Sooner or later, the systems stop. It might be a ransomware attack, a failed internet circuit, a vendor outage, a power problem or a bad software update. In a care facility, the computers may be down, but residents still need medications, meals, assistance and safety checks. The difference between a stressful hour and a dangerous one is whether staff know what to do.
A downtime plan is the set of procedures that keeps care safe when technology is unavailable. It is also part of the contingency planning that HIPAA requires, and the CMS emergency preparedness requirements for long-term care facilities expect plans for continuity of operations.
Plan for several scenarios, not only a total outage:
EHR unavailable but the network works
Internet down, so cloud systems are unreachable
Local network or Wi-Fi failure
Phone system outage
Power loss, short or extended
Cyberattack affecting multiple systems
Each may call for slightly different steps.
Keep printed materials on each unit, in a clearly marked location that staff can reach without a computer:
Blank medication administration records and treatment records
Assessment and progress note forms
Order forms and telephone order forms
Incident and fall report forms
Admission and transfer forms
Contact lists for physicians, pharmacies, families and vendors
Instructions for the plan itself
Systems fail without warning, so schedule regular printing of key reports: medication lists, allergies, diagnoses, code status, care plans and emergency contacts. Many EHRs offer a downtime or read-only report option. Ask your vendor how to use it. Store the printouts securely, because they contain PHI, and shred them when replaced.
Decide who declares downtime, who calls IT and vendors, who informs department heads and who documents the timeline. Set up a backup communication method, such as a phone tree or radios, because email and phones may be affected.
Define triggers: for example, if the EHR is unavailable for more than a set number of minutes, switch to paper. Do not leave it to individual judgment in the middle of a medication pass.
Work with your director of nursing and pharmacy. Medication records must remain accurate, and staff should have a way to confirm what has already been given, particularly across shift changes.
When systems return, someone must enter paper entries into the electronic record, verify them and mark them as late entries with accurate times. Assign this responsibility, and set a deadline. Keep the paper originals according to your retention policy.
Plans that are never rehearsed fail. Try:
A short drill at shift change where a unit completes a mock medication pass on paper
A tabletop exercise with leadership walking through a ransomware scenario
Checking that forms are stocked and printers work
Confirming that new staff know where the kit is
After each drill, capture lessons and update the plan.
Backups that are tested and protected from tampering
A secondary internet connection for critical systems
Uninterruptible power supplies for network equipment, phone systems and key workstations
Documented recovery priorities, so IT knows which systems to restore first
Vendor contact information and support agreements
A way to reach IT documentation, such as network diagrams and passwords, when the network is down, stored securely offline
Printing forms once and never updating them
Keeping the downtime kit only in the administrator's office
Assuming staff remember the paper process from years ago
No plan to reconcile records afterward
Forgetting non-clinical needs such as billing, payroll and door access
Where is our downtime kit, and is it current?
Who decides when we switch to paper?
How long could our EHR be down before care is at risk?
When did we last practice?
What would we do if the phone system also failed?
UnityCare IT helps healthcare organizations align technology recovery plans with clinical downtime procedures, including recovery priorities, redundancy and tabletop exercises. If you would like to test your plan, we can help you design a realistic scenario.
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