Working Offline When Your EHR Isn’t Available

Many of you will likely remember my series of posts on EHR down time: Cost of EHR Down Time, Reasons Your EHR Will Go Down, and SaaS EHR Down Time vs. In House EHR Down Time. Needless to say, it’s pretty much inevitable that sooner or later you’re going to encounter EHR down time. The key to EHR down time is to think ahead about how you’re going to deal with your EHR being inaccessible.

I started thinking about this a bit more when I came across this FAQ item on Practice Fusion’s EMR user forums.

When there’s a planned maintenance ahead:
•Print your daily calendar for the next day’s schedule
•Know your offline alternatives for handling labs and prescriptions
•Have a plan to document your patient visits so you can input them in the EMR later
•Clear out your To do list and complete any pending Rx refill requests the day before
•Update your web browser and Adobe Flash to the current version

Preparing your office:
•Have a prepaid wireless 3G hub or other back-up internet system ready to go in the event your main internet is down
•Use laptops with good batteries and connect computers to surge protectors and battery back-ups for short term power interruptions
•Identify a second location that you could use temporarily in the case of a serious, long-term outage such as a fire or flood

I’ll always remember the reaction of the director of the health center where I first implemented an EMR to the discussion about “What do we do if the EMR is down?” She basically said, “We can still take care of the patient. We just might have to ask a few more questions.”

Now I’m sure there are cases where a physician might choose not to treat a patient without access to their EHR. There are certainly also cases where you can treat a patient better, faster and with more information with an EHR, but those can either be rescheduled if that’s the case. It’s certainly bad customer service and you should employ techniques to minimize EHR downtime as much as possible. My point is that it’s usually not life or death when the EHR is down. Think about how many patients are treated in an ER every day with no access to the patient’s medical record.

With that said, it is a disruption to the clinic and will be a BIG disruption to your clinic if you don’t have a solid plan of attack for when (not if) your EMR is inaccessible.

I’d focus your efforts in two areas:
•Minimize EMR Down Time
•Plan of Action for When Your EMR Goes Down

Most people do a pretty decent job with the first part. The second part people don’t often give much thought. You can start with some of the comments from Practice Fusion above to build out your plan. I also think it’s worth making a plan for short down time versus long down time. It’s quite different to deal with 5 minutes of down time than 5 days. You should consider both options.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Having a wireless hotspot or “Air card” as they used to be referred to is probably the best insurance policy you can get for a web-based solution. Most cloud-based systems, such as ours, guarantees 99.6% up-time or better..

  • This is one of the issues discussed in our Informatics class recently while reviewing different EHR solutions. One aspect I question and wouldn’t mind seeing addressed here is what happens to your data and practice credibility if (Heaven forbid) your online EHR provider goes out of business or suffers a long term outage? Is your data transferrable? Lost in the cloud?

  • Steven,
    Those are some loaded and important questions. Needless to say it’s never pretty when something like that happens. Although the issues still are there if it’s in the cloud or if it’s client server. You still have to find a way to transfer the data.

    I think the key thing to consider is that up until now most EHR software doesn’t just shutter its doors and not show up to work. Usually they do a fire sale to some other EHR vendor or company. So, the new EHR vendor usually provides some path to get your data. Often it’s only to their system or you have to pay through the nose to get it.

    I can’t say I’ve seen any times where an EHR provider’s had a really long term outage. It’s actually kind of interesting that it hasn’t happened. I’m sure it will happen sooner or later and it will be interesting to see the fall out. Luckily, there are really great ways to avoid really long term outages.

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