October 14, 2026

When a healthcare practice's electronic health record (EHR) system goes down, the immediate priorities are to protect patient safety, activate downtime procedures, determine the scope of the outage, notify the appropriate technology providers, and maintain essential clinical operations.

A practical response follows 10 steps: identify the outage, activate the downtime plan, communicate with staff, protect patient care, use approved downtime documentation, manage prescriptions and orders, coordinate technical recovery, communicate with patients, restore and reconcile records, and review what happened.

For an independent healthcare practice, the most important preparation happens before the outage. Staff should already know who makes operational decisions, which workflows can continue without the EHR, what information remains accessible, and how documentation will be entered into the system once service is restored.

Why Does an EHR Outage Require More Than an IT Support Ticket?

An EHR outage can affect nearly every part of a healthcare practice.

Depending on the system and how the practice uses it, employees may lose access to patient schedules, medical histories, medications, allergies, clinical documentation, laboratory results, electronic prescribing, billing information, and patient communications.

The impact can extend beyond the EHR itself.

For example, an internet outage might prevent access to a cloud-based EHR while also disrupting phones, payment processing, and other applications.

A problem with a local workstation or network, on the other hand, may affect only part of the practice.

That distinction matters because the cause of the outage determines the technical response, while the impact on patient care determines the operational response.

The Practice Administrator, clinical leadership, EHR vendor, and IT Service Provider each have different responsibilities.

A successful downtime plan coordinates those responsibilities instead of expecting one person or vendor to handle everything.

What 10 Steps Should a Healthcare Practice Follow During an EHR Outage?

1. Identify the Outage and Determine What Is Affected

Start by establishing what is actually unavailable.

Ask:

• Is the entire EHR down, or only certain functions?
• Is the problem affecting one employee or everyone?
• Can staff access other websites and cloud applications?
• Is the internet connection working?
• Are multiple locations affected?
• Are connected applications or interfaces also unavailable?
• Has the EHR vendor reported a service disruption?

The purpose is not to turn the Practice Administrator into a technical troubleshooter.

It is to gather enough information to identify the scope of the problem and contact the appropriate support team.

For example, if one computer cannot access the EHR but other computers work normally, the issue may be local to that workstation.

If nobody can access the EHR, the problem may involve the EHR service, internet connection, network, or another shared dependency.

Document when the problem was first noticed and which functions are affected. That information helps both operational decision-making and technical troubleshooting.

2. Activate the Practice's EHR Downtime Plan

Once an outage is confirmed, the designated practice leader should determine whether to activate established downtime procedures.

The plan should identify:

• Who has authority to activate downtime procedures
• Who coordinates the response
• Which clinical workflows can continue
• Which activities must be modified, delayed, or suspended
• Where approved downtime forms and instructions are stored
• How employees communicate
• Who contacts vendors
• How decisions are documented

The Practice Administrator may coordinate the operational response, while a physician or designated clinical leader makes decisions involving patient safety and clinical services.

Those roles should be established before an incident.

Do not wait for the EHR vendor to provide an estimated restoration time before deciding how the practice will operate.

If essential information is unavailable, the practice needs to follow its approved clinical and operational contingency procedures immediately.

3. Communicate Clearly With Employees

Staff need a consistent understanding of what is happening and what they should do.

The initial communication should answer four questions:

1. What systems or functions are unavailable?
2. Which downtime procedures are now in effect?
3. Who is coordinating the response?
4. Where will employees receive updates?

Different departments may need different instructions.

Front-desk employees need guidance about registration, scheduling, and patient communications.

Clinical employees need instructions about documentation, medication information, orders, and access to essential patient records.

Billing personnel may need to pause or modify certain workflows.

Avoid having individual employees independently invent workarounds.

Unapproved methods can create privacy, security, documentation, and patient-safety problems.

Use the practice's designated communication channels and establish a clear process for reporting new issues during the outage.

