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Policy QIMMI04011.

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Department of Microbiology
Quality Manual
Section: LIS Downtime and System Maintenance Subject Title: Downtime Procedures Department of
Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 17, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

Microbiology Downtime Manual

1.0 PURPOSE.............................................................................................................................................3

2.0 INTRODUCTION...................................................................................................................................3

3.0 DOWNTIME PLANNING DOCUMENTS.....................................................................................3


3.1 USER DOWNTIME PROCEDURES..............................................................................................................3
3.2 COMMUNICATIONS/ESCALATION PLAN...................................................................................................4
3.3 HP/INFORMATICS RECOVERY PROCEDURES...........................................................................................4
3.4 EVALUATION OF THE DOWNTIME PROCEDURE.......................................................................................4
4.0 DEFINITIONS....................................................................................................................................4
4.1 SCHEDULED DOWNTIME.........................................................................................................................4
4.2 UNSCHEDULED DOWNTIME.....................................................................................................................4
4.3 HP...........................................................................................................................................................4
4.4 CUSTOMER CARE CENTRE......................................................................................................................5
4.5 SYSTEM COMPONENTS............................................................................................................................5
5.0 DOWNTIME PROCEDURES FOR HIS SYSTEMS (CERNER, MEDITECH OR MYSIS-EPR) 6
5.1 PURPOSE..................................................................................................................................................6
5.2 DOWNTIME POLICY.................................................................................................................................6
5.3 SYSTEM DESCRIPTIONS...........................................................................................................................6
5.4 DOWNTIME PROCEDURES GRID..............................................................................................................6
5.5 DESCRIPTION OF DOWNTIME PROCEDURES............................................................................................7
5.5.1 AA Mysis-EPR order that has been accessioned by SMC. Cerner or Meditech order that has been
received....................................................................................................................................................7
5.5.2 AB Mysis-EPR order that has not been accessioned by SMC. Meditech order that was not transmitted.
A stat Cerner order that must be ordered and collected manually..........................................................7
5.5.3 AC Results Reporting......................................................................................................................8
5.6 RECOVERY PROCESS...............................................................................................................................8
5.6.1 AA Mysis-EPR order accessioned by SMC, Cerner or Meditech order that has bee received.......8
5.6.2 AB Mysis-EPR order that has not been accessioned by SMC. Meditech order that was not transmitted
and a stat Cerner order that must be ordered and collected manually....................................................9
5.6.3 AC Results Reporting......................................................................................................................9
6.0 DOWNTIME PROCEDURES FOR HEALTHLINK INTERFACE ENGINE(S)...........................10
6.1 PURPOSE................................................................................................................................................10
6.2 DOWNTIME POLICY...............................................................................................................................10
6.3 SYSTEM DESCRIPTIONS.........................................................................................................................10
6.4 DOWNTIME PROCEDURES GRID............................................................................................................11
6.5 DESCRIPTION OF DOWNTIME PROCEDURES..........................................................................................11
6.5.1 BA HIS orders................................................................................................................................11
6.5.2 BB Results Reporting.....................................................................................................................11
6.6 RECOVERY PROCESS.............................................................................................................................12
6.6.1 BA HIS orders...............................................................................................................................12
6.6.2 BB Results Reporting....................................................................................................................12

UNIVERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 2 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

