delay in entering the order is greater than 2 minutes.

Impacted Application:

CRIS

Impacted Users:

All CRIS Users

Expected Resolution:

Unknown

Thank you for your support,

NIH CC/ Department of Clinical Research Informatics

Appendix J

Example of Standard Terminology to send in Email and Message for Downtime

There are various types of system downtimes or delays where standard terminology can be used in an e-mail

to users and a message to page operators informing them of what is affected by the Downtime/Delay. Until

issues are further defined, DCRI has created a generic template and specific downtime templates.

Types of downtimes:

1. Generic Template (used to get message out when issue first identified)- System interruption

2. Generic Template – Extension of Downtime

3. Admission, Travel, Voucher (ATV) Downtime

4. SoftID System Downtime

5. CCCasper Citrix Access Downtime

6. CC File Downtim

7. CC Website Downtime/ Multiple Website Downtime

8. Cellular outage (CIT) / NIH In-Building Cellular Service Outage

9. Citrix Downtime

10. CRIS Clinical Documentation Downtime

11. CRIS Delay (slowness)

12. CRIS Downtime

13. CRIS via Citrix System Interruption (CCCasper Citrix Access)

14. CRIS and Barcode Downtime

15. CRIS Downtime - using CRIS Sundown

16. CRIS Interface Delay

17. CRIS Interface Downtime

18. CRIS ADT Interface Downtime

19. CRIS Lab Interface Downtime

20. CRIS Laboratory Information System (LIS) Downtime

21. CRIS Printing Downtime

22. CRIS Printing Delay (Interruption)

23. ECG System Downtime

24. E-Mail Downtime/ / NIH Email Service Downtime:

25. Internet Access Downtime (Loss of access to SIS Web)

26. Omnicell Interface Downtime

27. Event (Occurrence) Reporting System (STARS)

28. Outlook- interruption in accessing .PST folders

29. Messenger and Escort Printing Downtime

30. MobileIron (Mobile Device Management System) service interruption

31. NIH Clinical Center Network Delay

32. NIH Clinical Center Potential Network Downtime/ Network Connectivity Issues (Intermittent Problems)

33. Network Downtime

34. Network Maintenance impacting CRIS, Interfaces, Clinical/Non Clinical applications

35. Nutrition (CBORD) Downtime

36. Perioperative Information System (POIS) Downtime

37. Perioperative Information System (POIS) Interface Downtime

38. Point of Care Testing

39. Printing / General Printing Interruption (CC0PPrint1 and CC0PPrint2)

40. Provation

(

Continued from previous page):

41. QuadraMed Acuity Plus System Downtime

42. Radiology Information System (RIS) Downtime

43. RADPACS (CC PACS) System Downtime

44. RTLS (Patient Call System)

45. Autostore Document Scanning System Downtime

46. Scriptpro (Outpatient Pharmacy) Delay

47. Scriptpro (Outpatient Pharmacy) Downtime

48. Surgical Information System (SISWeb) Downtime:

49. SMM Downtime (Sunrise Medication Manager / Pharmacy System Downtime)

50. SoftBank Downtime/ DTM Lab System Downtime

51. CDR Downtime (Clinical Center Database Server)

52. Telephone/ Cisco CCX Answering and Messaging System Downtime (DCRI ONLY):

53. Telephone System Downtime

54. Thin Client Devices Downtime

55. Training Database Downtime

56. Wireless Network Downtime

57. Workstation on Wheel (WOW)

58. Workstation on Wheel (WOW) Maintenance

Note: There may be other clinical applications not requiring house-wide communication, hence are not listed

above. The generic template (Appendix J, #1) may be used to communicate system/application issues to its

respective users and stakeholders.

Please note the CRIS status screen is to be updated unless otherwise indicated.

1. Generic Message Template: System interruption

This w

ill be initiated as soon as Systems Monitoring has recognized something is wrong with a system or

application etc (e.g. increased calls about issues). Calls could be for CRIS down, CRIS slowness, printing issues,

CRIS login issues to name a few

Message to Page Operator:

Present tense: Presently a system interruption has been reported for Insert name of the application or issue.

Please note that DCRI engineers are aware of the issue and are working to resolve.

