Telehealth’s rapid expansion into mainstream healthcare delivery has created a documentation and continuity challenge that did not exist at scale five years ago. When an EHR goes offline during an in-person encounter, the patient is physically present with a clinical team that can manage the situation in real time. When an EHR goes offline during a telehealth encounter, the clinical team is separated from the patient by a network connection that may itself be affected by the same infrastructure problems causing the EHR outage. The patient is alone at home. The provider has lost access to the patient’s record. And the documentation tools that were supporting the encounter have stopped working.
Telehealth downtime is not simply a smaller version of in-person downtime. It has distinct characteristics that require specific preparation, and most healthcare organizations that have expanded their telehealth programs have not thought through the downtime preparedness implications of that expansion.
What the Telehealth Workflow Depends On
Understanding telehealth downtime preparedness starts with mapping what a typical telehealth encounter actually depends on from the EHR and from the surrounding technical infrastructure:
- The patient record including medical history, current medications, allergy information, and prior encounter notes that the provider reviews during the visit
- The documentation tools used to record the encounter, including the progress note, orders, prescription generation, and any referrals or follow-up scheduling initiated during the visit
- The video platform that hosts the encounter, which in most healthcare organizations is either integrated with the EHR or hosted by a third-party vendor that interfaces with it
- The billing and charge capture workflow that records the encounter as a billable telehealth visit with the appropriate modifiers and documentation required for telehealth reimbursement
- For remote patient monitoring programs, the device data feeds that provide real-time clinical information during the encounter
When the EHR goes offline, each of these dependencies is affected differently depending on the specific nature of the outage, the architecture of the telehealth platform, and whether the video connection itself is dependent on EHR connectivity or runs independently.
The Three Telehealth Downtime Scenarios
Telehealth downtime does not present as a single uniform scenario. The three most common scenarios each require a different response:
The EHR Goes Offline While the Video Connection Remains Active
This is the most common telehealth downtime scenario. The provider and patient can still see and hear each other, but the provider has lost access to the patient’s record and cannot document the encounter in the EHR. The video platform continues functioning because it typically runs on infrastructure independent of the EHR.
In this scenario, the provider needs an alternative documentation tool immediately. dbtech’s eForms configured for telehealth encounter documentation allow the provider to complete a progress note, record any orders or recommendations, and document the clinical assessment using a form that mirrors the EHR encounter structure. The completed eForm is stored in the provider’s downtime system and exported back into the EHR after restoration, producing a complete encounter record rather than a gap in documentation.
The Video Platform Goes Offline While the EHR Remains Accessible
This scenario is less common but increasingly relevant as telehealth platforms experience their own availability challenges. When the video connection fails, the provider may be able to transition the encounter to a phone call if the patient’s contact information is accessible in the EHR, which it typically is. The documentation of the encounter transitions to a telephone encounter rather than a video telehealth encounter, with the appropriate billing modifier adjustment.
Both the EHR and the Video Platform Are Unavailable
This scenario, while less common, is the most disruptive because it eliminates both the clinical encounter and the documentation capability at the same time. For patients whose care is genuinely time-sensitive, the provider needs a protocol for transitioning to an in-person encounter or routing the patient to an appropriate care setting. For patients whose care can safely be rescheduled, the encounter should be rescheduled with a proactive patient communication that explains what happened and confirms the new appointment.
What Telehealth-Specific eForms Look Like
Telehealth encounters have documentation requirements that are distinct from in-person encounters in ways that affect how the downtime eForms should be configured. Specifically:
- Telehealth billing documentation requires specific attestation language confirming that the encounter was conducted via telehealth, the technology platform used, and whether the patient was in an eligible originating site. These fields need to be present in the telehealth encounter eForm and need to be completed by the provider during the encounter or immediately after it, because they are required for the encounter to be billed correctly.
- Telehealth encounters for established patients often involve reviewing and updating medication lists, ordering labs or imaging, and generating prescriptions, all of which require documentation in the patient record. The eForm for a telehealth encounter should include fields for each of these activities so that the provider can document them during the downtime period rather than relying on memory when the EHR is restored.
- For remote patient monitoring programs, the clinical data that would normally be automatically pulled from the monitoring device into the EHR during the encounter needs to be manually documented during a downtime event. The telehealth encounter eForm should include fields for the key monitoring parameters that the provider would review during a monitoring visit so that the clinical data from the encounter is captured even when the automated feed is unavailable.
Building Telehealth Downtime Into the Preparedness Program
The organizations whose telehealth programs are most resilient during downtime events have incorporated telehealth-specific considerations into their overall downtime preparedness program rather than treating telehealth as a separate system with separate considerations. Specifically:
- The downtime forms library includes telehealth encounter forms that have been reviewed by the clinical team providing telehealth services, confirmed to include the billing attestation language required for telehealth reimbursement, and tested to confirm that the completed form exports correctly into the EHR’s telehealth encounter structure.
- Providers who conduct telehealth encounters have received specific downtime orientation that covers what to do when the EHR goes offline during a video visit, how to access the downtime documentation tools, and how to communicate with the patient when a technical disruption affects the encounter.
- The patient communication for a telehealth downtime event is defined in advance, so that providers are not improvising an explanation of what happened and what the patient should do next when a video connection drops during an active encounter.
To discuss how dbtech’s eForms can be configured to support telehealth documentation workflows during a downtime event, request a demo or contact our team to walk through the telehealth-specific configuration options.