How should health systems prepare to operate when their EHR goes down? In this healthsystemCIO webinar sponsored by Interlace Health, three healthcare IT leaders share how their organizations approach operational resilience during planned and unplanned downtime events.
Topics include failover vs. backup systems, the four-hour wait threshold, hidden risks inside automated integrations, third- and fourth-party vendor dependencies, lessons from the UKG ransomware incident, and why structured electronic documentation outperforms paper during outages. The panel also covers disaster recovery drill design, tabletop exercises vs. real-world simulations, and what organizations consistently underestimate about downtime disruption.
Panelists:
Chris Akeroyd, CIO, Lee Health
Stuart James, VP, Chief Operations Officer & Deputy CIO, CHRISTUS Health
Allison Reichenbach, President & CEO, Interlace Health
Moderator: Anthony Guerra, Founder & Editor-in-Chief, healthsystemCIO
00:00 Introduction and Panelist Backgrounds
03:22 Defining Operational Resilience in the Age of EHR Downtime
11:26 Paper Backup vs Electronic Failover Strategy
22:00 Why Practicing Your Downtime Plan Matters More Than Having One
35:12 The Real Cost of Reconciliation After EHR Downtime
47:43 Lessons Learned From Unexpected Downtime Events
52:27 Final Advice for Health System IT Leaders
KEY THEMES AND TAKEAWAYS
Operational Resilience Is an Organizational Capability, Not an IT Problem
Akeroyd described a workforce that has never operated on paper, making extended outages a fundamentally different risk than a decade ago (5:02). James argued the focus should be on clinical fundamentals rather than specific tools, so teams can adapt when toolsets change (8:29). Reichenbach reframed paper as a fragmentation event rather than a fallback, noting the loss of standardization, visibility, and data integrity (8:54).
The Hidden Risk Inside Automated Integrations
James warned that the greatest downtime risk lives in automations staff never think about — like prescriptions flowing to the pharmacy without a conscious step (10:15). Akeroyd cited controlled substance prescribing and Surescripts connectivity as examples of small workflow dependencies that create outsized friction (15:31).
IT Recovery vs. Business Continuity Ownership
James drew a clear line: IT owns disaster recovery; operations owns business continuity (20:04). Akeroyd warned that IT's cross-functional visibility creates a default ownership trap that leaders must actively push back on (24:44). Reichenbach observed that cross-functional buy-in often requires a major incident as catalyst (26:39).
Practicing the Plan Matters More Than Having One
James shared a post-9/11 lesson: his DR plan required flying to a hot site, and when aircraft were grounded, the plan collapsed. His team redesigned drills with real constraints, including physically driving to the recovery center (33:53). He also shared a military story about trained instinct saving a sailor's life during a jet engine incident on an aircraft carrier (22:19).
The Failover Decision: Wait, Switch, or Go to Paper
James described the four-hour trigger point common across organizations (42:00). Reichenbach argued software failover preserves structure and data integrity that paper cannot, citing COVID-era offline check-ins as proof electronic workflows extend deep into emergencies (37:16, 39:17). Akeroyd stressed that failover policy must evolve alongside capability (44:45).
Third-Party Vendor Risk and the UKG Lesson
Akeroyd recounted how the UKG ransomware incident left his organization unable to process payroll with no internal workaround (48:35). James broadened the point to scenarios where internal systems work fine but external supply chain or internet infrastructure fails (20:42).
The Partial Downtime Problem
James identified partial downtimes as the most dangerous and least rehearsed scenario — when 98% of orders cross over but you cannot guarantee the remaining 2%, you may need to go fully offline for safety (51:31).
Source: IT Leaders Say Downtime Prep is a System-Wide Responsibility; Practicing the Plan is Essential on healthsystemcio.com - healthsystemCIO.com is the sole online-only publication dedicated to exclusively and comprehensively serving the information needs of healthcare CIOs.
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