Healthcare // Electronic Health Records
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8/15/2014
09:45 AM
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Practice Fusion EHR Caught In Internet Brown-Out

Free electronic health record software provider says its cloud system is up again after two days of outages that affected up to one-third of its clients.

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A number of small physician practices and clinics sent home patients and staff after cloud-based electronic health record provider Practice Fusion's site was part of a global two-day outage.

On Thursday, Practice Fusion wrote on its Facebook page that its datacenter partner had completed the upgrades necessary "to address widespread global connectivity network access problems that impacted Practice Fusion over the last 48 hours." About 35% of customers were affected on Tuesday; Practice Fusion did not disclose Wednesday's outage statistics to InformationWeek. The company took its EHR offline on Wednesday night to allow the upgrade and network resilience testing, and then turned the free EHR software back on today, it said. A Thursday afternoon check of IsItDownRightNow confirmed Practice Fusion's site was operational.

"Practice Fusion is one of several companies impacted by the global Internet brown-out, which started Tuesday," a Practice Fusion spokeswoman said in an email interview. "As a result of this brown-out, a subset of our customers had intermittent access to the EHR on Tuesday and Wednesday of this week. The recent connectivity issue that affected Practice Fusion's EHR has been addressed. That said, we believe the larger Internet brown-out issues recently reported have not been fully felt nor resolved. We are monitoring the situation closely with our data center partner to address any other issues that may arise."

[Big players are moving to take advantage of Apple's EHR integration software. Read Apple HealthKit Details Emerge.]

The developer blamed a global network brownout, citing news reports that the Internet is near or beyond 512,000 Internet routes. The servers that send Internet data across networks carry these routes, but older routers from various vendors won't add more routes without tweaks, Fox Business News said. To resolve this problem, engineers must increase the router's memory cap and reboot the device, Fox wrote. But unless IT professionals complete this manual process, routers left online can become overloaded and slow down Internet access times for users everywhere, the article said.

Those larger issues also apparently affected sites such as hosting provider LiquidWeb, which also blamed 512K for its downtime on Tuesday, Ars Technica reported. In addition, eBay, Comcast, and Time-Warner had outages, the article said. Cloud-based outages are comparatively rare, and the benefits outweigh these instances, said Rafi Sweary, president of WalkMe, via email.

"Service interruptions existed long before the cloud did, and even predated computers and the Internet in general. Periodic interruptions, caused by a diverse range of factors, have always impacted services from electricity to mail, and beyond," he said. "The Internet age before cloud computing actually had more technical problems than now. So we don't see this rare interruption affecting cloud adoption."

Cloud-based EHR PracticeFusion is accessible via multiple devices, including iPad. (Source: PracticeFusion)
Cloud-based EHR PracticeFusion is accessible via multiple devices, including iPad. (Source: PracticeFusion)

Medical offices accustomed to running their operations on Practice Fusion quickly turned to social media and other websites to voice both concerns and support.

Because the practice was unable to access its EHR, one Texas provider sent employees home, the office manager posted online. A New York pediatric office could not see any files on Wednesday, including the schedule, another healthcare professional said.  

Some complained about support and communication.

Practice Fusion "customer service is terrible now. Took them over seven hours to say they were having issues. We have been offline all day long. Terrible and no reason for it," wrote William Kniss on Facebook.

Added Jamie Little via Twitter: "I am not patient! Every other website works fine. The fault is with you, not the Internet. Get with it! You are hurting patient outcomes!"

It appeared an almost equal number of socially active customers voiced support for the developer of free EHR software and offered recommendations for improving the service and users' access to off-line data.

"Computer problems can happen to anyone, even if we used our own servers in our offices... I do not blame Practice Fusion for that. However, we would always have multiple redundant back ups of the data so if anything happened to our office we could set up shop elsewhere and be ok in a day or [two]," said Al Musella on Practice Fusion's Facebook page. 

Any EHR product, cloud-based or on site, can encounter problems, said Michelle Hellwig on Facebook: "I've been with them for 3 1/2 years and had a total of four hours of unplanned down time. How many other EHRs, free or expensive, can say that?"

Practice Fusion not only provided updates, but also gave customers suggested workarounds, said WalkMe's Sweary.

"In this specific case it is also should be noted that Practice Fusion responded extremely well, providing their customers with clear and consistent updates over the last few days, including information about alternative ways for users to connect to their EHRs, as well as updates about maintenance to their data center, and when their systems would be running again," he said. "From our experience, Practice Fusion provides an exemplary online experience for their customers, and they did that here."