4. Prioritize Patient Safety and Essential Clinical Services

Not every appointment or clinical activity can necessarily continue safely without the EHR.

Clinical leadership should determine which services can proceed using approved downtime procedures and which require postponement, transfer, or another appropriate response.

Consider whether staff can safely access or verify:

• Patient identity
• Relevant medical history
• Current medications
• Allergies
• Recent clinical information
• Critical laboratory or imaging results
• Treatment plans
• Necessary orders and documentation

The answer may differ depending on the specialty, patient condition, and reason for the visit.

For example, a routine administrative appointment may be easier to manage during an outage than a clinical encounter requiring immediate access to information that is unavailable.

The decision to continue patient care must be based on clinical judgment and established procedures, not pressure to maintain the normal appointment schedule.

The IT provider's responsibility is to help restore technology. It should not determine whether a particular patient can be treated safely without the EHR.

5. Use Approved Downtime Documentation Procedures

When electronic documentation is unavailable, staff need an approved alternative.

Depending on the practice's policies, that may involve:

• Paper encounter forms
• Patient registration forms
• Clinical notes
• Medication documentation
• Order tracking
• Appointment logs
• Other approved downtime records

These materials should be prepared before an outage, not created from scratch during one.

The practice also needs procedures for protecting patient information.

Paper records containing protected health information should be secured against unauthorized access, loss, or improper disposal.

Avoid storing patient information in unapproved personal applications, consumer cloud accounts, or employee devices simply because the EHR is unavailable.

Each downtime record should contain the information required by the practice's clinical and documentation procedures so it can be accurately reconciled later.

The goal is to preserve a reliable record of what occurred during the outage without creating unnecessary privacy or documentation risks.

6. Establish Safe Procedures for Prescriptions, Orders, and Results

An EHR outage may interrupt electronic prescribing, laboratory orders, imaging requests, referrals, and the delivery of results.

The practice needs approved alternative procedures for these activities.

Clinical leadership should determine:

• Which orders can be handled through approved downtime methods
• How prescriptions will be managed
• How urgent results will be communicated
• How orders and results will be tracked
• How completed activities will be documented
• How outstanding items will be reconciled after recovery

Some processes may have regulatory, clinical, or vendor-specific requirements.

For example, alternative prescribing procedures may differ depending on the medication and applicable laws.

Staff should follow established clinical policies and applicable requirements rather than assuming that any available communication method is acceptable.

A particularly important concern is tracking work that begins during the outage but remains incomplete when the EHR returns.

Without a reliable tracking process, orders, results, and follow-up responsibilities can be overlooked.

7. Coordinate With the EHR Vendor and IT Service Provider

The EHR vendor and IT Service Provider may need to work together, but they are not necessarily responsible for the same systems.

The EHR vendor generally addresses issues involving its application and the services it provides.

The IT Service Provider may investigate the practice's computers, network, internet connectivity, authentication, and other supporting technology within its scope.

A practical escalation process should identify:

Issue	Initial Responsibility to Verify
EHR service unavailable to multiple organizations	EHR vendor
One workstation cannot access the EHR	IT Service Provider
Entire practice has lost internet connectivity	IT Service Provider and internet provider
EHR login or authentication failure	EHR vendor and/or IT Service Provider, depending on the cause
EHR integration failure	EHR vendor, integration provider, and relevant IT support
Suspected cyberattack	IT/security incident response team and affected vendors

These are starting points, not universal assignments.

Actual responsibility depends on the practice's contracts and technical environment.

The Practice Administrator should know who is coordinating the technical response and how updates will be communicated.

If a cyberattack is suspected, staff should follow the practice's security incident response procedures. Avoid actions that could destroy evidence or interfere with containment and investigation.

For guidance on defining responsibilities before an incident, see How Should Healthcare Practices Manage IT Vendors Without Getting Caught in the Middle? A 7-Step Process.

8. Communicate With Patients and Adjust Operations

An outage may require changes to appointments, check-in procedures, communications, or other patient-facing activities.

