The Evolving Landscape of EHR Downtime

Healthcare organizations are facing a new era of downtime risk. Chris Akeroyd, CIO of Lee Health, noted that today’s clinical workforce often lacks experience operating outside of digital systems. Extended outages, therefore, present a fundamentally different challenge than they did even a decade ago. Stuart James, VP, Chief Operations Officer & Deputy CIO at CHRISTUS Health, emphasized the importance of focusing on core clinical fundamentals, enabling teams to adapt regardless of the tools available. Allison Reichenbach, President & CEO of Interlace Health, cautioned against viewing paper-based backups as a simple fallback, highlighting the fragmentation, loss of standardization, and compromised data integrity they introduce.

Hidden Dependencies and the Automation Risk

The webinar participants highlighted a frequently overlooked source of downtime vulnerability: automated integrations. James warned that the greatest risks reside in the background processes staff rarely consider – such as automated prescription refills flowing to pharmacies. Akeroyd specifically cited controlled substance prescribing and connectivity with Surescripts as examples of seemingly minor dependencies that can create significant friction during an outage. These hidden connections can quickly cascade into larger disruptions.

Defining Ownership: IT Recovery vs. Business Continuity

A clear delineation of responsibility is crucial. James drew a firm line between IT’s role in disaster recovery and operations’ ownership of business continuity. He explained that IT focuses on restoring systems, while operations ensures continued patient care. Akeroyd cautioned against IT inadvertently assuming ownership of broader business continuity due to its cross-functional visibility, a trap leaders must actively avoid. Reichenbach observed that achieving true cross-functional buy-in often requires the catalyst of a major incident.

The Power of Practice: Drills Beyond the Tabletop

Having a downtime plan is insufficient; regular, realistic practice is paramount. James shared a compelling post-9/11 lesson: a disaster recovery plan reliant on air travel became unusable when flights were grounded. His team subsequently redesigned drills to incorporate real-world constraints, including physically driving to the recovery center. He illustrated the point with a military anecdote, describing how ingrained training allowed a sailor to instinctively avert disaster during a jet engine incident. What seemingly small, routine drills can your organization implement to prepare for the unexpected?

Navigating the Failover Decision: Four Hours and Beyond

Many organizations operate under a four-hour trigger point for considering failover, as described by James. However, Reichenbach argued that software failover is preferable to reverting to paper, preserving crucial data structure and integrity. She pointed to the successful use of electronic workflows during the COVID-19 pandemic, even in offline scenarios, as evidence of their adaptability. Akeroyd stressed that failover policies must evolve alongside an organization’s capabilities.

The UKG Ransomware Incident: A Wake-Up Call

The UKG ransomware incident served as a stark reminder of the risks associated with third-party vendor dependencies. Akeroyd recounted how the attack left his organization unable to process payroll, with no internal workaround available. James broadened the scope, noting that disruptions can stem from failures in external supply chains or even internet infrastructure, even if internal systems remain operational. The UKG incident highlighted the cascading effects of external vulnerabilities.

The Peril of Partial Downtime

James identified partial downtimes – where some systems function while others are compromised – as the most dangerous and least rehearsed scenarios. When a small percentage of processes are unavailable, the potential for errors increases dramatically, potentially necessitating a complete system shutdown to ensure patient safety.

Final Insights from Healthcare IT Leaders

The panelists concluded with critical advice. Akeroyd emphasized that resilience must be a foundational design consideration from the outset. James offered a pragmatic warning: “This is not an if, it’s a when. Be ready.” Reichenbach underscored the importance of maintaining control over documentation throughout an outage. How can your organization proactively address these key takeaways?

Ensuring operational resilience in the face of EHR downtime requires a holistic, proactive approach. It’s a challenge that demands collaboration, rigorous planning, and a commitment to continuous improvement.

Frequently Asked Questions About EHR Downtime Preparedness