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Alison Diana has written about technology and business for more than 20 years. She was editor, contributors, at Internet Evolution; editor-in-chief of 21st Century IT; and managing editor, sections, at CRN. She has also written for eWeek, Baseline Magazine, Redmond Channel ... View Full Bio

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Alison_Diana
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Alison_Diana,
User Rank: Author
8/19/2014 | 9:57:58 AM
Additional Statement from Practice Fusion
"Last week, Practice Fusion's platform was never down but its third party data center provider, QTS, experienced 512K issues with their primary and secondary networking equipment" - according to the same company spokeswoman.

Me again: The cause of the brown-out seems to have been the 512K issues, but I think most people say a site is down when they can't access it, whether that's strictly accurate or not. 
Alison_Diana
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Alison_Diana,
User Rank: Author
8/18/2014 | 11:49:55 AM
Re: Cloud Beats Alternative
You bring up a lot of great points. I can only imagine how patients felt -- perhaps after waiting for weeks or months for an appointment, perhaps running out of critical medications or feeling awful -- when appointments were canceled on the same day as service. The idea of a paper or local backup makes a ton of sense. It does seem that Practice Fusion (and no doubt other cloud EMR developers) either currently or will soon allow providers to access their data offline. By saving that data in a couple of locations, providers should be able to access information even if their network or their EMR provider's network goes down. Regarding keeping paper records, that might be too onerous, given the manhours and money required to maintain both paper and electronic. 

Would love to hear from any practices that take this belt and suspenders approach and whether it's come in handy during a network outage (of any cause)?
moarsauce123
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moarsauce123,
User Rank: Ninja
8/16/2014 | 10:07:11 AM
Re: Cloud Beats Alternative
No matter if cloud or non-cloud, everyone relying on systems needs to have a "plan B". It always annoys me to no extent when my bank refuses to give me my money because "the computers are down". Seriously? That is when you take the ledger out and account by hand. This is how the Fugger family started and banks after them operated for centuries. Why have anyone sit at the counter when they aren't even capable of the most basic form of banking?

In health care a valid reason to not see patients is that there are no doctors available, either because there is no doctor there or they are swamped. If a computer system is that essential then you need to have at least one backup plan ready at all times. Write down the patient's information, make a copy of their insurance card, and then tell them the doctor will see you shortly. Once the system is available again type the records in. That not only helps the people coming in, it will also get the place paid.

Have we come that far that computers rule everything causing folks to lose focus from what really matters?
Alison_Diana
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Alison_Diana,
User Rank: Author
8/15/2014 | 2:25:29 PM
Cloud Beats Alternative
Reached after deadline, office manager Kayla Winter told me: "Fortunately, we did not have clinic on Wednesday and that was the only day I was down. I did send the staff home because there was no use in them sitting on the clock. Yes, we do plan on staying with PF barring this is not a regular occurrence. I'm sure you know it's quite an undertaking trying to move data from one EHR to another and this hopefully was an isolated incident. We have been on a non cloud based system and had way more trouble so no, this will not deter me from cloud based systems."

 
Alison_Diana
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Alison_Diana,
User Rank: Author
8/15/2014 | 2:24:17 PM
Re: Cloud versus closet
Looking at Practice Fusion's social media posts during the outage, the company updated pretty frequently and provided links to educate users on what they said was the underlying cause of the brown-out. Of course, when lots of people flood support phone lines, many companies cannot keep up with the unexpected surge in usage (which is something several online commenters said was the case at Practice Fusion). Not sure whether PF used some kind of automated message to let users know they were working on the problem, but that's one first line of support and communication in these cases.
Laurianne
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Laurianne,
User Rank: Author
8/15/2014 | 1:34:53 PM
Re: Cloud versus closet
Customer support will make or break how cloud-based providers of many kinds weather outages. Customers may forgive vendors when service goes out, but they expect clear communication during the outage.
David F. Carr
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David F. Carr,
User Rank: Author
8/15/2014 | 10:40:40 AM
Cloud versus closet
For the small medical practice like Practice Fusion, the real question is whether a cloud based EHR would be more reliable than one in the server closet down the hall, with staff or a contractor to maintain it. In many cases, the answer is probably yes.

Of course, manilla folders rarely suffer brownouts.
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