Knowing what to do when an EHR goes down can help a medical practice keep patient care organized while reducing confusion, missed tasks, and duplicate work. The key is to shift to a practiced downtime workflow, assign clear responsibilities, and keep a reliable record of everything that must be entered or followed up later.
Use your practice’s approved downtime forms and procedures, and follow clinician judgment and established safety protocols throughout. A planned response should cover check-in, documentation, prescriptions, orders, test results, patient communication, and recovery. The SAFER contingency planning guide and EHR downtime procedure guidance can help practices review their plans.
First, confirm the outage and activate the plan
When staff cannot access the EHR, avoid repeated troubleshooting attempts that delay the response or risk changing system settings. Report the issue through the practice’s established IT support channel. The person coordinating with IT should note when the problem began, which systems or locations are affected, and any relevant error messages, without recording patient information in an unapproved channel.
The designated incident lead should announce that downtime procedures are active, tell staff where to find approved forms and reference materials, and establish how updates will be shared. If the cause or expected restoration time is not known, say so. Do not assume that a slow or partially working system has saved information reliably.
Assign responsibilities so nothing falls between roles
- Incident lead: Starts the downtime workflow, communicates status, confirms when the practice can return to normal operations, and coordinates a final accounting of pending work.
- Front desk: Uses the practice’s approved patient-identification process, tracks arrivals and appointment status, and directs patients to the appropriate staff without relying on unavailable schedules or records.
- Clinicians and nursing staff: Decide how each visit should proceed, document care on approved downtime forms, and identify orders, prescriptions, or follow-up actions that need later attention.
- IT liaison: Contacts support, shares operational updates with the incident lead, and helps confirm that systems are available again. Staff should not treat an “online” status alone as proof that every function is working correctly.
One person may cover more than one role in a small practice, but ownership should still be explicit. The network troubleshooting guide can also help teams understand what information to provide when reporting a connectivity issue.
Keep check-in and patient flow organized
Use the practice’s downtime registration process to confirm patient identity with approved identifiers. Record arrival time, appointment status, and the clinician or care team responsible. If the normal schedule is unavailable, maintain a secure paper or approved offline tracking log so staff can see who has arrived, who is waiting, and who has been seen.
Do not rely on memory or loose notes for patient flow. If staff cannot access information needed to provide a visit safely, the clinician should determine whether the appointment can proceed, needs a modified workflow, or should be rescheduled. For urgent concerns, follow the practice’s established escalation and emergency procedures. Explain delays or changes to patients in a calm, clear way without promising a restoration time that has not been confirmed.
Document care and track every action
Use only practice-approved downtime forms. For each encounter, capture the patient’s approved identifiers, date and time, responsible clinician, reason for the visit, relevant information confirmed with the patient, and care provided. Include medications and allergies as verified, assessment and plan, instructions given, and any follow-up needed. Record the author and any required authentication according to practice procedure.
For orders, prescriptions, tests, referrals, and callbacks, make the intended action and its status easy to identify. Use a dedicated tracking log or fields on the approved form to show whether an action is pending, completed, or needs confirmation. Avoid creating informal workarounds that could leave an order or callback unassigned.
Prescriptions, labs, referrals, and results
If e-prescribing is unavailable, clinicians and authorized staff should use the practice’s approved alternative process and follow applicable organizational procedures. Confirm what has actually been transmitted or completed before repeating an action after the EHR returns. This helps reduce the risk of duplicate prescriptions or orders.
For lab orders and referrals, record the requested action, relevant destination or recipient, responsible person, and follow-up status on approved forms. Track incoming results and patient callbacks in the same way. If a result arrives during downtime, route it through the practice’s established clinical review process and document who is responsible for follow-up.
Protect paper records during downtime
Paper forms containing patient information still need careful handling. Keep them in a designated, controlled area, limit access to staff who need them for their work, and do not leave them in public or shared spaces. Do not photograph forms with personal devices or send patient details through unapproved email, messaging, or storage tools.
At the end of a shift or downtime period, account for completed forms, active encounter packets, and tracking logs. Store them securely according to practice procedure until they can be reconciled and handled appropriately. For related planning, see these healthcare data management practices.
When the EHR returns, reconcile before closing the incident
Wait for the designated lead or IT liaison to confirm that the required systems and workflows are available. Then review the downtime log and paper records systematically. Enter or otherwise reconcile encounter notes, orders, prescriptions, results, and follow-up tasks according to practice procedures. Identify the person responsible for each item and mark it complete only after it has been verified.
Check for duplicate entries before resubmitting anything. Confirm that pending results were reviewed, patient callbacks were completed or assigned, and records are connected to the correct patient and encounter. Keep the original downtime documentation available as required by practice procedure, and secure it after reconciliation. The incident lead should resolve discrepancies and confirm that no work remains unassigned before ending downtime operations.
Make the downtime plan usable through rehearsal
A written plan is more useful when staff know where the forms are and have practiced using them. Run a short scenario during a staff meeting: the EHR becomes unavailable during a busy clinic period, a walk-in arrives, a refill request is waiting, and a test result needs review. Ask staff to use the actual forms and explain who owns each step.
After the exercise, note where staff hesitated, which supplies or instructions were hard to find, and how the team would confirm all work was reconciled. Update the plan and make sure the current version is accessible to the people who need it. Practices can also include system backups and recovery responsibilities in broader continuity planning.
Frequently asked questions
What should staff record on paper during an EHR outage?
Use approved forms to record patient identification, encounter details, care provided, medications and allergies as confirmed, orders, instructions, and follow-up responsibilities. Follow the practice’s documentation and authentication procedures.
Should a clinic keep seeing patients during an outage?
There is no single answer for every visit. The clinician should decide whether the necessary information and safe workflow are available, using practice procedures and clinical judgment. Reschedule or escalate when the visit cannot be managed safely through the fallback process.
How should a practice handle paper notes after the EHR is restored?
Reconcile each note and action using the practice’s process, check for duplicates, confirm pending work is complete or assigned, and secure the original forms according to procedure.
How can a practice rehearse EHR downtime procedures?
Run a brief scenario using the real downtime forms and supplies. Practice check-in, documentation, order and callback tracking, secure storage, and the handoff back into the EHR.
Keep the response practical and patient focused
A clear downtime plan gives staff a consistent way to manage patients and outstanding work when the EHR is unavailable. Rehearse the workflow, keep approved forms accessible, and make reconciliation an assigned task rather than an afterthought. For help with healthcare IT infrastructure support, contact Zevonix at (904) 658-0777.