Most healthcare organizations have a business continuity plan. Far fewer have a business continuity plan that actually holds up when the EHR goes offline.
The gap between the two is significant. A general BCP might address physical disasters, staffing shortages, or infrastructure failures in broad terms. But EHR outages have specific operational and clinical impacts that require specific, tested, and documented responses. Without that specificity, a downtime event that should last a few hours can stretch into a multi-day recovery with compounding consequences for patient care, data integrity, and regulatory compliance.
Here is what a healthcare business continuity plan actually needs to include when it comes to EHR outages.
1. A Clear Distinction Between Planned and Unplanned Downtime
Not all EHR outages are surprises. Planned downtime happens regularly for system maintenance, upgrades, and migrations. Unplanned downtime, by definition, happens without warning. Your BCP needs to address both, and the response procedures are different.
For planned downtime, communication can go out in advance, staff can be briefed, and downtime workstations can be activated in a controlled way. For unplanned downtime, the plan needs to specify who is notified first, what immediate steps are taken to activate downtime procedures, and how quickly downtime workstations should be brought online. dbtech’s Downtime Solution supports both scenarios by maintaining continuously updated patient data that is accessible the moment it is needed, whether the outage was expected or not.
2. Predefined Downtime Workstation Locations and Activation Protocols
A business continuity plan for EHR outages should specify exactly where downtime workstations are located throughout the facility, who is responsible for activating them, and what the step-by-step activation process looks like. This is not the time for staff to be making judgment calls on the fly.
dbtech’s downtime workstations are configured in advance and placed in predefined locations, including nursing units, registration areas, the emergency department, pharmacy, and other departments based on the organization’s specific layout. When an outage begins, staff know exactly where to go and how to get started. The workstations are already loaded with current patient data, including census, medication administration records, and registration history, so there is no lag between activation and usefulness.
3. Electronic Patient Registration During Downtime
One of the most operationally disruptive aspects of an EHR outage is the inability to register new patients. If your BCP relies on paper forms and manually assigned encounter numbers during downtime, you are setting up a labor-intensive reconciliation problem that will take days to resolve once the EHR is restored.
A strong BCP specifies how patients will be registered during a downtime event using electronic tools that integrate with the EHR on recovery. dbtech’s downtime solution allows facilities to register patients electronically using a pre-loaded bank of downtime encounter and medical record numbers. Patient identification and insurance documents can be scanned directly into the system. Barcoded wristbands and labels can be printed without the EHR being online. All of that data is then exported back into the EHR once the system is restored, dramatically reducing the manual re-entry burden. You can learn more about how this process works on the dbtech Patient Registration page.
4. Medication Administration and Clinical Documentation Continuity
Your BCP needs to address how clinical staff will access medication administration records and document care during a downtime event. This is particularly critical for inpatient departments and the emergency department, where medication decisions cannot wait and clinical documentation cannot simply be deferred.
dbtech’s downtime workstations provide access to the MAR and other critical clinical data that was present in the EHR at the time of the outage. Using dbtech’s eForms, clinical staff can complete and electronically sign forms, record care activities, and capture documentation in a structured way that is reconcilable with the EHR after recovery. Paper-based documentation during downtime creates handwriting legibility issues, transcription errors, and records that are difficult to integrate into the EHR later. Electronic documentation during downtime solves all of those problems.
5. A Defined Communication Protocol
When the EHR goes down, the people who need to know are not just IT. Department heads, nursing supervisors, registration leads, pharmacy, the CMO, the CNO, and in many cases the Board and legal counsel all have roles to play depending on the severity and duration of the outage. Your BCP should define who is notified at which stage, through which channel, and with what information.
This is particularly important for unplanned downtime events that may eventually be classified as a cybersecurity incident. Having communication protocols in place in advance prevents information gaps and ensures that the right decisions are being made by the right people. The American Hospital Association’s cybersecurity resources provide useful frameworks for escalation and communication in healthcare IT incidents that can inform your BCP development.
6. Data Reconciliation and Recovery Procedures
What happens when the EHR comes back online is just as important as what happens during the outage. A BCP that does not address recovery is incomplete. Your plan needs to specify how data collected during the downtime period will be reconciled with the EHR, who is responsible for reconciliation in each department, what the timeline expectation is, and how accuracy will be verified.
dbtech’s bi-directional HL7 interface is specifically designed to support this process. Data collected in the downtime system, including patient registrations, form completions, and scanned documents, can be exported back into the EHR in a structured way that minimizes manual re-entry and reduces the risk of data loss or duplication. The smoother this recovery process is, the faster your organization returns to full operational status.
7. Regular Testing and Staff Training
A BCP that exists only on paper is not a plan. It is a document. Testing your downtime procedures regularly, including activating downtime workstations during planned maintenance windows, is the only way to identify gaps before a real outage exposes them. Staff who have practiced with downtime workstations respond to actual outages more calmly and more effectively than those who encounter the system for the first time during a crisis.
dbtech offers a complimentary Downtime Audit Assessment that reviews your current downtime procedures, evaluates where your plan is strong, and identifies areas for improvement. It is a practical starting point for any organization that wants to make sure its BCP will actually hold up when it matters.
Building a business continuity plan that genuinely protects your organization during an EHR outage takes more than checking a compliance box. It requires specific, tested procedures, the right technology infrastructure, and staff who know what to do the moment a downtime event begins. To learn how dbtech can strengthen your organization’s business continuity planning, explore our Downtime Solutions or request a demo.