The Practice Administrator should coordinate with clinical leadership to determine what patients need to know.

Depending on the situation, the practice may need to:

• Explain that check-in is taking longer than usual
• Notify patients about appointment delays
• Reschedule affected visits
• Adjust staffing assignments
• Provide instructions for urgent clinical concerns
• Communicate changes to normal office procedures

Patient communications should be accurate without unnecessarily exposing internal technical details or sensitive information.

Avoid promising a restoration time unless it has been confirmed and the practice has a reasonable basis for communicating it.

For example, if the EHR vendor estimates recovery within an hour, the practice should still consider whether its own systems, interfaces, and workflows will be ready immediately afterward.

Restoring access to the EHR does not necessarily mean normal operations can resume at once.

9. Restore Access and Reconcile Downtime Records

When the EHR becomes available again, the practice should not immediately assume that every system and workflow is functioning normally.

The IT provider and EHR vendor may need to verify that relevant technical services are working.

The practice should confirm that staff can perform essential activities, such as:

• Accessing patient records
• Reviewing schedules
• Documenting encounters
• Entering orders
• Processing prescriptions
• Accessing results
• Using required integrations

Clinical and administrative staff then need to reconcile work completed during downtime.

This may include entering paper documentation, updating encounter records, reconciling orders, verifying results, and addressing outstanding tasks.

The practice should have a designated process for preventing duplicate entries and ensuring that downtime documentation is accurately incorporated into the permanent record.

Depending on the amount of work accumulated, reconciliation may continue after normal EHR access is restored.

Assign responsibility for completing and verifying the reconciliation rather than assuming every employee will remember what needs to be entered.

10. Review the Outage and Improve the Downtime Plan

Once normal operations are restored, conduct a short review.

Include the Practice Administrator, appropriate clinical leadership, and relevant technology providers.

Discuss:

• What caused the outage?
• How long were essential functions unavailable?
• Which departments were affected?
• Did employees know when to activate downtime procedures?
• Were the necessary forms and instructions available?
• Did vendor communication work?
• Were any patient-safety concerns identified?
• Was information lost or delayed?
• How long did reconciliation take?
• What should change before the next outage?

Document the findings and assign responsibility for corrective actions.

For example, the practice may discover that its downtime forms were outdated, emergency contact information was incomplete, or employees did not know who could authorize changes to the appointment schedule.

Those findings should result in specific improvements.

An outage review is useful only when the practice follows through on the changes it identifies.

What Should an EHR Downtime Plan Include Before an Outage Happens?

A practice should not have to create its response procedures while patients are waiting.

The plan should be documented, accessible when the EHR is unavailable, and understood by the employees responsible for using it.

Planning Area	What the Practice Should Have Ready
Response leadership	Designated decision-makers and backup contacts
Emergency contacts	EHR vendor, IT provider, internet provider, and other critical vendors
Clinical continuity	Approved procedures for determining which services can safely continue
Downtime documentation	Approved forms, storage locations, and handling procedures
Prescriptions and orders	Authorized alternative workflows and tracking methods
Patient communication	Procedures for delays, cancellations, and operational changes
Technical escalation	Clear vendor responsibilities and support contact information
Recovery verification	Procedures for confirming essential functions are working
Record reconciliation	Assigned responsibilities for entering and validating downtime information
Training and testing	A schedule for reviewing and exercising the plan

The plan should also account for the possibility that multiple systems become unavailable simultaneously.

For example, an internet outage may disrupt the cloud EHR, cloud-based phones, and patient communication systems.

The practice should not rely exclusively on a document stored inside the EHR or another application that might be inaccessible during the same incident.

A broader business continuity strategy should address these dependencies. For additional guidance, see What Should a Healthcare Practice Business Continuity Plan Include? A 7-Part Checklist.

How Should a Practice Test Its EHR Downtime Procedures?

A documented plan is only useful if employees understand how to carry it out.

