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Keep patient care moving through a healthcare IT outage by activating a locally approved downtime plan—not by improvising at the bedside. That plan should define who declares downtime, who leads clinical and technical response, how staff receive updates, what approved workflows they use, and how information created during the outage is reconciled after systems return. An outage can affect the entire EHR or only part of it.
Define the outage and activate the right response
ONC’s 2025 SAFER Contingency Planning guide covers planned and unplanned EHR unavailability, including situations where users can access some functions but not others. Treat loss of a clinical system as a patient-care continuity event, even when the rest of the network appears to work. The current SAFER guides are available from ONC’s SAFER Guides page.
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The organization’s plan should make clear when staff declare downtime, how they report a partial failure, and who decides whether to expand or end the response. Name a clinical incident lead and a technical lead, along with escalation contacts and the method for notifying affected units. These roles and thresholds must fit local services, vendor arrangements, and risk; federal guidance does not establish one activation threshold for every facility. See ONC’s Contingency Planning guide.
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Once downtime is declared, teams need validated alternatives for the work affected by the outage. The plan should address essential care, documentation, orders, results, patient identification, handoffs, and communication. Which paper forms or other procedures are appropriate depends on the organization’s systems and clinical policies; ONC does not prescribe a universal bedside form set.
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Make the approved workflow explicit for each affected service, including how staff access necessary patient information and how they communicate when a usual electronic function is unavailable. Staff should use only the current, locally approved procedures. Do not treat a generic online template as an authorized clinical form.
Keep instructions and status updates accessible
ONC recommends that current downtime and recovery policies be available on clinical units and in a safe off-site location. Keep the instructions usable if the affected system is unavailable, and make sure staff know where approved forms and contact information are stored.
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Set a communication rhythm in advance: who sends updates, which channels reach affected staff, and how often updates are expected. Include what is unavailable, what remains usable, and where staff should direct questions. The organization—not an individual unit improvising during an incident—should define that cadence and escalation path in its plan.
Restore systems and reconcile downtime information
Recovery is part of continuity, not a separate IT-only task. ONC advises organizations to exercise the return to normal operations, including integrating data and orders created while systems were down. The local recovery procedure should assign responsibility for entering or importing downtime records and checking for missing, duplicated, or conflicting information before teams rely on the restored record.
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Plan reconciliation around the organization’s EHR and approved clinical processes. Determine which records, orders, results, and communications need review; who verifies completion; and how unresolved conflicts are escalated. The precise controls are organization-specific, so do not assume that restoring system access automatically reconciles work performed during downtime.
Test both downtime and recovery
Exercise the full cycle with the clinical and technical teams: activation, staff notification, alternate workflows, status updates, restoration, and reconciliation. A drill that ends when the EHR becomes available misses the handoff back into normal operations. Use exercises and post-incident reviews to uncover unclear roles, inaccessible instructions, communication gaps, workflow bottlenecks, and recovery problems.
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ONC’s 2018 disaster-planning guidance also recommends regular backups and testing recovery procedures, preferably with off-site backups to reduce the risk of facility loss. Apply that preparedness guidance to the organization’s current architecture and risk. ONC does not set a universal exercise interval or recovery-time objective; establish those locally based on clinical service needs, risk analysis, vendor arrangements, and applicable obligations. Review and update the written policy as systems and workflows change.
Apply the plan to your organization
ONC guidance is a U.S. federal resource, not a complete statement of every state-law, privacy, emergency-preparedness, accreditation, or contract requirement. Before adopting specific forms, thresholds, timelines, or procedures, align the downtime plan with the organization’s jurisdiction, facility type, clinical policies, cyber incident procedures, and vendor commitments. ONC’s Health IT Playbook section on quality and patient safety and its guidance on selecting or upgrading health IT provide related context.
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