E-Mail Message:

Subject:

Include title, date and time in subject line.

Eve

nt Details:

System interruption has been reported for ____________

(example to use: CRIS printing, access to CRIS, etc) - Remove before sending message.

Please note that DCRI engineers are aware of the issue and working to resolve. More information to follow.

Impacted Services/Applications:

Include name such as CRIS, etc.

Imp

acted Users:

Users of the service listed above.

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

Addit

ional Information:

Add text here as needed.

Thank

you for your support,

The Department of Clinical Research Informatics

(301)

496

-8400

2. Generic Message Template: Extension of Downtime

ternal information refer to section 2.1 -If the system is not operational at the designated time continue with

downtime overhead announcement and email notification that the system remains down. If it initially is an

extended downtime then follow the extended downtime procedure, otherwise go to unplanned downtim

procedure (e.g. continue immediate then hourly announcements if prior to 10pm and/ or every 2 hours if after

0pm).

The overhead and emails will continue per policy until it is operational.

Message to Page Operator:

The ______system remains unavailable for use. Please continue use downtime procedure.

E-Mail Message:

Subject:

Include title of downtime and EXTENDED, date and time in subject line.

Update- Event Details: ______Downtime Extended <date and time>

<Insert application name> remains unavailable for use. Please continue to use Downtime (manual)

procedures.

Impacted Application:

Impacted Users:

Users of the service listed above.

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

Thank you for your support,

The Department of Clinical Research Informatics

-----------------------Previous Information-----------------------

3. Admission, Travel, and Voucher Downtime:

Message to Page Operator:

The Admission, Travel, Voucher System (ATV) will be unavailable for use Date

from time -_____. During the ATV downtime, please use NIH Form 54 and contact the Admissions Department

to communicate request and obtain service.

E-Mail

Message:

Subject:

Include title, date, and time in subject line.

Event Details:

The Admission Travel Voucher System (ATV) will be down Date from time -_____.

During the ATV downtime, you ________ have access to CRIS.

Imp

acted Services/Applications:

The Admission Travel Voucher System (ATV).

Impacted Users:

Users of the service listed above.

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

Addit

ional Information:

Please use the “Request for Admission/Travel/Voucher/Local Transportation” (NIH- 54) manual form for

emergent requests. Deliver the completed form to the following areas during business hours:

• Admissions Request: Admissions front desk. For questions about completing the NIH -54 forms, conta

Admissions at 301-496-3315.

• Government-Arranged Travel Requests: Travel office (10/1-4553).

• Voucher Requests: Voucher Office (10 North Lobby (room 1606).

Evenings, Nights, Weekends, and Holidays: Contact Admissions at 301-496-3315.

If any of the requests are not emergent, please submit an electronic request once the ATV system is

operational. If you have submitted a manual form (NIH-54) to the appropriate area, you do not need to enter

the same ATV request electronically once the system is operational.

The manual form can be accessed from the Health Information Management Department’s online forms at the

following URL: http://intranet.cc.nih.gov/medicalrecords/forms/forms-

crisdowntime.shtmlmedicalrecords/forms/index.shtml

Thank you for your support,

The Department of Clinical Research Informatics

(301) 496- 8400

4. SoftID / SoftID.Tx System Downtime:

Message to Page Operator:

The S

oftID / SoftID.Tx Specimen Collection Verification and Transfusion Verification and Patient ID Systems w

ill

unavailable for use Date from time -_____. Please include CRIS Order ID with any specimen sent to the lab

that does not have a barcode label

E-Mail Message:

Subject: Include title, date, and time in subject line.

Event Details:

The SoftID / SoftID.Tx Specimen Collection Verification and Transfusion Verification and Patient ID Systems will

be unavailable.

IMPORTANT: Please include CRIS Order ID and completed manual lab ordering forms with any specimen sent

to the lab that does not have a barcode label. All specimens for Type and Screen must be initialed and dated by

the collector if barcode labels are not used.

Impacted Services/ Applications: The SoftID /SoftID.Tx system.

Impacted Users: Users of the service listed above.

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

Addi

tional Information:

• CRIS will be available for use during the SoftID / SoftID.Tx system downtim

• S

oftID / SoftID.Tx Specimen Labels will not print out.

