This page outlines the considerations with regards to business continuity in scenarios where Concentric is not able to be used as normal.
Most of our organisation deployments include demographics and document integration, with documents being viewed in theatre in the electronic health record (and/or document store), so this page will describe an approach to business continuity in that context. Please contact us to discuss the optimum approach in scenarios that are different to this.
There are a number of scenarios that can impact normal processes for the use of digital consent. These include:
- Concentric’s cloud deployment is down
- Integration issue to other systems
- Electronic Health Record is down
- Single Sign On login is down
The general principle followed is that there should be the minimum disruption to normal processes in each scenario, with a general preference hierarchy of:
- 1st: Concentric for episode management, with viewing of completed consent in the EHR
- 2nd: Concentric for episode management and viewing of completed consent
- 3rd: Paper consent fallback process
The process for incident alerting and suggestions around managing transitioning into and out of BCP processes are detailed below.
Concentric’s cloud deployment is down
This is generally the least likely scenario - we aim for 99.9% availability. When Concentric is down there are 2 scenarios to consider:
New or incomplete consent episodes
If Concentric is down and there are things that would need to be done in Concentric then the paper consent fallback process will need to be used.
Completed consent episodes
Where the consent episode has been completed in Concentric, for example following confirmation of consent, then the completed consent form PDF should be in the EHR store and can continue to be used as normal by ward and theatre teams.
Integration issue to other systems
The likelihood and duration of these issues are mostly dependent on the stability of internal organisation systems and the speed at which the client organisation’s technical team are able to resolve issues.
There are 2 scenarios to consider:
Demographic integration down
Demographic details are pulled from the patient database (i.e PAS) when required, creating a patient record within Concentric. Whenever that patient record is interacted with Concentric queries the patient database to check whether any demographic details have changed.
This means that if a patient number is searched for the first time in Concentric while the demographic integration is down (i.e there is no record for that patient in Concentric) then there is no way to proceed within Concentric and the paper consent fallback process will need to be used.
If Concentric does know about the patient then a warning message will be shown to state that the demographic details may be out of date as it has not been possible to check them on bringing up the patient record. As patient demographic details rarely change then it is usually appropriate to proceed within Concentric, but if you are aware that the patient demographics are different to what is shown in the patient banner then the paper consent fallback process will need to be used.
Document integration down
If the document integration is down then the end-to-end consent process moves to being within Concentric - i.e ward and theatre teams viewing the completed consent form PDF in Concentric rather than in the electronic health record / document store. Documents that have not been successfully sent by Concentric during the period of document integration being down will be sent once the integration is back working.
Electronic Health Record is down
If the organisation’s main EHR is down but Concentric and the relevant integrations are unaffected then the end-to-end consent process moves to being within Concentric - i.e ward and theatre teams viewing the completed consent form PDF in Concentric rather than in the electronic health record / document store.
Single Sign On login is down
If clinicians are required to use Single Sign On to log in to Concentric (e.g. ‘Log in with Microsoft’ or ‘Log in with NHSmail’ on the Concentric login page), and there is an issue with this provider, clinicians will be unable to access Concentric. Similarly to when there are issues with the Concentric cloud deployment, there are 2 scenarios to consider:
New or incomplete consent episodes
If there are things that need to be done in Concentric, including for new or incomplete consent episodes, then the paper consent fallback process will need to be used.
Completed consent episodes
Where the consent episode has already been completed in Concentric, for example following confirmation of consent, then the completed consent form PDF should be in the EHR store. Provided that clinicians are still able to access the EHR store (i.e. the issues with Single Sign On aren’t also affecting EHR store access), this can continue to be used as normal by ward and theatre teams.
Paper consent fallback process
Generally we do not advise that consent documentation is delayed until Concentric can be used, as this introduces a risk of consent not being completed appropriately or delaying clinical care. Therefore, a paper consent fallback process is generally put in place. Organisations will often arrange one or both of the following:
- Small number (less than 1 week supply) of paper consent forms, made available in the appropriate places (usually across a number of ‘Downtime Folders’)
- Template paper consent form within the organisation’s intranet that can be printed if required
Following a period of using the paper consent fallback process there generally needs to be a process for uploading completed consent forms into the EHR/document store as they would have been should they have been completed in Concentric. This is to both ensure there is no future confusion as to why there is no consent form documented digitally, and reduce the medico-legal risk of losing the paper consent form and not having a digital copy.
Alerting and transition to BCP
In order for the process of transitioning into and out of the business continuity plan to work smoothly there are two key elements:
- Robust processes are in place regarding when to transition into the BCP, what that entails to ensure that users are informed of what the correct process to follow is, and what the process is to transition out of the BCP back into normal operations.
