Building Resilience in Healthcare IT: Downtime Management and Application Rationalization Insights from the CHIME Fall Forum

Building Resilience in Healthcare IT: Downtime Management and Application Rationalization Insights from the CHIME Fall Forum

Healthcare IT leaders face a daunting challenge: managing critical system downtimes while tackling complex application rationalization in an increasingly interconnected and cloud-driven environment. During a focus group session at the CHIME Fall Forum, a group of 12 technology executives shared their strategies, challenges, and insights on these pressing issues. The discussion, facilitated by MediQuant, shed light on how healthcare organizations are addressing downtime preparedness, disaster recovery, and application management in a rapidly evolving landscape.

Downtime Preparedness: A Shared Priority

Downtime events—whether caused by hardware failures, network outages, or cloud service disruptions—are inevitable in healthcare IT. The CIOs emphasized the critical importance of proactive measures to minimize disruptions and maintain clinical workflows during outages. Key strategies included:

1. Redundancy and Failover Solutions: Many organizations have implemented primary and secondary data centers or hybrid environments to ensure failover capabilities. For example, some CIOs described leveraging geographically distributed cloud environments to mitigate risks associated with regional outages.
2. Downtime Servers for PACS: Picture Archiving and Communication Systems (PACS) emerged as a top concern for many participants. Unlike EHRs, PACS often lack alternatives during outages, leaving radiology departments particularly vulnerable. To address this, some organizations have deployed local downtime servers for PACS, enabling radiologists to access and store images locally during disruptions.
3. EHR Vendor-Provided Downtime Solutions: Many healthcare systems rely heavily on their EHR vendors, such as Epic or Meditech, to provide downtime solutions. These include Business Continuity Access (BCA) systems, shadow read-only environments, and isolated recovery environments (IREs) that maintain minimal workflows during outages.
4. Communication and Training: Effective communication with staff during downtimes is critical. Some CIOs highlighted the need for blast text systems or other tools to inform remote users of outages. Regular training and tabletop exercises were also emphasized as essential for ensuring staff readiness, particularly for night-shift teams who may be less familiar with downtime protocols.

Challenges in Downtime Management

Despite these efforts, the CIOs acknowledged several ongoing challenges in managing downtimes:

• Complexity of IT Environments: Mergers and acquisitions have led to sprawling IT infrastructures with multiple EHR instances, proprietary systems, and legacy applications. This complexity makes it difficult to identify the root cause of outages and coordinate recovery efforts.
• End-User Adoption: Physicians and clinicians often resist using alternative systems during downtimes, citing unfamiliarity and a lack of training. This resistance can delay recovery and complicate workflows.
• Data Reconciliation: Ensuring data integrity and reconciling transactions after a system comes back online remains a significant hurdle. CIOs noted the importance of robust processes for validating and reintegrating data after an outage.

Application Rationalization: Simplifying the IT Landscape

In addition to downtime management, the focus group explored the topic of application rationalization—a critical initiative for healthcare organizations dealing with the aftermath of mergers and acquisitions. Many CIOs reported managing thousands of applications, with some organizations tracking as many as 19,000. This proliferation of applications creates inefficiencies and increases the risk of downtime.

To address this, participants highlighted the following approaches:

1. Comprehensive Application Inventories: Several organizations have implemented application lifecycle management tools to maintain detailed inventories of their IT assets. While tools like ServiceNow, Freshservice and Jira are commonly used, CIOs expressed concerns about their limitations. Many noted that these platforms, while widely adopted, are not purpose-built for the unique needs of healthcare organizations. The high costs were cited as ongoing pain points.
2. Prioritization of Critical Systems: With limited resources, CIOs are focusing on rationalizing and modernizing the most critical systems first. PACS, for instance, was identified as a priority for many organizations due to its central role in patient care and its vulnerability during downtimes.
3. Archiving and Data Management: MediQuant’s expertise in data archiving and management was recognized as a valuable resource for organizations looking to simplify their IT environments. By consolidating and archiving legacy systems, healthcare providers can reduce costs, improve efficiency, and mitigate risks.

The Path Forward: Building Resilient IT Systems

As healthcare organizations continue to navigate the challenges of downtime management and application rationalization, the focus group participants identified several best practices for building resilient IT systems:

• Invest in Healthcare-Specific Solutions: Many CIOs expressed a desire for tools that are purpose-built for healthcare, rather than repurposed from other industries. While platforms like ServiceNow and Freshservice are widely used and handle many standard IT workflows well—such as support tickets, login issues, and uptime monitoring—other critical functions need to be healthcare-specific. Areas like application inventory management, application rationalization, and downtime planning are deeply shaped by healthcare’s regulatory environment, clinical dependencies, and operational complexity. These functions require a nuanced understanding of healthcare ecosystems, data flows, and compliance requirements. As a result, relying solely on generalized IT platforms often forces IT teams to bend the tools to fit their needs, reinforcing the case for solutions designed explicitly around healthcare workflows and constraints.
• Engage Stakeholders Across Departments: Effective downtime planning requires collaboration across clinical and operational teams. CIOs emphasized the importance of conducting department-specific tabletop exercises to identify critical workflows and ensure staff are prepared to respond to outages.
• Leverage Technology for Monitoring and Alerts: Tools that integrate seamlessly with healthcare environments and provide real-time monitoring and alerting are essential for identifying potential issues before they escalate. CIOs noted the need for solutions that are both cost-effective and tailored to the intricacies of healthcare IT.
• Focus on End-User Training: Regular training and drills are essential for ensuring that staff are familiar with downtime protocols and alternative systems. CIOs noted the importance of targeting high-priority areas, such as emergency departments, imaging, and labs, where disruptions can have the most significant impact on patient care.

Healthcare CIOs face the dual challenge of ensuring uninterrupted patient care during downtimes and managing increasingly complex IT environments. Their work is critical—not only in preparing their organizations for the inevitable but also in safeguarding the data and systems that underpin modern healthcare. As the industry continues to evolve, the focus must remain on building resilient, adaptable IT infrastructures that can weather disruptions while maintaining the highest standards of care.

Forward-thinking organizations are embracing innovative solutions and partnerships to stay ahead of these challenges. By prioritizing robust downtime strategies and streamlining application portfolios, CIOs can create a foundation for long-term success. Companies like MediQuant are committed to empowering healthcare leaders with the resources they need, ensuring that their organizations are ready for whatever the future holds.

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