**Prior to the Downtime, please be sure you have an extra set of Patient Labels on hand by ordering them

rom Admissions.

o U

nits that still receive LIS labels from the Zebra printers can use these labels during the SoftI

D /

oftID.Tx downtime.

o Units that no longer receive LIS labels from the Zebra printers, should use standard downtim

procedures for specimen collections.

That is, please complete a lab requisition (including protocol number) and apply a patient label to

specimen containers.

• SoftID.Tx Transfusion Verification will not be available

If CRIS is available, transfusions are documented in the “Blood Component Administration” structured

not

o If CRIS is unavailable, transfusions are documented in a Progress Note according to Nursing Procedures

and Standards of Practice:

Blood Product Administration -Appendix D: Downtime Procedure found at

http://intranet.cc.nih.gov/nursing/practicedocs/procedures_pdf/PRO_Blood_Products_Admin_App_E.

pdf

o Typenex expiration date can be confirmed in CRIS or by calling DTM.

o The Patient Transfusion Record will accompany the product when it is issued to the patient care area

• When the SoftID.Tx system comes back up, blood components that were issued during the downtime may

display in SoftID.Tx. Please contact DTM to verify status.

4B. SoftID Downtime:

Message to Page Operator:

The SoftID Specimen Collection Verification and Patient ID System will be unavailable for use Date from time -

_____. Please include CRIS Order ID with any specimen sent to the lab that does not have a barcode label

E-Mail Message:

Subject: Include title, date, and time in subject line.

Event Details:

The SoftID Collection System will be unavailable.

IMPORTANT: Please include CRIS Order ID and completed manual lab ordering forms with any specimen sent

to the lab that does not have a barcode label.

Impacted Services/ Applications: The SoftID system.

Impacted Users: Users of the service listed above.

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

Addit

ional Information:

• CRIS will be available for use during the SoftID system downtime.

• SoftID specimen labels will not print out.

**Prior to the Downtime, please be sure you have an extra set of Patient Labels on hand by ordering them

rom Admissions.

o U

nits that still receive LIS labels from the Zebra printers can use these labels during the SoftID

downtime.

o Units that no longer receive LIS labels from the Zebra printers, should use standard downtim

procedures for specimen collections.

That is, please complete a lab requisition (including protocol number) and apply a patient label to

specimen containers.

4C. SoftID.Tx Transfusion Verification System Downtime:

Message to Page Operator:

The SoftID.Tx Transfusion Verification System will be unavailable for use Date from time - ___

Please include CRIS Order ID with any specimen sent to DTM that does not have a barcode label.

E-Mail Message:

Subject: Include title, date, and time in subject line.

Event Details:

The SoftID.Tx Verification System will be unavailable.

CRIS and Laboratory Information System (LIS) are operational.

Impacted Services/ Applications: The SoftID.Tx system.

Impacted Users: Users of the service listed above.

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

Addit

ional Information:

1. SoftID.Tx Transfusion Verification will not be available.

o If CRIS is available, transfusions are documented in the “Blood Component Administration” structured

note.

o If CRIS is unavailable, transfusions are documented in a Progress Note according to Nursing Procedures

and Standards of Practice:

Blood Product Administration -Appendix D: Downtime Procedure found at

http://intranet.cc.nih.gov/nursing/practicedocs/procedures_pdf/PRO_Blood_Products_Admin_App_E.

pdf

o Typenex expiration date can be confirmed in CRIS or by calling DTM.

o The Patient Transfusion Record will accompany the product when it is issued to the patient care area.

2. When the SoftID.Tx system comes back up, blood components that were issued during the downtime may

display in SoftID.Tx. Please contact DTM to verify status.

5. CCCasper Citrix Access Downtime:

ssage to Page Operator:

The CCCASPER Citrix Access website will be unavailable for use (give date and time if you know in advance).

CRIS will be operational from WOWs and Thin Client devices.

IMPORTANT MESSAGE To Systems Monitoring:

PLEASE NOTE THAT EMAIL NOTIFICATION NEEDS TO BE SENT TO 5 different DLs:

1) CC Systems Notification

2) CC-ISD IE Notice

3) CC Staff

4) CCMEDSTAFF-L@LIST.NIH.GOV

5) CCAFFSTAFF-[email protected]

E-Mail Message:

Subject: Include title, date, and time in subject line.

