Sooner or later, every healthcare organization loses access to its electronic records. The cause may be a ransomware attack, a failed update, a power problem, a vendor outage or a cut internet line. What happens next depends less on technology and more on whether staff know what to do. A downtime plan that lives in a binder nobody has opened will not help a nurse at 2 a.m. with a medication pass underway.
Here is how to build a plan that people will actually follow.
List the functions that must continue during an outage, in order of clinical urgency:
Medication administration and the current medication list.
Resident census, allergies, code status and care plans.
Orders, including physician and nurse practitioner communication.
Admissions, discharges and transfers.
Treatments, vitals and incident documentation.
Nurse call and emergency communication.
Billing and payroll, which can usually wait longer.
For each, decide what the paper or manual alternative is and who is responsible.
A downtime kit is a physical set of materials on each unit, easy to find and checked on a schedule.
Blank paper forms: medication administration records, treatment records, progress notes, incident reports, admission forms, vitals sheets.
Printed or read-only reports, refreshed on a schedule: current medication lists, resident census with allergies and code status, and contact lists for physicians and families.
Pens, clipboards and labels.
A laminated quick-start card with who to call, how to declare downtime and the first five steps.
Phone numbers for IT, the vendor, administrators and on-call leaders, printed so they do not depend on the network.
Many EHR products can produce regular offline reports or a read-only local copy. Ask your vendor what options exist and how to schedule them.
Who can declare downtime, and who decides when it is over?
Who notifies staff and leadership?
Who contacts IT and the vendor?
Who is the downtime coordinator on each shift?
Who tracks what was documented on paper?
Write names or positions, not just departments, and include nights and weekends.
Decide how you will tell staff. If the network is down, email will not work. Use overhead paging, phone trees, text messaging on an approved platform, or a runner. Prepare a simple message: what is down, expected duration if known, instructions to begin paper procedures and the contact for updates.
When systems return, the work is not over. Paper records must be entered or scanned into the EHR so the record is complete.
Assign staff to enter data, with a priority order such as medications first.
Mark the time ranges the paper covers.
Reconcile orders and documentation to catch gaps.
Retain paper records according to policy, and scan them if possible.
Hold a short review afterward: what worked, what did not, what to change.
Your plan should reflect how long your IT systems can actually take to restore. If your backup restore would take several days, the downtime plan needs to be sustainable for several days, not just a few hours. Work with your IT provider and EHR vendor to document realistic recovery times.
A plan is only as good as the last drill.
Run a short unannounced or announced downtime drill on each shift at least once a year.
Review the kits quarterly: forms stocked, reports current, contact numbers correct.
Include new hires in orientation.
Document the drills for survey and HIPAA purposes.
The HIPAA Security Rule contingency plan standard requires a data backup plan, a disaster recovery plan and an emergency mode operation plan. CMS emergency preparedness requirements for long-term care facilities also call for plans that keep care going through disruptions. A tested downtime procedure supports both.
Printing the plan once and never updating it.
Keeping kits only at the administrator's office.
Assuming paper forms are still in stock.
Not including the pharmacy and therapy departments.
Forgetting how to access phone numbers when the network is down.
UnityCare IT helps healthcare organizations write downtime procedures, work with EHR vendors on offline reports and schedule drills that include both clinical and IT teams. If you would like a second opinion on your current plan, we are happy to review it.
Call or text: 405-285-3845
New customers: start@unitycareit.com
Existing customers: support@unitycareit.com
Address: 2524 N Broadway Ste 554 PMB 947974, Edmond, Oklahoma 73034