Of all the clinical workflows disrupted by an EHR outage, laboratory operations sit in a particularly precarious position. Lab orders sit at the intersection of physician decision-making, nursing execution, and clinical results that drive everything from medication adjustments to discharge decisions. When the EHR goes offline, the chain of communication that moves a lab order from the ordering physician to the collection team to the analyzer to the result view breaks at multiple points simultaneously.
The consequences are not abstract. Delayed lab results mean delayed diagnoses. Untracked specimen collections mean duplicate draws or missed collections. Results that cannot be viewed in the EHR mean physicians are making clinical decisions with incomplete information. In high-acuity settings like the ICU or ED, those gaps have direct patient safety implications.
Understanding exactly what breaks during a downtime event and how to protect it is the starting point for any organization that takes lab continuity seriously.
What Specifically Breaks in the Lab Workflow During an EHR Outage
The lab workflow involves more handoffs than most clinical processes, which means more points of failure during a downtime event. Here is what typically stops working when the EHR goes offline:
- Physicians cannot enter new lab orders through the EHR ordering interface
- Nursing staff cannot see pending orders or verify that a collection has been completed
- The lab information system (LIS) may lose its ADT feed from the EHR, affecting patient demographic data associated with specimens
- Specimen labels that are normally printed from the EHR cannot be generated through the standard workflow
- Results that return from the analyzer cannot be routed to the EHR for physician review
- Critical value notifications that are triggered through the EHR may not fire during the outage
- Charge capture for lab services performed during the outage may be incomplete or missing
Each of these failures compounds the others. An order that cannot be entered cannot be collected. A specimen collected without a proper label creates identification risk. A result that cannot be viewed cannot inform a clinical decision. The ripple effect through a single patient’s care episode during even a short outage can be significant.
How Organizations Typically Try to Manage Lab Downtime on Paper
The traditional response to lab downtime is to revert to paper requisitions. Physicians handwrite orders, nurses transcribe them to paper lab slips, and the lab processes specimens using manual patient identification. This approach has been used for decades and it does work in the sense that care can continue. But it creates several problems that persist long after the EHR comes back online:
- Handwritten orders introduce legibility and transcription errors that can affect test selection and patient identification
- Paper requisitions have to be manually reconciled with the EHR after recovery, which is labor-intensive and error-prone
- There is no systematic way to track which orders were placed, collected, and resulted during the downtime period without manually reconstructing the record
- Charge capture for downtime-period lab work is frequently incomplete, creating revenue cycle gaps
For organizations that experience downtime events multiple times per year, this manual burden accumulates into a significant operational cost.
How dbtech Keeps Lab Workflows Moving During an Outage
dbtech’s Downtime Solution addresses the lab workflow problem at several levels. By maintaining a continuously updated local copy of patient data through an HL7 interface, dbtech ensures that the information needed to support lab workflows is available on downtime workstations even when the EHR is completely offline.
Specifically, dbtech supports lab continuity in the following ways:
- Nursing and lab staff can access the current patient census and patient information from downtime workstations, providing the demographic data needed to identify specimens correctly
- dbtech’s eForms solution allows organizations to configure electronic lab requisition forms that can be completed and submitted during a downtime event without the EHR being online
- Barcoded specimen labels can be generated from downtime workstations using patient data already in the system, reducing the risk of misidentification that comes with handwritten labels
- Documents and orders captured during the downtime period are stored electronically and can be exported back into the EHR after recovery, reducing the manual reconciliation burden
The ability to generate barcoded labels and electronic requisitions during a downtime event is one of the most impactful differences between a dbtech-supported downtime and a paper-based one. Specimen identification errors are among the most serious patient safety risks in laboratory medicine, and the College of American Pathologists lists specimen identification as a priority focus in laboratory accreditation. Anything that reduces reliance on handwritten identification during a high-stress outage directly reduces that risk.
What Happens to Lab Orders After the EHR Comes Back Online
The recovery phase is where many organizations discover how costly their paper-based downtime procedures really are. Every handwritten requisition from the downtime period has to be located, reviewed, and entered into the EHR. Results that were called in by phone or recorded on paper have to be manually attached to the correct patient record. Charges for downtime-period services have to be reconstructed from whatever documentation exists.
With dbtech, the recovery process is structured and electronic. Orders and forms captured in dbtech during the outage are available for export in a format the EHR can receive. Patient registrations and downtime encounter numbers link back to the EHR record, so the reconciliation process is organized and trackable rather than a manual search through a stack of paper. For most organizations using dbtech, post-outage lab reconciliation takes hours rather than days.
What Lab Directors and IT Teams Should Be Asking
If your organization does not have a specific plan for maintaining lab workflows during an EHR outage, these are the questions worth asking now rather than during an actual event:
- How will physicians communicate urgent lab orders to nursing and lab staff if the EHR is offline?
- How will specimens be labeled and tracked without EHR-generated labels?
- How will the lab know which patients have pending collections during the outage?
- How will results be communicated to the care team if the EHR result view is unavailable?
- How will downtime-period lab orders and results be reconciled into the EHR after recovery?
If the answers to those questions involve paper and manual processes, a dbtech Downtime Audit Assessment is a practical next step. To learn more about how dbtech protects clinical workflows during outages, explore our Downtime Solutions page or request a demo.