Event Details:

The CCCASPER Citrix Access website will be unavailable for use on <insert date and time>

CRIS will be operational from WOWs and Thin Client devices.

Impacted Services/Applications:

Access to applications on the CCCASPER Citrix Access website https://cccasper.cc.nih.gov

Remote access to Citrix.

Imp

acted Users:

Users accessing applications on the CCCasper Citrix Access site. Users accessing CRIS via Citrix.

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

Addi

tional Information:

During the CCCASPER Citrix Access website downtime, you will have access to CRIS only from WOWs and Thin

Client devices.

Clinic

al Information Systems such as: RIS, LIS, ECG, PACS, CBORD, Omnicell, PYXIS, SoftID (barcode), Standard

to CRIS.

Thin Client devices will have access to CRIS.

Email through Citrix will be unavailable for use during the downtime.

Remote access from off site will be unavailable.

Thank you for your support,

The Department of Clinical Research Informatics

(301) 496-8400

other template:

Purpose: CC CITRIX Upgrade

Date:

Time:

Impacted Users: All CCCASPER and Thin Client Users

Event Details:

Citrix infrastructure including CCCASPER and Thin Clients is being upgraded between ____and ____ on DATE.

There could be momentarily interruptions in launching applications and logging into Thin Clients during this

time. If you are unable to log in or launch an application, please wait 5 minutes and try again.

No existing Citrix sessions will be interrupted.

Impacted Services/Applications:

CCCASPER and Thin Clients

Expected Resolution Time:

DATE & TIME

Additional Information:

Existing sessions will not be interrupted, but logging in and starting new applications could fail during this time.

If you are unable to launch an application or log in, please wait 5 minutes, refresh your browser and try again.

After the upgrade operation will resume as normal. No change in functionality is expected.

Thank you for your continued support,

The Department of Clinical Research Informatics

(301) 496-8400

6. C

C File Downtime

Message to Page Operator:

Present tense: The network server, CC File, is down. You will not have access to your personal folders such

your H: Drive and various other CC File related folders during this time.

IMPORTANT MESSAGE To Systems Monitoring

PLEASE NOTE THAT EMAIL NOTIFICATION NEEDS TO BE SENT TO 3 different DLs:

1) CC Systems Notification

2) CC

-ISD IE Notice

3) CC Staff

E-Mail Message:

Subject:

Include title, date, and time in subject line.

Event Details:

The CC File server is down. During this network server interruption, you will not have access to your personal

folders such as your H Drive (home directory) which include shared departmental directories and Outlook

archive files on CC File.

Impacted Services/Applications:

CC File including “H: Drive” and other related folders.

Impacted Users:

Users of the service listed above.

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

Addi

tional Information:

If working in documents on your H drive, any changes made could be lost. Please save locally.

DCRI engineers are aware of the issue and attempting to resolve.

Thank you for your support,

The Department of Clinical Research Informatics

(301) 496-8400

7. CC Website/ Multiple Website Downtime:

Message to Page Operator:

There will be no over head page for the Multiple Website Potential Downtime.

IMPORTANT MESSAGE To Systems Monitoring:

PLEASE NOTE THAT EMAIL NOTIFICATION NEEDS TO BE SENT TO 3 different DLs:

1) CC Systems Notification

2) CC

-ISD IE Notice

3) CC Staff

E-Mail Message:

Subject:

Include title, date, and time in subject line.

Event Details:

On <date / time> the Department of Clinical Research Informatics will be performing maintenance on the web

servers supporting CC websites in the Data Center.

CRIS will be operational during this time.

Impacted Services/Applications:

Users will experience connectivity loss (outage) to the various websites noted below.

Impacted Users:

Users of the service listed below.

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

dditional Information:

During the duration of this maintenance activity, users will experience connectivity loss (outage) to the various

websites noted below.

