Being prepared is a very important part of any veterinary hospital or emergency center. 


SmartFlow has proved to be a critical tool in managing patients visits, treatments & anesthetic events. Digital flowsheets, anesthetic sheets & whiteboards facilitate greater accuracy and make patient information visible to all staff in real-time from many locations. As SmartFlow is a cloud-based system, it is easy to think that a loss of power, internet service, or server connection might shut you down and negatively affect patient care.


This would be an incorrect assumption!

With a bit of planning, there is no reason that your patients can't keep getting all the care they need and all the benefits that SmartFlow brings to your clinic. Please read this document carefully, evaluate your clinic's risks, put appropriate safeguards in place, and ensure that all of your staff have trained should an emergency happen. A loss of power, internet, or server outage: is no different than having your team prepared to handle a hit by a car or cardiac arrest patient.


PREP- Prepare Relax Educate Perform


Stay Calm

No need to stress as you already know that your iPads will keep on working even offline. You will be prompted with a pop-up message that the connection has been lost, as detailed in THIS article. Your Whiteboards will be out if you have no power, so rely on the iPads to manage treatments and know which patients need care and when.

Once the power or internet connection returns, the iPads will sync automatically.


Assess your needs and risks

  • How many iPads do you have?
  • How many departments?
  • How many technicians/nurses work at once?
  • How many anesthetic procedures at once?
  • Is your location prone to natural disasters (e.g. hurricanes, snowstorms, flooding, etc.)?
  • Does your facility have emergency power backup (e.g. generator(s)? If so, how long will they continuously run?)

Recommended Step:  As soon as you go to Offline Mode (Airplane Mode) - Use the End of Shift Billing Feature to Mark the time (FAQ Here).  This will help when you go back online and access the Billing PDF.  


Solutions to increase your Offline time and continue patient care uninterrupted

If you lose power, phone service, or internet, we understand that your clinic is going to be struggling to take care of clients and patients. Using Smart Flow does not have to be one of those concerns if you put some backup plans in place.


Label the iPads so the same iPad is used for the same patients

Consider color coordinating or labeling your iPads to be used on specific wards or departments. During a disaster, keep those iPads in that location. If you perform treatments on one patient using one iPad, you want to make sure that the same iPad is used for all that patient's treatments until it is able to be synced again. If the internet, server, or router are down, the iPads don't communicate with each other. That specific iPad is how you will know when that patient's treatments are due and what has been done.


For example, you could have all the red iPads in Sx, green iPads in ICU, blue iPads in boarding, and black iPads in radiology. Decide what will work best before the power goes out. If you have more than one iPad of the same color, number them or label them with individual names. You can then make sure the same iPad is either used in one location, or an individual keeps the same iPad for the same patient. Keep a list of patients at your iPad station listing which patient is being managed with which iPad.

  • Blue iPad #1 is Ward #1
  • Blue iPad #2 is Ward #2

If you have a large clinic, following these steps can be useful as a normal practice, not only will you need to not make any changes if a disaster happens, you won't have to worry about someone disregarding a brief offline event.


Extend the life of your iPads

You should always make sure your iPads are kept charged. All clinics should create charging stations where iPads are kept while not in use. There are commercial iPad charging stations for multiple devices or you can create your own with cabinets, paper trays, or DIY creations. If needed, get crafty. 



Decide if you need just one iPad station or if you want one in each department or ward. The bigger your clinic the more likely you will want a station for each area. 


Once you have your iPad station or stations in place, make sure that they are all connected to a backup system. If your clinic doesn't have a system-wide backup generator, make sure that the iPad stations are all connected to portable battery backups. 


These are the same battery packs that are often used for computers in case the power goes out. Just calculate how much power you need and what the longest time you might need it for.

  • How many iPads do you have?
  • What is the maximum time that you might be down? 
  • If it may be days without power, consider having two or more battery packs for each station.
  • Once the power goes out, turn off the battery backups when not in use.
  • Once one battery backup runs out, then replace the battery pack with the next one. This can get you many days of iPad power.


Conserve, Conserve, Conserve

Keep your iPads in airplane mode or sleep mode when not in use and don't charge them until they need to be recharged. 



Don't forget to turn the display brightness down as well - this will help further conserve power.


What if we didn't prepare? 

You will pretty much do the same thing.

