Downtime readiness guide

EHR downtime procedures: a department-by-department checklist

Published July 30, 2026 · CodeDark Health editorial team

A downtime procedure should do more than tell staff to use paper. It should give every affected department a clear activation signal, a safe alternative workflow, accountable owners and a controlled route back to the EHR. This checklist is a planning aid for hospital leaders—not a substitute for clinical policy, legal review or incident command.

Start with a single activation decision

Define who can declare downtime, how teams receive the message and which systems or locations are affected. The announcement should distinguish an EHR outage from a network, Wi-Fi, vendor or cyber-containment event because each may change what information and devices are available.

Checklist for every department

1. Confirm scope: Identify unavailable systems, expected duration, safe communications and escalation contacts.
2. Activate approved workflow: Use the department’s current, approved downtime process—not an improvised one.
3. Assign a local lead: Name the person responsible for decisions, handoffs and exception escalation during the event.
4. Protect patient identification: Follow hospital identification, allergy, medication and documentation safeguards at every transition.
5. Record time and ownership: Make it possible to determine what happened, who completed it and what requires reconciliation.
6. Coordinate dependencies: Clarify how nursing, pharmacy, laboratory, imaging, EVS, registration and billing exchange essential information.
7. Manage exceptions: Define how urgent, missing, duplicated or unclear documentation is escalated.
8. Prepare restoration: Preserve a queue of work that must be reviewed or entered once normal systems return.

Role-specific questions

Inpatient and emergency teams

Can staff document assessments, medications, orders, transfers and handoffs according to hospital policy? Who verifies a patient’s current status when the usual view is unavailable? These questions should be answered before an outage—not while care is underway.

Pharmacy and laboratory

Map controlled-drug documentation, medication verification, specimen labeling, collection and chain-of-custody steps. A procedure is only useful if the teams that exchange information can see their responsibilities and escalation path.

Revenue cycle and operations

Identify the data required for charge capture, room status, service documentation and later reconciliation. Clinical safety remains first, but lost operational records create additional recovery work when the event ends.

Finish with a recovery checklist

Include restoration confirmation, queue ownership, priority review, reconciliation, exception handling and an after-action review. Read our EHR reconciliation guide for a more detailed recovery sequence.

Related resources: How to conduct an EHR downtime drill · Downtime drill planning guide · Schedule a Hospital Downtime Readiness Demo