The Websites that may be affected are as follow:

1. Bioethics.nih.gov

2. Bloodbank.nih.gov

3. btris.nih.gov

4. Clinical studies.cc.nih.gov

5. Clinicalresearch.nih.gov

6. Cris.cc.nih.gov

7. Druginfo.cc.nih.gov

8. Intranet.cc.nih.gov

9. Nursing.nih.gov

10. Training.cc.nih.gov

11. www.cc.nih.gov

We t

hank you for your support,

The Department of Clinical Research Informatics

301 496-8400

8. Cellular Outage/ NIH In-Building Cellular Service Outage

Message to Page Operator:

Building 10 and ACRF will experience cellular service outages on < Enter date/ time >.

uring this time, all in-building cellular services (e.g. ATT, Verizon, Sprint and T-Mobile) will rely on cellular

towers outside the building.”

IMPORTANT MESSAGE To Systems Monitoring:

PLEASE NOTE THAT EMAIL NOTIFICATION NEEDS TO BE SENT TO 5 different DLs:

1. CC-ISD IE Notice

2. C

C Systems Notificatio

3. C

C Building 10 - Blind carbon copy

4. CC Building 10A - Blind carbon copy

5. CC Building 10-CRC - Blind carbon copy

E-Mail Message:

Subject:

Include title, date, and time in subject line.

Eve

nt Details:

<Confirm location - Building 10 and ACRF> will experience cellular service outages on < Enter date/ time >

During this time, all in-building cellular services (e.g. AT&T, Verizon, Sprint and T-Mobile) will rely on cellular

towers outside the building. If you need to use your cell phone, reception outside the building is available.

Areas in basements and away from exterior walls may only provide a weak signal.

Impacted Services/Applications:

All cellular services (e.g. AT&T, Verizon, Sprint and T-Mobile)

Impacted Users:

Cellular users in Building 10 CRC, Old Building 10 and ACRF <Confirm location>

Users relying on the in-building cellular services

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

If assistance is needed, please contact the NIH IT Service Desk at 301-496-HELP, 301-496-8294 (TTY), or visit us

on the web at http://itservicedesk.nih.gov

Thank

you for your patience,

The Department of Clinical Research Informatics and

The Center for Information Technology.

Ano

ther template example:

The Cellular Antenna System (DAS = Distributed Antenna System) Unavailable – Verizon Cellphone Users

Date:

Duration:

Purpose: DAS Maintenance

Who is Affected:

During the DAS maintenance work, Verizon cellphone users in all buildings covered by DAS on the NIH campus

(including building 10 and CRC) will temporarily lose DAS services causing either no in-building cell phone

signal or cell phone signal not as strong as it usually is depending on customers’ location inside the building.

Maintenance Start Time:

Impacted Services/Applications:

Verizon in-building cellular services (DAS)

Impacted Users:

Verizon cellphone users in all DAS covered buildings on the NIH campus (including building 10 and CRC)

Targeted Maintenance Completion Time:

** Verizon customers must make sure the WI-FI setting on the cellphone is on and using ‘NIH-Wireless’ (not

the NIH-Guest-Network) during this maintenance to receive the paging

Thank you,

Department of Clinical Research Informatics

On Behalf of The Center of Information Technology

9. Citrix Downtime:

essage to Page Operator

The Citrix system will be unavailable for use (give date and time if you know in advance).

During the downtime, CRIS will be operational from Workstations on Wheels (WOWs) only.

IMPORTANT MESSAGE To Systems Monitoring:

PLEASE NOTE THAT EMAIL NOTIFICATION NEEDS TO BE SENT TO 5 different DLs:

1) CC Systems Notification

2) CC-ISD IE Notice

3) CC Staff

4) CCMEDSTAFF-[email protected]

5) CCAFFSTAFF-[email protected]IH.GOV

E-Mail Message:

All email will be sent from the CC DCRI Notifications (DO NOT REPLY) DL

ubject: Include title, date, and time in subject line.

Event Details:

The Citrix system will be unavailable.

Impacted Services/Applications:

Citrix and access to applications on the CCCASPER Citrix Access website https://cccasper.cc.nih.gov

Remote access to Citrix.

pacted Users:

Users of the service listed above.

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

dditional Information:

During the Citrix downtime, you will have access to CRIS only from Workstations on Wheels (WOWs). Thin

Client devices will not have access to CRIS.

Clinical Information Systems such as: RIS, LIS, ECG, PACS, CBORD, Omnicell, PYXIS, SoftID (barcode), Standard

to CRIS.

