Technology failures are not a matter of if but when. A storm knocks out power, a fiber line is cut, an EHR vendor has an outage or ransomware locks a server. When screens go dark, the quality of care depends on whether staff know what to do next. Facilities that practice downtime procedures keep medications on schedule and records accurate. Those that do not often improvise under stress.
CMS emergency preparedness requirements for long-term care facilities already expect planning for emergencies, including communication and continuity of operations. A downtime plan for information systems fits naturally within that work, and HIPAA's contingency plan standard requires an emergency mode operation plan to protect ePHI during emergencies.
A good plan answers four questions for each critical system:
How will we know the system is down, and who declares downtime?
What do we do in the meantime?
Who is responsible for each task?
How do we enter or reconcile information afterward?
List the systems whose loss would affect care or safety:
Electronic health record and electronic medication administration record
Nurse call and resident monitoring systems
Phone systems and overhead paging
Pharmacy ordering and delivery communications
Door access control and security cameras
Time clock and scheduling
Admissions, billing and email
Internet connectivity itself
Rank them by how quickly an outage affects resident safety, not by how inconvenient it is.
Paper-based forms are the heart of downtime readiness. Keep a labeled kit at each nursing station and in the administrator's office, containing:
Blank medication administration records and treatment records
Care plan and Kardex forms
Admission, transfer and incident report forms
Physician order forms and telephone order sheets
Resident census, room lists and allergy lists
Emergency contact lists for staff, families, vendors and IT
Instructions for each major task, written in clear steps
Check kits quarterly for missing forms and outdated information.
A blank form is not enough if staff cannot see what medications each resident takes. Ask your EHR vendor about downtime reports: printed or locally stored read-only snapshots of medication lists, orders, care plans and allergies. Schedule regular printouts or exports, such as at the start of each shift or daily, stored securely in a locked location. Remember that printed PHI must be protected and shredded when no longer needed.
Decide in advance:
Who can declare a downtime and who is notified
How staff are told, such as overhead page, runners or a phone tree, in case email is down
Who contacts IT and vendors, and with what numbers saved outside the affected systems
Who updates families and the corporate office
Who documents the timeline of the outage
Designate a downtime coordinator on each shift.
Many downtime events begin with power or network failure. Review:
Battery backup for network switches, firewalls and critical servers, so devices shut down cleanly and stay up through short outages
Generator coverage for the server and network closets, not just life safety circuits
A backup internet connection or cellular failover, and how phones behave without data
Charged mobile devices and battery packs
When systems return, there is a backlog. Plan how paper entries will be entered into the EHR, who verifies them, and how to prevent duplicate or missed medication documentation. Compare paper records against the system and fix discrepancies. Document the incident, response times and lessons learned.
A plan sitting in a binder helps little. Include downtime procedures in orientation, and run drills at least once a year, perhaps during a planned maintenance window. Ask staff to complete a medication pass using the paper process and note where it breaks down. Use drills to find missing forms, unclear instructions or unrealistic assumptions.
What is your uptime history and your downtime support process?
Does the EHR have an offline mode or a read-only viewer?
How can we get a backup copy of our data, and how quickly?
What do you expect us to do while your system is unavailable?
Start small: choose one system, such as the EHR, and write a one-page downtime procedure with a printed kit. Then expand to others. UnityCare IT helps care organizations design downtime plans, test backups and failover and coordinate with EHR vendors. If you would like a facilitated drill or a review of your readiness, we are happy to help.
Call or text: 405-285-3845
New customers: start@unitycareit.com
Existing customers: support@unitycareit.com
Address: UnityCare Technologies, 2524 N Broadway Ste 554, PMB 947974, Edmond, Oklahoma 73034-4172