- Appropriate alerting mechanisms are in place to alert the relevant people of incidents that may require transitioning into the BCP.
Transition in and out BCP
In terms of the process of transition in and out of BCP there are three things to consider:
- How will the relevant people be informed of the transition to BCP and reminded of what the correct process to follow is (and subsequently how are they informed of resolution and return to normal processes)
- What are the triggers for transitioning into BCP
- Who is responsible for coordinating and actioning resolution
Who to inform and how
When considering who the relevant people are, we generally consider all who need visibility of the change to BCP (i.e Concentric clinician users, theatre staff checking consent forms in the EPR, and others), and then Concentric clinician users themselves (i.e the clinicians who use the Concentric application itself as part of their workflow) as a specific subset of that whole.
All relevant people - This will usually be via the same mechanisms that the client organisation uses for other urgent messages. Mechanisms may be via the clinician communications application that the organisation uses or via desktop or EPR alerts.
Concentric users - With the exception of when Concentric is entirely down and not even the login page can be shown, Concentric will share status messages with the user regarding status and issues such as with the demographics integration.
When to inform and who to do so
We would advocate informing the relevant people as soon as practicable, without worrying much regarding transitioning only briefly into BCP processes.
There should be agreement within the client organisation regarding which role / group has responsibility to send the message out in a reasonable timeframe. This will often be managed by the internal service desk.
This applies to both transition into and out of BCP processes.
Who is responsible for coordinating and actioning resolution
The majority of issues require some input internally to resolve, which may be a Concentric specific fix, or a fix for a broader issue - for example the internal network is down affecting many systems including Concentric.
There needs to be agreement around the process of coordinating and actioning resolution, and the communication of this to users via the above described mechanisms.
This may involve different mechanisms ‘in-hours’ and ‘out-of-hours’, or a decision that internal issues are not actively worked on out-of-hours. When considering whether issues will be actively worked on out-of-hours it is worth noting that a large proportion of Concentric activity occurs between 7-9am.
Email alerting is in place to inform client organisations of issues that are visible to Concentric (there are often some integration issues that are outside of Concentric’s visibility, for example downstream document integration issues between a Trust Integration Engine and the EPR).
This is split into two pathways, ‘Concentric’s cloud deployment is down’ and ‘Integration issue to other systems’. Client organisations should consider who needs to be informed in both scenarios, the following are a guide:
Concentric’s cloud deployment is down:
- Project team
- Those who are responsible for informing users
- Service desk (as they may get queries directly from users)
Integration issue to other systems: (as above, with the addition of)
- Those who are responsible for coordinating and actioning resolution
As part of the deployment you should inform Concentric the contact details for each of these individuals/groups.
Other incident notification
Some incidents will become apparent via other mechanisms (most commonly involving document integration downstream from what is visible to Concentric) - this may be notified by users, or by technical teams who are aware of an issue with other systems that impact the consent process (for example in the EPR is down).
Both groups need visibility of who to contact should there be an issue that may require consideration of the BCP process. For clinician users the internal service desk is usually the point of contact and this should be communicated within the onboarding information shared. Similar processes as for other interdependent systems should be applied for technical teams, with details passed to those responsible for coordinating and actioning resolution and those responsible for sending messages out to users.
BCP process checklist
- Mechanism in place for sending messages out to all relevant people
- Clarity regarding who is sending out messages
- Process in place regarding coordinating and actioning resolution both in-hours and out-of-hours
- Concentric informed of all who need alerting regarding Concentric cloud or integration alerts
- Clinician onboarding information includes details regarding who to contact if there are issues
- Technical teams are aware of which systems may impact the consent process and know who to contact if there is an issue with a linked system.
Example copy for transition messages
Concentric - cloud deployment is down:
Concentric is temporarily down. For incomplete consent episodes please revert to paper consent. For complete consent episodes please continue to review the consent form PDF in the EPR. We will send another message when you can return to normal digital consent processes.
Concentric - demographics integration is down:
There is a temporary issue with the demographics integration with Concentric. For patients who have an existing record within Concentric you can continue to use Concentric unless you are aware the patient’s demographics have changed compared to what is shown in Concentric. For patients who do not have an existing record within Concentric please revert to paper consent. We will send another message when you can return to normal digital consent processes.
Concentric - document integration is down:
There is a temporary issue with the document integration with Concentric – i.e. the ingestion of consent form PDF’s back into the EPR. Please continue to use Concentric including viewing completed consent forms within Concentric rather than within the EPR. Consent forms not ingested into the EPR during this time will be ingested once the integration is back up. We will send another message when you can return to normal digital consent processes with viewing completed consent forms in the EPR.
EPR is down:
During this period of EPR downtime please continue to use Concentric. You can view completed consent forms within Concentric.