
Healthcare systems, like those impacted during the Ascension Healthcare ransomware attack, have traditionally focused their downtime planning efforts on Electronic Medical Record (EMR) systems. While EMR outages undeniably disrupt patient care and operations, the growing complexity of healthcare environments demand a broader approach to downtime planning—one that encompasses the entire ecosystem of systems and services supporting inpatient care.
In this article, we explore why hospitals must expand their downtime planning beyond EMRs and how a comprehensive approach can better safeguard patient care during crises.
Why Focusing Solely on EMRs Is No Longer Enough
The reliance on EMR systems for managing patient records, medication orders, and treatment plans makes them a critical area for downtime planning. However, healthcare operations involve an intricate web of interdependent systems that extend far beyond EMRs. When downtime planning is limited to a single system, hospitals risk overlooking vulnerabilities that could cripple other essential areas of care.
The Ascension Healthcare cyberattack is a cautionary tale of the broader impacts of IT outages. Alongside EMR downtime, critical systems such as medication delivery tools, imaging services, and laboratory diagnostics were disrupted, delaying care and compromising patient safety. These disruptions highlight the need for hospitals to think beyond EMRs and develop robust procedures for all systems critical to inpatient care.
Expanding the Scope of Downtime Planning
To build resilience and ensure continuity of care during crises, hospitals must address downtime procedures across all four major categories of inpatient care systems:
1. Patient Care Systems
These systems are at the core of hospital operations, directly impacting patient safety and outcomes. Beyond the EMR, patient care systems include:
Life-Sustaining Equipment:Â Devices like ventilators and IV pumps must remain functional during outages.
Monitoring Systems:Â Real-time patient monitoring tools are essential for tracking vitals and alerting staff to changes.
Medication Delivery Systems:Â Automated medication dispensing systems, such as IV pumps, need clear manual protocols during downtime.
2. Care Team Support
The care team relies on several systems to provide efficient and accurate care, including:
Nursing Communication Tools:Â Systems for care coordination and task management.
Nutrition Services:Â Tools for tracking dietary needs and meal distribution.
Clear procedures for these systems ensure continuity in delivering care when automated tools are unavailable.
3. Ancillary Services
Key diagnostic and treatment services must have downtime procedures, including:
Imaging Services:Â CT scans, MRIs, and X-rays often rely on digital systems. Manual protocols are needed to ensure imaging results are documented and shared effectively.
Laboratory Services:Â Lab equipment and systems for tracking specimens and reporting results must have backup workflows.
Pharmacy Systems:Â Medication preparation and tracking tools are critical to avoid errors in patient treatment.
4. Support Services
Supporting the infrastructure of inpatient care is just as vital as direct patient systems. This includes:
Environmental Services:Â Maintaining sterile environments and infection control during downtime.
Supply Chain Management:Â Ensuring critical supplies like PPE, medications, and devices are available despite disruptions.
IT Support:Â IT systems are essential for troubleshooting and restoring operations quickly.
Strategies for Comprehensive Downtime Planning
Developing a robust and comprehensive downtime plan requires a strategic, multi-layered approach that addresses the unique challenges and dependencies of a hospital's systems.
Here are five key strategies, with actionable details to ensure effective preparedness:
Conduct System-Wide Risk Assessments: A hospital's operations rely on a network of interconnected systems. Begin by identifying all critical systems—beyond the EMR—that support patient care, ancillary services, and infrastructure. Conduct detailed risk assessments to map system dependencies, evaluate the potential impact of downtime, and prioritize which systems need immediate attention during disruptions. Tools like dependency mapping and value stream analysis can help uncover hidden vulnerabilities.
Develop Role-Specific Protocols and Cross-Department Coordination Plans: Each department and role within a hospital has unique responsibilities during downtime. Tailored protocols ensure that clinical staff, ancillary teams, and support services know exactly what to do when systems fail. For example:
Nurses: Clear guidelines for documenting patient care manually when EMRs are offline.
Laboratory Staff: Steps for tracking and reporting specimens using paper-based workflows.
Pharmacy Teams: Instructions for managing medication dispensing and administration when automated systems are unavailable.
Additionally, create cross-department coordination plans to align workflows and ensure seamless communication during downtime.
Prioritize Regular Training and Drills: A downtime plan is only as effective as the staff implementing it. Regular training ensures that all personnel understand their roles and responsibilities during system outages. Include:
Scenario-Based Role-Playing: Simulate real-world outages (e.g. emergency scheduling with VoIP failure, lab system disruption) and guide teams through manual workflows.
Onboarding for New Staff: Integrate downtime procedures into employee onboarding programs.
Competency Testing: Evaluate staff understanding through tests and role-specific drills to identify knowledge gaps.
Utilize Scenario-Based Tabletop Exercises: Tabletop exercises allow hospitals to simulate complex scenarios and test downtime procedures in a controlled environment. Design exercises that include:
Multi-System Failures: Include cascading effects, such as simultaneous EMR and lab system outages.
Interdepartmental Challenges: Emphasize coordination between teams like IT support, nursing, and pharmacy.
Dynamic Variables: Introduce unexpected events, such as communication breakdowns or infrastructure failures, to evaluate adaptability.
After each exercise, conduct after-action reviews to identify gaps and refine procedures.
Invest in Redundant Systems and Offline Capabilities: Even with the best plans in place, having reliable redundancy can significantly reduce the impact of system failures. Hospitals should:
Implement backup power solutions, such as generators and battery backups, for critical systems like life-sustaining equipment.
Ensure offline capabilities for key systems, such as imaging services or medication dispensing, allowing basic functionality without full system access.
Maintain redundant communication tools, like satellite phones or two-way radios, to ensure uninterrupted communication across teams.
Investment in Broader Downtime Resilience is a Must-Have in 2025
The complexity of modern healthcare environments means that downtime planning cannot stop at the EMR. Hospitals must embrace a broader approach, addressing vulnerabilities across patient care, ancillary, and support systems. By broadening the scope of downtime planning, healthcare organizations can better protect patients, ensure continuity of care, and minimize operational disruptions during crises.
At Stone Risk Consulting, we specialize in helping healthcare organizations develop comprehensive downtime procedures tailored to their unique needs. Whether it's assessing vulnerabilities or designing multi-system response plans, we can help your hospital build resilience in the face of any disruption.
👉 Contact us today to learn more about our Downtime Procedures Assessment and Strategy services: Stone Risk Consulting – Contact Us. Let us help you ensure your systems and teams are ready for any challenge.
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