Analysis of Healthcare IT Downtime: Real-World Examples & Considerations

In today's digital age, healthcare facilities rely heavily on information technology systems, especially Electronic Health Records (EHR), to provide efficient and high-quality care. However, IT downtime is an inevitable reality, whether due to scheduled maintenance, unexpected technical failures, or cyberattacks. Preparing for such downtimes is crucial to ensure continuous, safe, and effective clinical care. 

The Impact of IT Downtime in Healthcare

When IT systems go down in a healthcare setting, the consequences can be severe. Clinical workflows are disrupted, leading to delays in patient care. Without access to EHRs, healthcare providers lose real-time access to patient histories, medication records, and other critical information. This not only lessens the quality of care but also poses significant risks to patient safety, such as medication errors or missed diagnoses. Additionally, prolonged downtimes can have substantial financial implications, from increased labor costs to potential legal liabilities. 

Preparing for IT Downtime

Given these risks, it is essential for healthcare organizations to have a robust downtime plan in place. An effective contingency plan should include:

• Comprehensive Assessment: Identify which systems are critical and the potential impact of their downtime.
• Detailed Procedures: Develop step-by-step instructions for staff to follow during downtime.
• Regular Training: Ensure all staff are trained and familiar with downtime procedures.
• Backup Systems: Implement reliable backup systems and ensure they are regularly tested.
• Communication Plans: Establish clear communication protocols to keep all stakeholders informed during downtime. 

Maintaining Critical Care Without EHR Access

During IT downtimes, healthcare providers must revert to manual processes to maintain clinical care. This involves:

• Manual Record-Keeping: Using paper records to document patient information and treatment plans.
• Critical Information Access: Ensuring vital patient information, such as allergies and current medications, is available in a non-digital format.
• Communication Protocols: Maintaining clear and effective communication among healthcare teams to coordinate patient care. 

Real-World Examples & Lessons Learned

Several healthcare organizations have successfully navigated IT downtimes through thorough preparation and execution of their contingency plans. For instance, during a major EHR outage, one hospital's pre-planned response ensured minimal disruption to patient care, with staff efficiently transitioning to manual record-keeping and maintaining clear communication throughout the downtime. Conversely, other facilities that lacked adequate preparation faced significant challenges, underscoring the importance of having a well-thought-out downtime strategy. 

University of Vermont Health Network 

In late 2020, the University of Vermont Health Network experienced a significant IT downtime due to a ransomware attack known as Ryuk. This attack not only affected the hospital's internal systems but also its patient-facing applications, such as the MyChart Patient Portal. As a result, patients were unable to access their medical records, and elective procedures had to be postponed. The hospital's IT department had to disconnect all impacted systems to prevent further damage, demonstrating the critical need for robust cyber defenses and a well-prepared response plan​. 

Massachusetts General Hospital 

Massachusetts General Hospital has developed a detailed downtime toolkit to manage unplanned IT outages. This toolkit includes comprehensive procedures for maintaining operations in the laboratory and emergency department (ED) during downtimes. A study analyzing three years of patient safety reports found that 46% of downtime incidents were due to inadequate procedures or lack of adherence to existing ones. By implementing a discrete-event simulation model, the hospital was able to predict the impact of different downtime strategies, such as limiting lab tests and increasing staff during outages. This proactive approach significantly reduced the time to see a physician and improved lab result turnaround times during downtimes​​. 

Scripps Health 

In May 2021, Scripps Health, a prominent healthcare provider in California, faced a severe ransomware attack that led to a significant IT system shutdown. The attack disrupted patient care and operations across its five hospital campuses and numerous outpatient clinics. The incident highlighted the importance of having offline access to critical patient information and maintaining manual documentation processes. Despite the disruptions, Scripps Health managed to continue providing essential services, underscoring the effectiveness of having a comprehensive downtime plan and regular staff training on manual procedures​. 

 IT downtimes in healthcare are unavoidable, but their impact can be mitigated with proper preparation. Healthcare organizations must prioritize developing, updating, and regularly testing their downtime procedures to ensure continuous, high-quality patient care even when digital systems fail. By doing so, they can safeguard patient safety and maintain operational efficiency in the face of unexpected challenges.