Email through CCCasper Citrix Access will be unavailable for use during the downtime.

Remote access from off site will be unavailable via CCCasper Citrix Access.

Thank you for your support,

The Department of Clinical Research Informatics

(301)

496

-8400

10. CRIS Clinical Documentation Downtime

essage to Page Operator:

NO overhead announcement is made

MPORTANT MESSAGE To Systems Monitoring:

PLEASE IDENTIFY WHAT NOTES ARE AFFECTED AND SEND TO DISTRIBUTION LISTS:

1. CC Systems Notification

2. CC

-ISD IE Notice

3. CCMEDSTAFF-L@LIST.NIH.GOV

4. CCAFFSTAFF-[email protected].GOV <INCLUDE IF PRESCRIBER NOTES ARE AFFECTED>

E-Mail Message:

Subject: Include title, date, and time in subject line.

Specific Clinical Documentation Downtime in CRIS

**CRIS WILL BE OPERATIONAL**

Eve

nt Details:

On <Date and Time>, the Department of Clinical Research Informatics will be performing updates on

specific clinical documents in CRIS.

During the downtime, the following document(s) listed below (including the patient care areas that will be

impacted) will be unavailable for use.

Users will not be able to enter information in the specific documents identified below and are requested to

use downtime procedure for the affected document(s) ONLY.

Unavailable Structured Notes:

Impacted Areas:

Imp

acted Services/Applications:

CRIS Clinical Documents as indicated above

Impacted Users:

CRIS Prescriber Users

Impacted Locations:

Clinical areas as indicated above.

Expected Resolution Time:

Additional Information:

CRIS will be operational during this time

We thank you for your patience,

The Department of Clinical Research Informatics

301 496-8400

11. CRIS Delay (Slowness):

essage to Page Operator:

Present tense: Presently CRIS is experiencing intermittent slowness with entering CRIS Orders,

Documentation, and printing. Please contact CC Service Center if the delay in entering CRIS orders is greater

than 2 minutes.

IMPORTANT MESSAGE To Systems Monitoring:

Please include CC-DCRI External CRIS Down Notifications DL when opening conference line.

E-Mail Message:

Subject:

Include title, date, and time in subject line.

Event Details:

CRIS Slowness- Delay in entering Orders, documentation, printing.

Impacted Services/Applications:

Access to CRIS

Impacted Users:

Users of the service listed above.

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

Addit

ional Information:

Presently CRIS is slower than normal. Please note that DCRI is aware of the issue and working to resolve.

Please contact CC Service Center (301 496-8400) if the delay in entering CRIS orders is greater than 2 minutes.

Thank you for your support,

The Department of Clinical Research Informatics

(301)

496

-8400

12. CRIS Downtime:

ssage to Page Operator:

The CRIS system will be unavailable for use (give date and time if you know in advance). (We will provide

information IF downtime procedure will be initiated).

IMPORTANT MESSAGE To Systems Monitoring:

ICU Staff to print ICU CDV report 1 hour prior for planned CRIS downtimes or

Systems Monitoring to print within 30 minutes of the CRIS being down if unplanned

1. CC Systems Notification

2. CC-ISD IE Notice

E-Mail

Message:

Subject:Include title, date, and time in subject line.

ent Details:

CRIS will be or is unavailable for use. (We will provide information IF downtime procedure will be initiated).

You will not have access to CRIS.

Imp

acted Services/Applications:

Access to CRIS

Impacted Users:

All CRIS users. (Users of the service listed above).

Expected Resolution:

Enter date/ time OR enter “There is no current estimated time of resolution.”

Addit

ional Information: (INCLUDE if use of downtime procedure is initiated)

• Please begin using Downtime (manual) procedures.

• You can NOT enter orders, document, schedule/modify/cancel patient appointments, print or retrieve

information in either system.

• You cannot admit, transfer or discharge a patient in CRIS until it becomes operational.

Inpatient wristbands or patient labels will not printout.

• Specimen Labels may or may not print out. Use patient labels or Generic Patient Labels. Please verify all labs

are collected based on available information (medical care plan, lab form etc).

