Table 2.

Sample Questions and Recommendations to Help Health Care Organizations Get Started with the Contingency Planning SAFER Guide

Mitigation / Prevention	Key Questions	SAFER Recommendation	Key Stakeholders
Mitigation	Are paper forms available to replace key EHR functions (e.g., enter orders and document medications administered) during downtimes?	There should be preprinted paper forms to care for patients on an in-patient unit for at least 8 hours.	Nursing and pharmacy staff
Mitigation	Is there a communication strategy that does not rely on the computing infrastructure (e.g., paging or cell phones) for downtime and recovery periods?	The organization has a mechanisms in place to activate the read-only backup EHR system and notify clinicians how to access it and to notify clinicians when the EHR is back on-line.	IT, Administration, nursing staff
Prevention	Is hardware that runs applications critical to the organization’s operation is duplicated?	Large HCOs that provide care 24 hrs/day have a remote “warm-site” (i.e., a site with current patient data that can be activated in less than 8 hrs and a redundant path to the Internet.	IT, Administration
Prevention	Is there is a comprehensive testing and monitoring strategy in place to prevent and manage EHR downtime events?	The HCO routinely monitors and reports on system downtime events and response time.	IT, Administration, Clinicians