  • Stay calm. There may be numerous emergencies that your staff needs to deal with, but using Smart Flow isn't one of them.
  • Immediately grab some medical tape and number all your iPads.
  • Write on a piece of paper each patient's name or location and the iPad number that will be used for those patients.
  • Turn off the iPads when not in use. If you need to keep one on to check when treatments are due, keep the screen off as much as possible.
  • If you have battery backups for computers that are not in use, commandeer one or more for your iPad station.
  • If you have time and a power outage is expected to be extensive, consider purchasing a battery backup. Some are sold with a full charge.  


Important things to remember!

Although Smart Flow will definitely function even when working offline but, there are a few things you need to remember to be sure no data or information is ever lost. It is VERY important to check the information provided below once you are back online:


Checklist when back online:

1. Make sure all iPads have been successfully synced to the server. You may even want to manually do this by clicking on the sync button. See below:


2. Any patient who has had anesthesia should have the web checked to be sure the anesthetic report is present before any patient is discharged. If this does not happen, information could be lost permanently.  (Do not finalize anesthesia sheets while in Offline mode).


3. Should your clinic have billing integration with your EMR, carefully check all billing items from the billing PDF before the bill is finalized, to be sure of no missed charges. 


Conclusion

 

As you can see, there isn't a lot that you need to do to prepare for a disaster to be able to keep using Smart Flow uninterrupted. In fact, if you do nothing except stay calm and use your iPads offline you will be okay. But take the time to set up your clinic to be ready should your patients need you while a long unexpected disaster strikes and you will be able to focus on what you really care about: providing patient care and not worrying about caring for devices.

 

Additional Recommended Steps:

 

  1. Do NOT finalize any anesthesia sheets when in Emergency Protocol 
    1. Make a Whiteboard for Anesthesia Sheets Pending and put the patient in that whiteboard as well as the normal one  (Click HERE on How to Make a New Whiteboard)
    2. When re-established connection go in and finalize all the anesthesia sheets 
    3. Move patients out and then delete the whiteboard.

 

  1. Do NOT Discharge any patients when in Emergency Protocol
    1. Make a whiteboard for Pending Discharge
    2. When re-established connection – Discharge from SmartFlow 
    3. Delete Whiteboard 

 

  1. Toggle Settings In EMR Settings from Limiting Patient Creation from EMR to OFF (FAQ HERE)

 

  1. For Integrated Systems that are NOT Ezyvet - you will need to use the Billing PDF for charges.

  2. For Ezyvet Integrated SmartFlow Accounts, existing patients in Ezyvet, all billable items that were marked off during Offline mode will sync; once the connection is re-established.   For any NEW patients entered into SmartFlow during the offline mode, follow the unallocated patient process. (FAQ found HERE)


 

--If the ipads are needed for Ezyvet usage - and going completely Offline with ipads is not an option.  Changing the SmartFlow settings will keep SmartFlow from communicating to Ezyvet but the iPad online.  That FAQ is HERE The two toggles in the red box need to be in the OFF position.
  

--Also a change to the Documents management settings is required.  The FAQ for that is HERE   Place the Export to EMR, Save to Disk and Send Email to NO. 


 

**IMPORTANT TO NOTE:  Using the above method when SmartFlow is intermittently down might cause data loss because SmartFlow will attempt to sync to additional iPads and the web version of SF as usual. Treatments could not be marked as complete on devices other than the one on which they were done. Due to the possibility of double invoicing, this method will only stop SF from interacting with Ezyvet (or other practice management software).

It is advised if iPads are required for use with the Practice Management System - to designate those iPads for that use and NOT use them for SmartFlow - and have iPads being used for Patient Care be in Offline (Airplane) Mode and follow the workflow as stated.  


 

Once users wish to come out of Recovery mode and the toggles were changed 

 

  • 1st the Documents management page and put the toggles back - Export to EMR to yes - and if the practice has decided to merge the PDF's to one file versus separate put that toggle to YES.  Otherwise all toggles except for Export to EMR will be on NO.  
      
  • 2nd - Return to the EMR page and place the toggles back to yes for Send Billing and Send Anesthesia.  


 

  • For Cornerstone billing integrated practices.  During Offline mode the use of the billing PDF will be needed.  Once the connection is re-established, billing will resume.  On any NEW patient checked into SmartFlow during Offline mode; The PATIENTS ID will need to be placed in the Patient File Number.  (FAQ HERE is helpful for this step).  Once the patient has been connected, any billing item marked off once the connection is established – integrated billing will resume.