7.0 DOWNTIME PROCEDURES FOR ORDER ENTRY INTERFACE..............................................12


7.1 PURPOSE................................................................................................................................................12
7.2 DOWNTIME POLICY...............................................................................................................................13
7.3 SYSTEM DESCRIPTIONS.........................................................................................................................13
7.4 DOWNTIME PROCEDURES GRID............................................................................................................13
7.5 DESCRIPTION OF DOWNTIME PROCEDURES..........................................................................................14
7.5.1 CA HIS orders...............................................................................................................................14
7.6 RECOVERY PROCESS.............................................................................................................................14
7.6.1 CA HIS orders...............................................................................................................................14
8.0 DOWNTIME PROCEDURES FOR HIS ADT INTERFACE...........................................................15
8.1 PURPOSE................................................................................................................................................15
8.2 DOWNTIME POLICY...............................................................................................................................15
8.3 SYSTEM DESCRIPTIONS.........................................................................................................................15
8.4 DOWNTIME PROCEDURES GRID............................................................................................................15
8.5 DESCRIPTION OF DOWNTIME PROCEDURES..........................................................................................15
8.5.1 DA ADT transactions....................................................................................................................15
8.6 RECOVERY PROCESS.............................................................................................................................16
8.6.1 DA HIS orders...............................................................................................................................16
9.0 DOWNTIME PROCEDURES FOR HIS RESULTS REPORTING INTERFACE........................17
9.1 PURPOSE................................................................................................................................................17
9.2 DOWNTIME POLICY...............................................................................................................................17
9.3 SYSTEM DESCRIPTIONS.........................................................................................................................17
9.4 DOWNTIME PROCEDURES GRID............................................................................................................17
9.5 DESCRIPTION OF DOWNTIME PROCEDURES..........................................................................................17
9.5.1 EA Results Reporting....................................................................................................................17
9.6 RECOVERY PROCEDURES......................................................................................................................18
9.6.1 EA1 and EA2.................................................................................................................................18
10.0 DOWNTIME PROCEDURES FOR LABORATORY INFORMATION SYSTEM......................19
10.1 PURPOSE..............................................................................................................................................19
10.2 DOWNTIME POLICY.............................................................................................................................19
10.3 SYSTEM DESCRIPTIONS.......................................................................................................................19
10.4 DOWNTIME PROCEDURES GRID..........................................................................................................19
10.5 DESCRIPTION OF DOWNTIME PROCEDURES........................................................................................20
10.5.1 FA Order Entry............................................................................................................................20
10.5.2 FB Results reporting...................................................................................................................20
10.6 RECOVERY PROCESS...........................................................................................................................21
10.6.1 FA Order entry.............................................................................................................................21
10.6.2 FB Results Reporting..................................................................................................................21

Department of Microbiology
UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 3 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

Instructions for Downtime

1.0 Purpose
The purpose of the downtime policies and procedures manual is to ensure that during all types
of downtimes, the Microbiology Department remains functional, no data is lost and the
recovery procedures have minimal impact on the organization.

2.0 Introduction
A downtime is any period of time when a computer information system is not available. This
includes scheduled downtimes (planned downtimes for system maintenance and upgrades)
and unscheduled downtimes (due to hardware/software failures).

The information systems at Mount Sinai Hospital are highly integrated. Interfaces exist
between the Hospital Information Systems (HIS) which are Cerner and Mysis-EPR, the
Laboratory Information System, SCC and the MDI Solutions and Courtyard Group Ltd.
interface engines. Downtimes can occur within Cerner, Mysis-EPR, one of the departmental
systems, or the interface between them. Downtimes in any of these areas likely to affect other
areas and the impact must be considered. Each area should have sufficient workarounds to
ensure continuity of services during a downtime.

An accurate record of all information related to a patients care must be maintained at all times.
In the event that a system is not available, information will be recorded manually on designated
forms. When the system becomes available, information captured manually will be entered
into the system in the recovery phase to ensure the retention of complete and accurate
information.

3.0 Downtime Planning Documents


The Downtime Plan consists of three main documents:
User Downtime and Recovery Procedures
Communication/Escalation Plan
HP/Informatics Recovery Procedures
Evaluation of Downtime Plan

3.1 User Downtime Procedures


Upon notification that a system is down, or when users find they cannot access a system, they
must implement the User Downtime Procedures. These procedures describe what actions to
take to continue operations using paper-based or other alternative processes. User Downtime
Procedures do not describe how to alert HP of a problem, nor explain how to diagnose or fix
the problem. They only describe what to do in the absence of the system. Upon notification
that the system is available, users must implement the recovery phase of the User Downtime

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
controlled and should be checked against the document (titled as above) on the server prior to use

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 4 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

Procedures. The intended audience for User Downtime Procedures includes departmental
managers, application specialists and system users.

