Island Health Staff Keep Calm and Carry on Through 8-hr. Planned Downtime

Posted on: March 20, 2024

The night of February 23 to 24 might have felt longer than usual for some staff on duty at Island Health, as a planned Cerner downtime (Code Grey) of eight hours had medical and clinical staff moving back to paper documents while all the Cerner systems moved to remote servers (known as Remote Hosting Option). Planning and plenty of communication with clinical and medical staff helped smooth the transition.

Danica Kay, interim Emergency Department manager at Victoria General Hospital looks back on what was a heavy workload night made better with advance planning, extra leadership, and on-site support.

"We organized a downtime room for all paperwork. Staff knew that I was the logistics person for the night so our charge nurse could deal with patients and flow," says Kay.

This was the first long, planned downtime since Cerner Millennium activations began in 2014. The servers that the Cerner system were running on were at the end of their lifespan, and Oracle Cerner required the system to be moved to their remote servers for their continued support. The new remote hosting platform provides Island Health with disaster recovery and tightened security as well as ongoing updates.

"Doctors and nurses said it was challenging to keep track of labs as they were spitting out all the time," Kay adds. “It was great to have Josh from medical imaging come and brief emergency room physicians on that process. Having all the phone numbers pre-printed for porters and others helped, and having directors there gave confidence to the staff that leadership recognized the downtime as an increased workload for the teams."

Rebecca McGregor, Director of Clinical Services at Nanaimo Regional General Hospital, also reported the night to be a success due to the “considerable amount of prep work and time put in by front line clinicians and site leadership."

“I'm incredibly grateful to everyone who leaned in as much as they did," she says. “It was because of them that we were able to smoothly transition care of our patients."

One of the radiology team physicians who worked during the Code Grey, Dr. David Thomas, was even nominated for a Gold Star Award from the South Island Medical Staff Association. Dr. Thomas made sure that CT reads during the downtime were done efficiently and communicated clearly. He called with reads within minutes of scans, and called out incidental findings verbally, which alleviated concerns about such findings going unnoticed.

“He went out of his way to ensure that the clinicians got the information they needed to look after the patients in real time, and it made a big difference during the Code Grey," according to the nomination.

Michael Reece, Executive Director of Solutions Engineering in IM/IT says he was happy overall with how the move to remote hosting has gone, considering the complexity of the move.

"Most people don't know that Island Health's Cerner system is comprised of over 37 distinct systems that together make up Cerner Millennium," says Reece, "so it is a lot of work to move these components from one data centre to another. It's like moving the core components of an airplane from one airplane to another (engine/navigation/fuselage/etc.)… during an eight-hour window. And perform all the necessary safety checks and then resume flying immediately following."

Of course, a change as large and complex as this one doesn't come without a few issues. The fixes the team are working on now are mainly with the systems that help performance and ease of use.

"We're going to be fine-tuning the system over the coming days and weeks to address those items that have come up," says Reece.

For example, since the Cerner system came back online, physicians are encountering challenges with Dragon microphones when roaming and a noticeable delay in transcription recording when dictation starts, as well as some difficulty accessing applications remotely (e.g. Up to Date). Teams are working to address these and other technical issues.

Reese credits clinical staff for much of the preparation. "We couldn't have done it without everyone's support and cooperation. There is a lot of work that the clinical areas did to get ready, and that was evident during the night of the change."  

“I would also encourage staff to apply the learnings from this event and be prepared for any planned or unplanned system outages, including knowing where your downtime materials and Cerner 7x24 devices are, and checking them regularly."

Thank you to the clinical and medical staff working that night for their diligence and to all staff for their continued patience as stabilization continues around this important project. ​​