Sooner or later every electronic health record goes offline. The cause might be an internet outage, a vendor maintenance window, a ransomware attack, a power failure or a software fault. The question is not whether it will happen, but whether your staff will know what to do when it does.
A downtime procedure is a short, practiced plan that keeps care safe and documentation intact until systems return. It also forms part of the contingency plan required by the HIPAA Security Rule, which includes data backup, disaster recovery and emergency mode operation plans.
List what staff must be able to do without the EHR. For a skilled nursing facility, typical items include:
Medication administration and review of orders
Access to resident allergies, diagnoses and code status
Treatment records and vital signs documentation
Admission, discharge and transfer processes
Physician communication and orders
Care plans and recent notes
Contact information for families and responsible parties
Each function needs an answer for how it will be done on paper or by another method.
Blank medication administration records, treatment records, vital sign sheets, progress notes, incident forms, admission paperwork and order sheets. Keep enough for several days.
Many EHRs can produce read-only reports on a schedule, such as current medication lists, census, allergy lists and care plan summaries. Print them regularly, for example each shift or daily, and store in a binder at each station. Some systems offer a downtime viewing workstation or local read-only copy. Ask your vendor what is available.
Physicians, pharmacies, the vendor's emergency support number, IT support, and leadership, on paper.
Pens, clipboards, labels and a flashlight. A basic kit is useful in severe weather too, and supports your emergency preparedness plan.
Keep the procedure to a few pages. Include:
How downtime is declared and who declares it
Who is notified, including leadership and IT
Where the downtime kit is stored
Step-by-step instructions for medication passes and documentation
How to handle new admissions
How information is communicated across shifts
How and when return to normal operations is announced
Use checklists and plain words. A night-shift nurse should be able to follow it without calling anyone.
When the system returns, the work is not over. Paper records must be entered, and data integrity checked.
Assign staff to enter missed documentation, prioritizing medication records
Mark paper records with dates and times, and note who entered them
Reconcile orders placed or changed during downtime
Confirm there were no gaps or duplicates in medications
Keep paper originals according to your retention policy, and secure them as PHI
A plan that has never been used will not work smoothly. At least once a year, run a drill on one unit for an hour or a shift. Observe where staff get stuck, whether forms are missing and how long recovery takes. Update the plan based on what you learn. Include new employees and agency staff in orientation.
Ask your EHR vendor about their uptime history, maintenance schedule, backup and recovery practices and how they communicate during incidents. Understand your own dependencies, such as internet circuits, firewalls and single sign-on, since a failure in any of them looks like an EHR outage to the nurse.
Downtime is a moment when people improvise. Remind staff not to photograph screens with personal phones, send PHI through unapproved messaging, or share logins to speed things up. Keep paper records secured, and ensure printed reports are shredded when no longer needed.
Update contact lists and forms whenever systems or leadership change, and review the procedure alongside your emergency preparedness plan.
UnityCare IT works with long-term care operators to identify dependencies behind their EHR and to design resilient infrastructure, including connectivity, power and backup. We can also help facilitate a downtime drill with your clinical leaders.
Call or text: 405-285-3845
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Existing customers: support@unitycareit.com
Address: UnityCare Technologies, 2524 N Broadway Ste 554, PMB 947974, Edmond, Oklahoma 73034-4172