3.2 Communications/Escalation Plan


All notification of system failures must be made to the HP Customer Care Centre (Helpdesk) at
Extension 4357. Upon notification of a problem, HP will initiate the escalation plan to alert the
appropriate technical staff to respond to the problem, to update users, and to notify users when
the system is once again available. The Escalation Procedures include a predefined list of
messages for communication to users to ensure that they understand the impact and which
downtime procedure to implement.
The intended audience for the Escalation Procedures is the staff of the Customer Care Centre.

3.3 HP/Informatics Recovery Procedures


HP maintains a separate Disaster Recovery Plan to coordinate staff responsibilities in
responding to a system failure, and to provide the necessary information to speed the recovery
phase. This plan is triggered by notification of a failure via the Escalation Procedures, and
ends when the recovery team notifies the Customer Care Centre that the problem is resolved.
The intended audience for the HP Disaster Recovery Plan is HP and MSH Informatics staff.

3.4 Evaluation of the Downtime Procedure


An important part of downtime planning is evaluation of the event in downtime. Debriefing of
the event is important to evaluate the strengths and weaknesses of the procedure.

4.0 Definitions

4.1 Scheduled Downtime


Scheduled downtime is defined as a planned period of time when the system is unavailable for
use. These are scheduled during a time when the system usage is low to minimize impact on
end users. The established downtime window for all clinical applications may commence
23:30 hrs on the third Wednesday of the month until the 03:30 hrs of the third Thursday of the
month as approved by the Technical Advisory Board (TAB) and the Change Advisory Board
(CAB). Scheduled downtimes are used for updating the sytem with new hardware/software
releases, fixes, or enhancements. User Downtime Procedures for scheduled downtimes are
essentially the same as for unscheduled downtimes, but may involve some preparation before
the downtime that could not be done if the downtime were not expected ahead of time.

4.2 Unscheduled Downtime


Unplanned failures caused by power failures, software problems, or hardware problems.

4.3 HP
Shared Information Management Services (SIMS) provides technical support for Mount Sinai
Hospital and the University Health Network (UHN).

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 5 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

4.4 Customer Care Centre


The Customer Care Centre provides Helpdesk support for desktop PCs and serves as a
central point of contact for notification of any problem related to the computer systems. The
Customer Care Centre service is provided by Compaq Canada, and is reached by dialing
Extension 4357.

4.5 System Components


The microbiology department has identified 6 sets of downtime procedures. Each will be
accessed separately.

Table 2
A B C D E F
Components HIS Healthlink HIS order HIS ADT HIS LIS
(Mysis- Interface entry (Cerner or results
EPR engine (Mysis- Mysis- reporting
Cerner or EPR, EPR) (Cerner,
Meditech) Cerner or Mysis-
Meditech) EPR or
Meditech)

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 6 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

5.0 Downtime Procedures for HIS Systems (Cerner, Meditech or Mysis-EPR)

5.1 Purpose

The purpose of the HIS downtime procedures is to ensure that orders from the HIS (Cerner,
Meditech or Mysis-EPR, ) continue to be processed and results from the LIS are sent out to the
facility whose HIS (Cerner, Meditech or Mysis-EPR) is down and no data is lost.

5.2 Downtime Policy

In the event of one or more of the HIS systems going down, the Microbiology Department will
continue to facilitate the entry of orders from the facility(s) into the LIS. Results will be phoned,
faxed, printed or hand delivered to the facility (MSH, UHN or Rouge Valley) where the HIS is
unavailable.