• Systems such as: SoftID, SoftID.Tx, CBORD, CITRIX, ECG, IDMS, LIS, Omnicell, PACS, PYXIS, RIS, Scriptpro,

3M/Transcription, & more will be operational but results will not cross over to CRIS, as applicable. ATV is not

operational, use NIH-54 manual form. Chart View will be available in Citrix.

• POIS and SIS Web- are not available during the down. You will not be able to submit OR case in SIS Web. To

request an emergency surgical procedure, please use NIH-2891 manual form. During Business hours: Please

call the front desk of the Operating Room (OR) if you need to schedule an OR case. If clinical documentation

from POIS is needed please call the OR (Mon. - Fri. 7:00 am – 3:30 pm). After hours: Contact the DPM

Surgical On call team via the page operator.

• SoftID / SoftID.Tx will display only active orders for both specimen collection and transfusion verification

entered prior to CRIS down. Please use all available information (e.g., Medical Care Plan, written orders) to

determine what specimens should be collected and/ or products transfused. Collection status and

transfusion information (e.g. vital signs and transfusion report) will update once CRIS is operational.

• Omnicell and PYXIS will be functional but ADT information will not be updated. Please admit by hand per

manual procedure. Medication orders manually placed or discontinued during the Downtime will not be

updated at the Omnicell cabinet and Anesthesia Workstations. Medication orders entered and verified by

Pharmacy prior to the downtime will be accessible from the cabinet. Emergency medications may be

removed using the override process at the cabinet.

• Enterprise Scheduling is not available. Use Form NIH 2955 to request a patient appointment.

• Please do not send non-emergent orders on the manual ordering forms during the Downtime period.

• P

lease wait and enter non-emergent orders in CRIS after CRIS becomes operational

• Y

ou will need to call Departments to communicate the orders and obtain service.

• For Messenger and Escort, you will need to call all transport requests to the Messenger and Escort’s CRIS

Downtime phone line (301) 496-0094.

Emergent Lab Order, Please Follow This Procedure:

1. S

end the specimen to the lab with the appropriate completed (Patient Identifiers, Location, Phone

Number, Protocol Number, Tests Requested, LIP Name and Signature) manual Department of Laborato

edicine Ordering Record form or Transfusion Medicine Ordering Record form

2. Do

not enter Emergency Orders into CRIS. The Lab will enter the orders on their end.

3. Do not redraw specimens for orders entered during the down.

4. Keep a written record of the results called back to the unit.

All Other Emergent Orders Follow the Defined Manual Ordering Process by Service (Pharmacy, Imaging

Services, Transfusion Medicine, Respiratory Care, Nutrition and All Other Clinical Services)

During the downtime, please use manual ordering and/ or documentation forms.

These forms are located on every patient care area in the CRIS Downtime Toolkit.

For additional forms, contact Health Information Management Department (301-496-2292)

Monday- Friday 7:00 am- 5:00 pm or go online to the following URL:

http://intranet.cc.nih.gov/medicalrecords/forms/forms-crisdowntime.shtml

Appointment Scheduling - You will be unable to view new patient information or demographic updates on

patients in the Scheduling System.

Than

k you for your support,

The Department of Clinical Research Informatics

(301)

496

-8400

13. CRIS via Citrix (CC Casper Citrix Access) System Interruption

ssage to Page Operator:

System interruption has been reported for CRIS access via Citrix (CC CASPER)

During the downtime, CRIS will be operational from Workstations on Wheels (WOWs).

IMPORTANT MESSAGE To Systems Monitoring:

PLEASE NOTE THAT EMAIL NOTIFICATION NEEDS TO BE SENT TO 5 different DLs:

1. CC Systems Notification

2. CC

-ISD IE Notice

3. CC Staff

4. CCMEDSTAFF-L@LIST.NIH.GOV

5. CCAFFSTAFF-[email protected].GOV

E-Mail Message:

Subject: Include title, date, and time in subject line.

ent Details:

System interruption has been reported for accessing CRIS via CITRIX.

Please note that DCRI engineers are aware of the issue and working to resolve.

More information to follow.

Impacted Services/Applications:

Access to CRIS via Citrix (CCCASPER Citrix Access website https://cccasper.cc.nih.gov

Remote access to Citrix.

pacted Users:

Users accessing CRIS via Citrix (CCCasper Citrix Access site).