One practical approach is to conduct a tabletop exercise in which the Practice Administrator and relevant staff walk through a hypothetical outage.

For example, consider this scenario:

A 20-employee Houston medical practice loses access to its cloud-based EHR at 9:15 a.m. on a busy Tuesday. The vendor confirms a service disruption but cannot provide a reliable restoration time.

The practice has patients waiting, scheduled appointments throughout the morning, and several employees who need access to clinical information.

During the exercise, ask:

• Who declares that downtime procedures are active?
• Who determines whether appointments can continue?
• Where are the approved downtime forms?
• How are patients notified about delays?
• How are prescriptions and orders handled?
• Who communicates with the EHR vendor?
• How will work be reconciled when the EHR returns?

This is a hypothetical exercise, not an actual ResTech client incident.

The objective is to discover gaps before a real outage.

For example, the exercise might reveal that the front desk has paper registration forms but the clinical team lacks an approved process for tracking outstanding laboratory orders.

That is a problem the practice can address before an emergency.

The frequency and scope of testing should reflect the practice's risks, operational complexity, and applicable requirements. Testing should also be repeated after significant changes to the EHR, staffing, or clinical workflows.

Frequently Asked Questions

Can a Healthcare Practice Continue Seeing Patients When the EHR Is Down?

Yes, some services may be able to continue under approved downtime procedures, but the decision depends on the clinical situation and whether necessary patient information and safeguards remain available.

Clinical leadership should determine which activities can safely proceed and which should be delayed or modified.

Does a Cloud-Based EHR Need a Downtime Plan?

Yes, cloud-based EHR systems can become unavailable because of vendor outages, internet disruptions, authentication failures, cybersecurity incidents, or other problems.

The practice still needs procedures for maintaining essential operations when the application cannot be accessed.

Who Is Responsible for Restoring the EHR?

Responsibility depends on the cause of the outage.

The EHR vendor generally handles problems within its application or hosted environment. The IT Service Provider may handle local computers, networks, internet connectivity, and other supporting systems.

The practice should define those responsibilities before an incident.

Should Employees Use Personal Devices or Applications During an EHR Outage?

No, employees should not independently move patient information into personal devices, email accounts, or unapproved applications as an emergency workaround.

The practice should use approved downtime methods that account for privacy, security, documentation, and operational requirements.

How Long Can a Healthcare Practice Operate Without Its EHR?

There is no universal safe duration.

The answer depends on the services provided, availability of essential clinical information, approved downtime procedures, staffing, and the nature of the outage.

Clinical leadership should continually reassess whether operations can continue safely.

Should a Healthcare Practice Keep Paper Downtime Forms?

Yes, approved paper forms can provide a useful alternative when electronic systems are unavailable.

However, forms should be current, securely stored, accessible when needed, and supported by procedures for protecting information and reconciling records afterward.

Final Thoughts

An EHR outage does not have to mean that every part of a healthcare practice immediately stops functioning.

But continuing operations safely requires more than restoring a computer connection.

The practice needs clear leadership, approved clinical procedures, reliable communication, coordinated vendor support, and a plan for reconciling work after recovery.

The time to determine how your practice will operate without its EHR is before the EHR becomes unavailable.

About ResTech Solutions

ResTech Solutions helps independent healthcare practices throughout the Houston area manage technology, cybersecurity, Microsoft 365, backups, vendor relationships, and long-term technology planning.

Founded in 2011, ResTech takes a security-first, compliance-focused approach to helping small businesses manage technology risks and improve operational preparedness.

For healthcare practices, that includes helping identify technical dependencies, clarify vendor responsibilities, evaluate backup and recovery capabilities, and plan for disruptions affecting critical business technology.

While clinical leadership remains responsible for patient-care decisions and the EHR vendor remains responsible for its application, ResTech can help practices address the technology systems and coordination needed to support their broader continuity plans.

If your practice is unsure how it would respond to an EHR outage, book a 10-minute discovery call to discuss your technology environment and identify potential gaps worth reviewing.