5.3 System Descriptions

HIS is used
To send orders from the inpatient and outpatient wards from all of the facilities to the LIS.
Orders are placed in Cerner, Meditech or Mysis-EPR. For Mysis-EPR, the specimens are
ordered and sent to the Specimen Management Center (SMC) where they are
collected/accessioned. The act of accessioning sends an order to the LIS. The specimens
are sent from SMC to the Microbiology Department. For Cerner, the specimens are
ordered which sends an order to the LIS. When the specimen is collected, the collection
date and time is updated. Specimens are brought to the lab. For Meditech, the specimens
are ordered collected and sent to the labs at Rouge Valley. Once ready a batch
transmission is sent to the LIS and the specimens arrive by courier.
To send ADT transactions to the LIS as patients are admitted, discharged or transferred
within both MSH and UHN. ADT transactions are not received from Rouge Valley.
To send results from the LIS to the HIS (Cerner Meditech or Mysis-EPR)

5.4 Downtime Procedures Grid

A B C D E
Stage System Mysis-EPR HIS order Results
Time period order/acce no SMC reporting
ssioned by accessio
SMC or n or
Cerner and Cerner or
Meditech Meditech
order recd order not
received
1 Less than 1 hour AA1 AB1 AC1
2 After 1 hour AA1 AB2 AC1
UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 7 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

3 After 24 hours AA1 AB3 AC2


4

5.5 Description of Downtime Procedures

5.5.1 AA Mysis-EPR order that has been accessioned by SMC. Cerner or Meditech
order that has been received.

AA1 For Mysis-EPR, the downtime occurred between accessioning by SMC and the arrival of
specimens in the microbiology lab. For Cerner, downtime occurred after the order was placed
but the specimen has not been received in the lab. For Meditech, the downtime occurred after
the batch transmission was sent but the specimen has not arrived by courier.
The specimens are received as usual in the LIS.

5.5.2 AB Mysis-EPR order that has not been accessioned by SMC. Meditech order that
was not transmitted. A stat Cerner order that must be ordered and collected
manually.

The Mysis-EPR downtime occurred between specimen collection and the arrival of the
specimens at SMC. The Meditech downtime occurred after the order was placed and
specimen collected but prior to the batch transmission for Meditech. A stat Cerner specimen
would be sent with a requisition.

AB1 Immediately

All un-accessioned specimens from Ulitcare are sent to the Microbiology Lab. The specimens
are held refrigerated for up to one hour. No other action is taken.
All non-transmitted specimens from Meditech are held by the facilities until the system is back
up. The stat Cerner specimen would be entered manually into the LIS and follow the
procedures under AB3.

AB2 After 1 hour


Mysis-EPR only:

1. Blood cultures: keep a list of specimens with patient name, MRN, HIS number and bottle
ID. Incubate off line in incubator. If the HIS is not back up, one hour before the lab closes,
load bottles in the Bact/Alert by scanning the bottle ID.
2. All other specimens: use the HIS specimen number for labeling plates and smears during
planting. Save the specimens in a separate basket for recovery.
3. Specimens that arrive with requisitions with complete patient information (MRN and visit #),
generate the order in the LIS.

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 8 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

4. Specimens that arrive with requisitions with incomplete patient information, use an internal
numbering system. Place the internal lab number on the requisition and plant the
specimens.

AB3 After 24 hours

All specimens will arrive in the microbiology laboratory with requisitions. The patient
information on the requisition may be complete because the patient is already registered in the
HIS or incomplete because the patient has just been admitted and the HIS is down.

1. For those patients who are registered (MRN and visit #), generate the order in the LIS.
2. For those patients without a MRN and/or visit number, use an internal numbering system.
Place the internal lab number on the requisition and plant the specimens.

5.5.3 AC Results Reporting

AC1 Immediate and after 1 hour

No change. Call Critical results and force print important results to fax, print or deliver at the
technologists discretion.

AC2 After 24 hours

1. Notify the LIS officer to activate a print run in the LIS.


2. Print LIS reports for appropriate status of culture results.
3. For UHN, the secretary will fax/send printed reports to ward, clinic or office. For MSH,
reports can be printed on inpatient wards and clinics and outpatient wards will be delivered.
For Rouge valley, the reports can be automatically faxed or delivered.

5.6 Recovery Process

5.6.1 AA Mysis-EPR order accessioned by SMC, Cerner or Meditech order that has bee
received.

AA1 No action required

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 9 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

5.6.2 AB Mysis-EPR order that has not been accessioned by SMC. Meditech order that
was not transmitted and a stat Cerner order that must be ordered and collected
manually.

