Four coping strategies for unplanned EHR system downtime

Whether from a natural or man-made disaster, system failure, cyber incident, or any variety of other reasons, healthcare practices need to be prepared for unexpected EHR downtime. This can bring risk to the unprepared medical practice, which is why an up-to-date EHR downtime policy and procedures guide is essential to every organization.

Effective contingency planning includes drawing up processes and needed actions to minimize both the frequency and operational impact of downtime and to handle its occurrence. The main goal is to ensure continued quality patient care while maintaining the confidentiality and integrity of protected health information.

Since downtime affects clinical decision-making, throughput (and even tasks like medication reconciliation or tracking inventory in on-site pharmacies), preparation directly influences how well a practice can maintain safe operations.

Here are four strategies to implement when your EHR system goes down.

1. Readily accessible paper documentation
2. Medication safety checking
3. Flexibility, professionalism, and communication
4. Track difficulties for future preparation

1. Readily accessible paper documentation

Practices should have a sufficient supply of paper documentation forms stored in each department, in the case of planned or unplanned EHR downtime. This ensures medical care can continue and clinicians have a reliable way to document what care was given. Of course, this information will need to be added to the EHR once it is restored, causing duplication of work. The practice may assign this to a specific department or clinician.

For most practices, a simple SOAP note format is sufficient, as this is a standard documentation template for many healthcare professionals. It is important to note that younger clinicians may not have experience with paper charting if they were only trained in EMR/EHRs. Annual downtime drills can help close this skills gap and confirm whether clinicians can quickly locate the forms they need.

Recommended reading: Don’t let EHR system downtime stand in the way of your project’s success - have a look at our EHR selection survival guide.

In addition, practices that maintain on-site inventory (e.g. ambulatory surgical centers or outpatient pharmacies) may need downtime forms for tasks such as supply tracking or documenting how to improve warehouse operations during outages. Including these in the downtime kit prevents operational bottlenecks that can affect patient flow.

2. Medication safety checking

A significant risk to any medical practice is an increased chance of medication errors during downtime.

Most EHR systems have automatic safety alerts for medication interactions, allergies, and dosing. Clinicians can come to rely on these alerts when prescribing or administering medication.

In the event of EHR downtime, clinicians must have a protocol to monitor the prescribing and administration of medication. A binder with commonly used medications should be accessible, including information on appropriate dosing and potential interactions. Many practices now supplement this with a pre-approved list of reliable offline references, such as laminated pocket cards or secure PDF copies, so clinicians aren’t dependent on internet-based tools that may also be unavailable.

Some organizations add a second-checker workflow for high-risk medications, a precaution many consider prudent when electronic safety alerts are offline, though formal evidence of error reduction remains limited.

3. Flexibility, professionalism, and communication

In most practices, each person has a clearly defined role and set of responsibilities. However, during EHR downtime events, staff and clinicians will need to be flexible while staying professional. If staff remain calm and organized, patients are more likely to be patient and understanding. Have processes in place for patient follow-up once the system is restored. A simple phone call after discharge will likely be sufficient.

Communication is key

This helps avoid chaos, anxiety, and confusion. Consider creating a workflow or communication tree in which one individual from each department is responsible for sharing updates with the team. Lead administrators and clinicians should meet regularly throughout downtime to ensure that operations and patient care are continuing.

Adding a downtime status board (digital or physical) helps keep everyone aligned on what functions are operational, what workarounds are active, and which areas need support. Even brief, predictable communication intervals reduce uncertainty and prevent duplicated efforts.

For multi-site organizations, a central coordination function can ensure consistent procedures across locations, especially when downtime affects shared services such as laboratory results or order routing.

4. Track difficulties for future preparation

If the practice is prepared for downtime and stays calm throughout the event, chaos can be minimized. Troubleshoot difficulties in order to implement a strategy for future downtime.

After every incident, planned or unplanned, conduct a structured debrief. Capture what worked, what slowed care, and where communication or documentation gaps appeared.

Turning these observations into updated EHR downtime procedures strengthens the organization’s readiness. Many health systems also perform short tabletop sessions to validate changes before the next real outage.