At some point your EMR will be unavailable. The cause might be a power failure, a vendor outage, an internet problem, a software update gone wrong or a security incident. How well your team handles those hours depends largely on preparation. Staff who have practiced paper procedures can keep medication passes and documentation moving safely. Staff who have never seen the downtime forms will improvise under stress.
A downtime plan is not only an IT document. It is an operational procedure that nursing, administration, dietary, therapy and the business office must all understand. Here is how to build one.
Specify the triggers, such as the EMR being unavailable for more than a short threshold or a loss of network access on a unit. Name who has the authority to declare downtime and who notifies staff. Partial outages, such as the medication administration record working but the documentation module failing, need defined responses too.
Downtime coordinator: Usually an administrator or director of nursing, who decides when to start and end the procedure
IT contact: Provides status updates and estimated recovery times
Unit leaders: Ensure each unit follows the procedure and has supplies
Scribe or recorder: Keeps a log of actions and times
Communications lead: Updates staff, families and, if needed, regulators or corporate leadership
Include after-hours contacts, because outages do not respect business hours.
Every unit should have a clearly labeled binder or box containing:
Blank paper forms for medication administration, treatment records, vitals, intake and output, nursing notes, incident reports and admission paperwork
A current printed medication list and care plan summaries for each resident, refreshed on a regular schedule, such as daily or at each shift, and stored securely
Printed emergency contact lists, including physicians, pharmacy, vendors and IT support
Instructions for the downtime process in a short checklist format
Pens, clipboards and any needed labels
Because printed records contain PHI, keep them locked and shredded after use, consistent with your privacy policies. Some systems provide a read-only downtime workstation that is updated regularly and can display recent data even when the main system is down. Ask your EMR vendor what is available.
Make sure at least one workstation per area can print locally
Keep network equipment and key servers on uninterruptible power and generator circuits
Maintain a documented list of vendor support numbers and account details
Know who to call for internet, EMR, pharmacy and phone system issues
Plan communications: if email is down, how will you reach staff? Consider a text alert system or phone tree
Declare downtime and notify all units
Switch to paper forms, and note the start time on each
Prioritize resident safety, especially medication administration and high-risk residents
Verify orders and allergies using printed information before giving medications
Keep a running log of events, vendor contacts and updates
Provide regular status updates to staff, so they are not guessing
When the system returns, careful catch-up prevents errors.
Announce the end of downtime and the time systems are verified
Assign staff to enter paper documentation into the EMR, with a second person verifying critical entries such as medications
Scan paper forms into the record according to policy, then secure or destroy originals
Reconcile orders placed during downtime
Check for duplicate or missing entries
Update the downtime log
Within a few days, hold a short debrief.
What worked and what did not?
Were forms and printouts current and easy to find?
Did communication reach everyone on every shift?
Were there any medication errors or near misses?
What needs to change in the plan, supplies or training?
Document the review. It supports HIPAA contingency planning and CMS emergency preparedness expectations.
Run a short drill at least once or twice a year, including on a night shift. Walk staff through finding the kit, using the forms and entering data afterward. Rotate which unit leads. Even a thirty-minute exercise reveals gaps such as missing forms, outdated phone numbers or staff who have never seen the binder.
If the outage might be caused by a cyberattack, do not restart or connect devices without guidance. Follow your incident response plan and involve IT security, leadership and your insurer as needed.
UnityCare IT helps healthcare organizations write downtime procedures, assemble kits and run drills that connect IT recovery to clinical operations. If your plan has not been tested lately, we are glad to help you set up an exercise.
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Address: UnityCare Technologies, 2524 N Broadway Ste 554, PMB 947974, Edmond, Oklahoma 73034-4172