AB1 Immediately

Take specimens from storage, receive in LIS and plant as usual. Specimens will arrive from
Rouge valley and a batch transmission will have been sent.

AB2 After 1 hour


Mysis-EPR only:

1. For all specimens: accession the specimen in the HIS, receive the specimen in the LIS and
re-label plates, smears and blood culture bottles with the LIS order number.
2. Blood cultures: for bottles incubated off-line, label and load bottles as usual. For bottles
loaded by bottle ID, re-label bottle and use quick data entry in the Bact/Alert to attach the
order to the corresponding bottles.
3. For those specimens received with requisitions containing complete patient information, no
action is required.
4. For those specimens received with requisitions with incomplete information, generate an
order in the LIS and re-label plates.

AB3 After 24 hours

1. For those specimens received with requisitions containing complete patient information, no
action is required.
2. For those specimens received with requisitions with incomplete information, generate an
order in the LIS and re-label plates.

5.6.3 AC Results Reporting

AC1 and AC2

Results will queue on the interface engine and as soon as the HIS is up, they will post to the
HIS.

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 10 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

6.0 Downtime Procedures For Healthlink Interface Engine(s)

6.1 Purpose

The purpose of the interface engine downtime procedures is to ensure that orders from the HIS
(Cerner, Meditech or Mysis-EPR) continue to be processed and results from the LIS are sent
out to the facility whose HIS (Cerner, Meditech or Mysis-EPR) is down and no data is lost.

6.2 Downtime Policy

In the event of the interface engine(s) going down, the Microbiology Department will continue
to facilitate the entry of orders from all facilities into the LIS. Results will be phoned, faxed,
printed or hand delivered to the facility (MSH, Rouge valley or UHN) when the interface engine
is down.

6.3 System Descriptions

Healthlink Interface Engine is used:


As part of the link sending orders from the inpatient and outpatient wards from MSH,
Rouge valley and UHN to the LIS. Orders are placed in Cerner, Meditech or Mysis-EPR.
For Mysis-EPR, the specimens are collected and sent to the Specimen Management
Center (SMC) where they are accessioned. The act of accessioning sends an order
through the datagate interface engine to the LIS. The specimens are sent from SMC to the
Microbiology Department. Batch transmissions from Meditech are received through the
datagate interface engine to the LIS. When orders are placed the transmission is passed
to the LIS via the cloverleaf interface engine.
As part of the link sending ADT transactions to the LIS as patients are admitted, discharged
or transferred within both MSH and UHN. The interface engine between Cerner (MSH) and
the LIS is HCI and the engine between Mysis-EPR (UHN) and the LIS is datagate.
As part of the link sending results from the LIS to the HIS (Cerner, Meditech or Mysis-EPR)

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 11 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

6.4 Downtime Procedures Grid

A B C D E
Stage System HIS Results
Time period orders reportin
g

1 Less than 1 BA1 BB1


hour
2 After 1 hour BA2 BB1
3 After 24 hours BA2 BB2
4

6.5 Description of Downtime Procedures

6.5.1 BA HIS orders

BA1 Immediately

The specimens are ordered and accessioned in Cerner, Meditech or Mysis-EPR but no LIS
order is generated. Transactions are queued to the interface engine. No action is taken.
Specimens are stored appropriately.

BA2 After 1 hour

1. Blood cultures: keep a list of specimens with patient name, MRN, HIS number (Meditech
and Mysis-EPR) or internal lab number (Cerner) and bottle ID. Incubate off line in incubator.
If the HIS is not back up, one hour before the lab closes, load bottles in the Bact/Alert by
scanning the bottle ID.
2. All other specimens: use the HIS specimen number (Mysis-EPR or Meditech) or an internal
lab number (Cerner) for labeling plates and smears during planting. Save the specimens in
a separate basket for recovery.