Expected Resolution Time:

Enter date/ time OR enter “There is no current estimated time of resolution”.

Addi

tional Information:

• During this Citrix interruption, you will have access to CRIS from Workstations on Wheels (WOWs).

• Clinical Information Systems such as: RIS, LIS, ECG, PACS, CBORD, Omnicell, PYXIS, SoftID (barcode),

3M/Transcription, IDMS & more will be operational and results will cross over to CRIS

• Thin Client devices will not have access to CRIS.

Thank you for your support,

The Department of Clinical Research Informatics

(301)

496

-8400

14. CRIS and Barcode Downtime

• Barcode Information:

Mes

sage to Page Operator:

CRIS & SoftID and SoftID.Tx Specimen Collection Verification and Transfusion Verification system will be

unavailable for use (give date and time if you know in advance). Please use Downtime procedures.

IMPORTANT MESSAGE To Systems Monitoring:

ICU Staff to print ICU CDV report 1 hour prior for planned CRIS downtimes or

Systems Monitoring to print within 30 minutes of the CRIS being down if unplanned

Please include CC-DCRI External CRIS Down Notifications DL when opening conference line.

Event Details:

CRIS & the SoftID / SoftID.Tx Specimen Collection Verification and Transfusion Verification system will be

unavailable. Please begin using Downtime (manual) procedures.

You will not have access to CRIS or SoftID system.

Impacted Services/Applications: Access to CRIS & SoftID system.

Impacted Users: All CRIS & SoftID system users.

Expected Resolution:

Enter date/ time OR enter “There is no current estimated time of resolution.”

Additional Information:

• Plea

se begin using Downtime (manual) procedures.

• You will not have access to CRIS.

• You can NOT enter orders, document, schedule/modify/cancel patient appointments, print or retrieve

information in either system.

• You can not admit, transfer or discharge a patient in CRIS until it becomes operationa

• So

ftID Spec

imen Labels and generic labels will not print out.

**Prior to the Downtime, please be sure you have an extra set of Patient Labels on hand by ordering the

rom Admissions. **

o Units that still receive LIS labels from the Zebra printers can use these labels during the Bar Code/

SoftID downtime.

o Units that no longer receive LIS labels from the Zebra printers, should use manual downtime

ocedures for specimen collections.

CRIS and Barcode Downtime: (continued):

• SoftID / SoftID.Tx Transfusion Verification will not be available

o If CRIS is available, transfusions are documented in the “Blood Component Administration” structured

not

o If CRIS is unavailable, transfusions are documented in a Progress Note according to Nursing Procedures

and Standards of Practice: Blood Product Administration -Appendix F: Downtime Procedure found at

http://intranet.cc.nih.gov/nursing/practicedocs/procedures_pdf/PRO_Blood_Products_Admin_App_E.p

o Typenex expiration date can be confirmed by calling DTM.

o The Patient Transfusion Record will accompany the product when it is issued to the patient care area.

• Sy

stems such as: SoftID, CBORD, CITRIX, ECG, IDMS, LIS, Omnicell, PACS, PYXIS, RIS, Scriptpro,

3M/Transcription, & more will be operational but results will not cross over to CRIS. ATV is not operational,

use NIH-54 manual form.

• POIS and SIS Web are not available during the down. You will not be able to submit OR case in SIS Web. To

request an emergency surgical procedure, please use NIH-2891 manual form. During Business hours:

Please call the front desk of the Operating Room (OR) if you need to schedule an OR case. If clinical

documentation from POIS is needed please call the OR (Mon. - Fri. 7:00 am – 3:30 pm). After hours:

Contact the DPM Surgical On call team via the page operator.

• Omnicell and PYXIS will be functional but ADT information will not be updated. Please admit by hand per

manual procedure. Medication orders manually placed or discontinued during the Downtime will not

pdated at the Omnicell cabinet and Anesthesia Workstations. Medication orders entered and verified by

Pharmacy prior to the Downtime will be accessible from the cabinet. Emergency medications may be

removed using the override process at the cabinet.

• Enterprinse Scheduling is not available. Use Form NIH 2955 to request a patient appointment.