Implementation 14 min read

EHR Downtime and Ransomware Response Runbook for Clinics and BH Centers

During a ransomware or major outage event, teams lose time when ownership is unclear. This runbook defines role-based actions for the first hour, first day, and first week.

First 60 Minutes

  1. Declare incident severity and assign incident commander.
  2. Isolate affected systems under security lead direction.
  3. Activate clinical downtime procedures and communication tree.
  4. Preserve logs and forensics artifacts for investigation.

Clinical Safety During Downtime

  • Use approved paper or offline chart templates for medication and allergy capture.
  • Prioritize high-risk and medication-assisted treatment workflows in BH settings.
  • Escalate care transitions needing external records retrieval.

Revenue and Scheduling Continuity

  • Run manual registration and insurance verification fallback process.
  • Track charge-capture backlog in structured batch sheets for later entry.
  • Protect filing deadlines with denial-prevention and claims hold policy.

Communications and Compliance

  • Use preapproved external statements for patients and partners.
  • Coordinate legal and compliance review for breach-notification triggers.
  • Maintain decision log with timestamps for all incident milestones.

Recovery Week Plan

  1. Validate restore integrity and access controls before reopening broad user access.
  2. Reconcile downtime documentation into the EHR with QA checks.
  3. Review root cause and update hardening roadmap, training, and vendor obligations.

Pair this runbook with our HIPAA security readiness checklist and implementation guide for quarterly resilience exercises.

Frequently Asked Questions

What should clinics do in the first hour of an EHR ransomware incident?

Assign incident command, isolate affected systems, activate downtime workflows, and preserve forensic evidence while maintaining patient safety operations.

How should downtime documentation be handled after recovery?

Use a structured reconciliation process with quality checks to re-enter downtime records into the EHR and validate completeness for clinical and billing continuity.

How often should organizations test downtime readiness?

Run at least quarterly tabletop and workflow tests, including communication drills, restore validation, and role-based escalation exercises.

Editorial Standards

Last reviewed:

Methodology

  • Mapped healthcare incident-response best practices into time-phased operational actions.
  • Aligned clinical downtime tasks with patient-safety and documentation continuity requirements.
  • Integrated compliance and communication checkpoints for legal defensibility.

Primary Sources