6.5.2 BB Results Reporting

BB1 Immediate and after 1 hour


UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 12 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

No change. Call Stat and critical results and force print important results to fax, print or deliver
at the technologists discretion.

BB2 After 24 hours

1. Notify the LIS officer to activate a print run in the LIS.


2. Print LIS reports for appropriate status of culture results.
3. For UHN, the secretary will fax/send printed reports to ward, clinic or office. For MSH,
reports can be printed on inpatient wards and clinics and outpatient wards will be delivered.
For Rouge valley, the reports can be automatically faxed or delivered.

6.6 Recovery Process

6.6.1 BA HIS orders

BA1 No action required. As soon as the interface engine recovers, the order will be generated
in the LIS automatically.

BA2 Orders will still have queued and will be passed to the LIS as soon as the engine is back
up. The orders should be received in the LIS and the plates and smears re-labeled with the LIS
order numbers.

6.6.2 BB Results Reporting

BB1 and BB2

Results will queue to the interface engine and as soon as the engine is up, they will post to the
HIS

7.0 Downtime Procedures For Order entry Interface

7.1 Purpose

The purpose of the order entry downtime procedures is to ensure that orders from the HIS
(Mysis-EPR, Cerner and Meditech) continue to be processed and no data is lost.

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
controlled and should be checked against the document (titled as above) on the server prior to use

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 13 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

7.2 Downtime Policy

In the event of the order entry interface going down, the Microbiology Department will continue
to facilitate the entry of orders from all facilities into the LIS.

7.3 System Descriptions

The order entry interface is used:


To send orders from the inpatient and outpatient wards from UHN to the LIS. Orders are
placed in Mysis-EPR. The specimens are collected and sent to the Specimen
Management Center (SMC) where they are accessioned. The act of accessioning sends
an order through the datagate interface engine to the LIS. The specimens are sent from
SMC to the Microbiology Department. Batch transmissions from Meditech for Rouge valley
are sent through the datagate interface engine to the LIS. An order placed in Cerner will
send a transmission through the cloverleaf interface engine to the LIS.

7.4 Downtime Procedures Grid

A B C D E
Stage System Order
Time period entry
1 Immediate CA1
2 After 1 hour CA2
3
4

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 14 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

7.5 Description of Downtime Procedures

7.5.1 CA HIS orders

CA1 Immediately

The specimens are ordered and accessioned in Mysis-EPR, ordered in Cerner or a batch
transmission is sent from Meditech but no LIS order is generated. Transactions are queued to
the interface engine. No action is taken. Specimens are stored appropriately.

CA2 After 1 hour

1. Blood cultures: keep a list of specimens with patient name, MRN, HIS number (Meditech or
Mysis-EPR) internal number (Cerner) and bottle ID. Incubate off line in incubator. If the HIS
is not back up, one hour before the lab closes, load bottles in the Bact/Alert by scanning
the bottle ID.
2. All other specimens: use the HIS specimen number (Meditech or Mysis-EPR) or the
internal lab number (Cerner) for labeling plates and smears during planting. Save the
specimens in a separate basket for recovery.

7.6 Recovery Process

7.6.1 CA HIS orders

CA1 No action required. As soon as the interface is back up, the orders will be generated in the
LIS automatically.

CA2 Orders will still have queued and will be passed to the LIS as soon as the interface is
back up. The orders should be received in the LIS and the plates and smears re-labeled with
the LIS order numbers.

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
controlled and should be checked against the document (titled as above) on the server prior to use

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 15 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

8.0 Downtime Procedures For HIS ADT interface

8.1 Purpose

The purpose of the HIS admission, discharge and transfer (ADT) interface downtime procedure
is to ensure that updates from the HIS (Mysis-EPR at UHN and Person Management at MSH)
continue to be processed when the interface is down and no data is lost.

8.2 Downtime Policy

In the event of the HIS ADT interface going down, the Microbiology Department will continue to
facilitate the entry of orders from UHN and MSH into the LIS.

8.3 System Descriptions

The ADT interface is used:


To send ADT transactions to the LIS as patients are admitted, discharged or transferred
within both MSH and UHN.

