The Downtime Plan That Fails When You Need It Most
Most healthcare organizations have some form of a downtime plan. A binder. A set of printed forms. A policy document last updated two EHR versions ago. A SharePoint folder nobody can find when the system is down.
Having a downtime plan and having an effective downtime plan are not the same thing. After working with hundreds of healthcare organizations across the country, dbtech has identified a consistent set of gaps that leave facilities exposed during real-world outages, gaps that aren’t obvious until the system is actually down and the gap becomes a crisis.
Here’s what most downtime plans are missing.
Gap 1: No Communication Protocol
Who tells the ED charge nurse the system is down? Who notifies radiology? Who calls the on-call CMO? Most downtime plans detail what clinical staff should do during an outage but say almost nothing about how the organization communicates when the EHR, which often serves as an internal messaging backbone, is unavailable.
A complete downtime plan includes:
- A defined notification chain from IT → clinical leadership → department heads → frontline staff
- Backup communication methods (overhead paging, cell phone trees, Vocera or similar)
- A patient/family communication template for extended outages
- A vendor notification protocol (EHR vendor SLA activation, third-party vendor alerts)
Gap 2: Your Printed Forms Are Out of Date
Paper downtime forms are only useful if they reflect your current clinical workflows, formularies, and protocols. Most organizations print their downtime packets at implementation and never update them. Three form committee updates later, the forms reference fields, order sets, or workflows no longer exist.
This is one of the core issues dbtech’s platform solves: downtime workstations are automatically updated with current patient data and form sets. There’s no manual printing, no outdated packets, and no risk that staff are documenting on forms that don’t match your live workflows. See Your Downtime Solution Needs These 7 Things for a full checklist.
Gap 3: No Department-Level Downtime Protocols
A single facility-wide downtime policy is not sufficient. The ED, ICU, pharmacy, radiology, and the business office all have fundamentally different needs during an outage. A one-size-fits-all approach means every department improvises, and improvisation during a downtime event is how errors happen.
Each of the following departments should have a standalone downtime protocol:
- Emergency Department (triage workflows, EMTALA considerations)
- ICU and critical care (medication order management, ventilator documentation)
- Pharmacy (order verification, controlled substance management)
- Radiology (imaging order intake without CPOE access)
- Labor and Delivery (fetal monitoring documentation, obstetric emergency protocols)
- Revenue cycle and HIM (charge capture, late entry documentation procedures)
Gap 4: Your Plan Has Never Been Tested
A downtime plan that has never been exercised is not a plan, it’s a hypothesis. Yet a significant number of healthcare organizations have never run a formal downtime drill. The Joint Commission expects organizations to demonstrate continuity of care during system outages, but many facilities discover their gaps during a real event rather than a controlled exercise.
dbtech recommends regular testing cadences based on facility size and risk profile. See How Often Should You Test Your Downtime Procedures? for a practical testing framework.
Gap 5: No Plan for the First 15 Minutes
The first 15 minutes of a downtime event are the most chaotic, and the most likely to result in patient safety incidents. Most downtime plans describe steady-state downtime operations but provide no guidance on the transition period between normal operations and full downtime mode.
Questions that need to be answered in the first 15 minutes:
- How do we confirm this is an actual outage vs. a local connectivity issue?
- Which patients are currently in active, high-acuity workflows (OR, ICU, active resuscitation)?
- Where are the downtime workstations and who has access credentials?
- What is the expected duration, and at what threshold do we escalate to full downtime protocols?
A complete downtime plan includes an activation checklist that answers each of these questions before a real event forces improvisation.
Gap 6: No Data Reconciliation Plan for After the Outage
What happens when the EHR comes back online? Most organizations focus their planning on surviving the outage and don’t think about the recovery period. But the hours immediately after restoration are critical — and poorly managed reconciliation creates documentation gaps, coding errors, and potential compliance exposure.
A complete plan includes a formal reconciliation protocol: who reviews downtime documentation, how late entries are flagged and entered, and how charge capture gaps are identified and resolved. FAQ Friday: What Happens to Data Captured During Downtime Once the EHR Comes Back Online? walks through how dbtech handles this automatically.
Gap 7: No Plan for Extended Outages
Most downtime plans are designed for outages measured in minutes to a few hours. But ransomware attacks, major infrastructure failures, and natural disasters can take healthcare systems offline for days. Does your organization have a plan for a 48-hour outage? A five-day outage?
The Kettering Health ransomware attack in May 2025 resulted in system-wide outages that lasted days, forced cancellations of elective procedures, and required crisis-level operational adjustments. An extended outage plan should address staffing ratios, supply chain documentation, and external communication protocols that go far beyond a standard downtime binder.
Gap 8: Downtime Is Treated as an IT Problem, Not a Clinical One
Perhaps the most pervasive gap in healthcare downtime planning is organizational: downtime preparedness is owned by IT, not by clinical and operational leadership. When IT owns the downtime plan, the clinical workflow nuances are often underrepresented, and frontline staff don’t feel ownership over the protocol. Downtime as a Patient Safety Strategy, Not an IT Backup makes the case for why downtime readiness should be a clinical leadership priority.
Is Your Downtime Plan Ready for a Real Outage?
If your organization has any of the eight gaps above, you’re not alone, and the solution is more straightforward than you might think. dbtech’s Downtime Solution is designed to address each of these gaps: automated data updates eliminate stale forms, department-level configurations address diverse clinical needs, and offline workstation access ensures staff have what they need in the first 15 minutes of any outage.
Start with a free downtime assessment to identify where your plan needs strengthening.