What Healthcare CIOs Are Really Saying About EHR Downtime

Insights from a recent HealthSystemCIO web conference and what they reveal about where most strategies still fall short Watch the full recording

Most conversations about EHR downtime focus on the outage itself. How long systems were down. What the recovery looked like. What the plan said to do.

What you hear far less often is what it actually feels like to be inside one.

In a recent HealthSystemCIO web conference, two health system CIOs, Chris Akeroyd of Lee Health and Stuart James of CHRISTUS Health, shared something more valuable than best practices. They shared what they’ve lived through. And the picture that emerged was more complex, more human, and more instructive than most downtime frameworks acknowledge.

The Moment Nobody Plans For

Ask most organizations about their downtime plan and they’ll describe a clear sequence: systems go down, procedures activate, teams execute. Clean. Linear.

That’s not how it unfolds in practice.

“Every time we’re in a downtime, it’s always a unique scenario, it’s never the same. Some things are up, some things are down.” – Chris Akeroyd, CIO, Lee Health

What the CIOs described is something far messier: a window of ambiguity where systems are degraded but not fully down, where leaders are making real-time judgment calls with incomplete information, and where the cost of getting the decision wrong runs in both directions.

Stuart James framed the hardest version of this scenario clearly: “You see that 80 percent of your lab orders and medication orders are crossing over, but you can’t figure out why that 20 percent, or even 2 percent, is not. At what point do you decide you need to know 100 percent of what your medication orders are, and if you can’t do that, you say: we have to take this offline?”

That decision, wait or activate, degrade or go fully down, is one of the most consequential calls a health system leader makes during a downtime event. It’s also one of the least discussed. Understanding where that threshold lives, and what it costs to get it wrong in either direction, is where real downtime preparedness begins.

The Problem Isn’t Just the Outage. It’s What Breaks Quietly.

Both CIOs were asked what surprised them most during real downtime events. Neither described a dramatic system failure. Both described something smaller and in some ways more unsettling.

Chris Akeroyd described the UKG ransomware event that hit in December 2021. “We hadn’t planned that scenario. We couldn’t pull data from clocks, there was no mechanism internally to track time and get it over to payroll. It shined a light on inadequacies in our planning.” His clinical operations were solid. His downtime binders were ready. His payroll system was gone, and no one had thought through what that meant.

Stuart James pointed to a different blind spot: the sub-processes that run automatically in the background that nobody fully understands until they stop. “There’s always some little sub-process that nobody understands that causes so much trouble during the downtime. When you find those, document them, and then go looking for more like them.”

The lesson both CIOs were pointing to is the same: downtime plans tend to cover the workflows people think about. The real exposure lives in the ones they don’t.

Paper Doesn’t Fail During Downtime. It Defers the Failure.

There’s a reason paper persists in downtime strategies. It’s accessible. It doesn’t require system availability. In the first hour of an outage, it keeps care moving. CIOs know this, and they’re not wrong to keep it as a layer in their approach.

But as Allison Reichenbach, CEO of Interlace Health, put it directly: “The moment you go to paper, you’re losing standardization, visibility, and data integrity, and that’s really where the risk starts to creep in.”

What the panelists described, and what we see consistently across the health systems we work with, is that paper’s real cost doesn’t show up during the outage. It shows up after.

Documentation captured on paper is inconsistent across departments. Forms vary. Data is incomplete. There is no traceability around what was captured, when, or by whom. And all of it still needs to find its way back into the health record.

The longer the outage, the larger that reconstruction effort becomes. For extended events, it can mean weeks of HIM backlog, delayed coding, held claims, and compliance exposure that surfaces long after the system is back online.

Paper doesn’t fail you during downtime. It defers that failure to recovery, and recovery is where the real operational and financial cost lives.

Training Isn’t About the Plan. It’s About What Happens When the Plan Meets Reality.

One of the most memorable moments in the conversation came from Stuart James, who described how his team rediscovered the limits of tabletop exercises after 9/11 grounded all aircraft, including the plane his disaster recovery team was supposed to take to their hot site in Pennsylvania.

“We never contemplated a time when we couldn’t fly. So we redid our plans and we didn’t tell the teams when our drills were.”

His point wasn’t just about logistics. It was about the difference between knowing a plan and being able to execute under pressure. The teams that perform best during downtime events aren’t the ones with the best binders. They’re the ones who have practiced until the right response becomes instinct.

Chris Akeroyd echoed this directly: “The challenge is that technology departments know more about the connectivity and processes than anybody else in the organization. The risk we run as leaders is if we’re not having that risk-based, leadership-based conversation about who needs to be around the table.”

Training, in this context, isn’t a checklist item. It’s how organizations close the gap between the plan that exists on paper and the performance that’s actually possible when systems go down. As Reichenbach put it: “Downtime is not the time to improvise. Everyone’s got a plan until they get punched in the face.”

The Shift: From Surviving Downtime to Operating Through It

What came through most clearly across the full conversation is a fundamental shift in how experienced health system leaders are starting to think about downtime.

The old model treated downtime as an emergency, an exception to normal operations that required a fallback plan. The new model recognizes something different: downtime is an operating condition. It will happen. The question is whether the organization is designed to function through it, or only to survive it.

That distinction has direct implications for how downtime readiness is built.

Survival-based approaches focus on keeping care moving during the outage. Continuity-based approaches ask a harder question: how do we maintain the structure, consistency, and traceability that makes recovery manageable afterward?

The organizations doing this well aren’t just preparing for the outage. They’re designing for the full event; from the moment systems degrade through the last documentation that gets reconciled back into the record.

Because while the outage may be inevitable, fragmentation and prolonged recovery are not. As Reichenbach observed: “The organizations that handle downtime best are the ones maintaining control over documentation during the outage, not just worrying about system access, but maintaining control. That really determines whether downtime is a short disruption or a prolonged operational issue.”

What This Means in Practice

At Interlace Health, we work with health systems every day on exactly this problem, not just keeping operations moving during downtime, but ensuring that what’s captured during an outage can return to the record efficiently, accurately, and with full traceability.

The CIOs in this conversation validated something we’ve seen across the organizations we work with: the gap isn’t effort or intention. It’s that most downtime strategies were designed for a different era, one where systems were less interconnected, outages were shorter, and paper was a reasonable bridge.

That era is over.

The health systems that manage downtime best today are the ones treating it as a designed operating capability, not a contingency plan. And the ones that recover fastest are the ones who thought about recovery before the outage started.

Watch the Full Discussion – Hear directly from health system CIOs on how downtime is evolving and what they’re seeing in real environments. Watch the recording

Go Deeper – Explore how modern health systems are rethinking downtime beyond paper-based processes. Download the white paper: “Why Paper-Based Processes Can’t Support Modern EHR Downtime”