8.4 Downtime Procedures Grid

A B C D E
Stage System ADT
Time period
1 Immediate DA1
2 After 1 hour DA2
3
4

8.5 Description of Downtime Procedures

8.5.1 DA ADT transactions

DA1 Immediately

For specimens from UHN:


The ADT interface when it is down affects a small percentage of orders. Only when the
admission transmission has not been received by the LIS will the LIS order not be generated
from the HIS to the LIS. For these few specimens, no action is taken. Specimens are stored
appropriately.

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
controlled and should be checked against the document (titled as above) on the server prior to use

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 16 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

For specimens from MSH:


Look up the patient information in the HIS and manually enter the information into the LIS and
complete the order.

DA2 After 1 hour

For UHN for the few specimens that are affected:


1. Blood cultures: keep a list of specimens with patient name, MRN, HIS number and bottle
ID. Incubate off line in incubator. If the HIS is not back up, one hour before the lab closes,
load bottles in the Bact/Alert by scanning the bottle ID.
2. All other specimens: use the HIS specimen number for labeling plates and smears during
planting. Save the specimens in a separate basket for recovery.

8.6 Recovery Process

8.6.1 DA HIS orders

DA1 Immediately

For UHN: No action required. As soon as the interface is back up, the ADT transactions and
the orders will be generated in the LIS automatically.

DA2 After 1 hour

For UHN: ADT transactions and orders will still have queued and will be passed to the LIS as
soon as the interface is back up. The orders should be received in the LIS and the plates and
smears re-labeled with the LIS order numbers.

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
controlled and should be checked against the document (titled as above) on the server prior to use

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 17 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

9.0 Downtime Procedures For HIS Results Reporting Interface

9.1 Purpose

The purpose of the results reporting interface downtime procedures is to ensure that results
from the LIS are sent out to the facility whose HIS (Cerner, Meditech or Mysis-EPR) is down
and no data is lost.

9.2 Downtime Policy

In the event of the results reporting interface going down, the Microbiology Department will
continue to ensure that results willl be phoned, faxed, printed or hand delivered to the
appropriate facility (MSH, Rouge valley or UHN).

9.3 System Descriptions

The results reporting interface is used:


To send results from the LIS to the HIS (Cerner, Meditech or Mysis-EPR)

9.4 Downtime Procedures Grid

A B C D E
Stage System Order
Time period entry
1 Immediate EA1
2 After 24 hour EA2
3
4

9.5 Description of Downtime Procedures

9.5.1 EA Results Reporting

EA1 Immediate

No change. Call Stat and critical results and force print important results to fax, print or deliver
at the technologists discretion.
UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 18 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

EA2 After 24 hours

1. Notify the LIS officer to activate a print run in the LIS.


2. Print LIS reports for appropriate status of culture results.
3. For UHN, the secretary will fax/send printed reports to ward, clinic or office. For MSH,
reports can be printed on inpatient wards and clinics and outpatient wards will be delivered.

9.6 Recovery Procedures

9.6.1 EA1 and EA2

Results will queue to the interface and as soon as it is up, they will post to the HIS.

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
controlled and should be checked against the document (titled as above) on the server prior to use

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 19 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

10.0 Downtime Procedures For Laboratory Information System

10.1 Purpose

The purpose of the LIS downtime procedures is to ensure laboratory orders from MSH, Rouge
valley and UHN are processed in a timely manner and that results from the LIS are sent out to
MSH and UHN while the LIS is down and no data is lost.

10.2 Downtime Policy

In the event of the LIS going down, the Microbiology Department will continue to ensure that
orders will be processed and Stats and critical results are phoned to the appropriate facility
(MSH, Rouge valley or UHN).

10.3 System Descriptions

The LIS is used:


To track, record, result and report all aspects of microbiology and related processes.
Serology activities are processed in SoftLab both manually and through an interface with
the Axsym.
Routine C&S, mycology, TB, parasitology, virology are processed in the SoftMic module
with interfaces to the Bact/Alert and Vitek.
On line QC is processed in the Lab QC module and the MicQC module.
Access to the LIS is provided through the security module
The workload module captures processes and provides reports.
Patient costing is output to an access database through ODBC and provided to Decision
Support.

10.4 Downtime Procedures Grid

A B C D E
Stage System Order Results
Time period entry reportin
g
1 Immediate FA1 FB1
2 After 1 hour FA2 FB2
3 After 5 hours FA3 FB3
4

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 20 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

10.5 Description of Downtime Procedures

10.5.1 FA Order Entry

FA1 Immediately

No action is taken. Store all specimens appropriately. Continue with all processes that do not
require the use of the LIS.

FA2 After 1 hour

1. For specimens with an Mysis-EPR or Meditech number, use the HIS specimen number to
label the plates and smears. Save the specimens in a separate basket for recovery. For
Cerner orders with an LIS number, process as usual.
2. For specimens received with a requisition, use an internal lab number. Label the
requisition, plates and smears with the internal number.
3. During the downtime, the LIS officer will be in frequent communication with the LIS vendor.
As the downtime approaches 5 hours, a decision will be made to switch to the auxiliary
system after approximately 5 hours of downtime.

FA3 After 5 hours

1. Specimens already planted using the Mysis-EPR or Meditech number will now have orders
generated in the LIS. These orders will need to be received and plates and smears
relabeled with the LIS labels.
2. Specimens received with a requisition, can be reordered in the LIS and the requisition,
plates and smears relabeled with the LIS numbers.
3. All new orders can be processed as usual.
4. Once the main system is fixed, there will be another period of downtime while all
transactions on the auxiliary system are passed back to the main system for catch up.
During this shorter period of downtime, procedures 1 and 2 from FA2 will have to be
instituted again.

10.5.2 FB Results reporting

FB1 Immediately

No action is taken. All Stats and critical results are phoned and documented.

FB2 After 1 hour


UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 21 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

1. All technologists will be issued blank requisitions which will be numbered from the plates as
they are read.
2. All observations and test results will be written on the backs of the requistions.
3. All Stats and critical results will be phoned and documented.

FB3 After 5 hours

1. Once the auxiliary system is functioning, all results can be entered into the LIS.
2. The results documented on requisitions will have to be re-entered into the LIS.
3. Results that file back to the HIS(S) will be automatically sent out.
4. The LIS officer(s) will manually print other print runs for distribution of reports to the wards.
5. During the switch back to the main system, all necessary observations, test results and
phoned results will need to be recorded again on paper.

10.6 Recovery Process

10.6.1 FA Order entry

FA1 Immediate

No action required

FA2 and FA3

1. All specimens from Mysis-EPR and Meditech that have not been received in the LIS from
the main downtime and all from the downtime for the switch back to the main box will have
to be received in the LIS and the plates and smears re-labeled.
2. All specimens received on requisitions that have not had orders generated in the LIS from
the main downtime and all from the downtime for the switch back to the main box will need
orders generated in the LIS and the plates and smears re-labeled.

10.6.2 FB Results Reporting

FB1 Immediate

No action required.
UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

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TML/MSH Department of Microbiology Quality Policy QIMMI04011.03 Page 22 of 22
Manual
Section: LIS Downtime and System Subject Title: Downtime Procedures Department of
Maintenance Microbiology
Prepared by: LIS Committee Original Date: October 22, 2008
Issued by: Laboratory Information System Revision Date: June 15, 2010
Approved by: Laboratory Director Annual Review Date: May 31, 2013

FB2 and FB3

1. All observations and test results that have not been re-entered into the LIS must be
completed.
2. All results will have queued up and will be transmitted automatically to the HIS.
3. The LIS officers will follow up on any outstanding print runs and manually print the reports
for distribution.

UNIV ERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY

NOTE: This is a CONTROLLED document. Any documents appearing in paper form that are not stamped in red "MASTER COPY" are not
controlled and should be checked against the document (titled as above) on the server prior to use

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