Have you ever seen an airport during a simulated disaster exercise?
It’s remarkable. The whole operation feels so real.
Airport staff rehearse worst-case scenarios so when something serious actually goes wrong, like a fire, power failure, or medical emergency, the response is second nature.
In many rural healthcare systems, business continuity for patient care is handled with similar training, but surprisingly, downtime planning for supply chain systems is often an afterthought. In general, risk leaders across industries struggle with proactive risk management – only 11% spend significantly more on proactive risk management efforts than on reactive efforts, according to PwC.
That number will likely change, especially after the recent AWS outage that took a good chunk of cloud infrastructure offline. For about 15 hours, most applications and the online world came to a halt, affecting every industry from finance to retail to healthcare.
The incident, while unfortunate, gave us two important reminders. First, systems are always at risk of going down. It doesn’t have to be an outage from one or more cloud service providers either. The downtime can come from a cyberattack, power loss, or if a fiber line is accidentally cut during construction. Meaning, if your ERP, inventory, or purchasing system goes dark, it can have a large ripple effect across your entire supply chain.
The second reminder is business continuity in the rural healthcare supply chain is a mission-critical priority. Since every rural healthcare setting is unique in some way, it’s difficult to apply a one-size-fits-all approach to business continuity planning for supply chains.
However, there are five things your team can consider to plan and practice your own approach to keep your healthcare supply chain running no matter what.
When planning for downtime, the most important thing to think about is, “Which systems, people, and workflows will break when there’s downtime?”
Understanding dependencies is the foundation of any strong business continuity plan. Typically, when one domino falls, others will follow, so you should consider the impact across each area (systems, people, and workflows).
Why It Matters
Systems like ERPs, inventory management, EHR, dispatch systems, and so many more tools are interconnected. If your ordering portal depends on a single region, a regional outage can really set you back.
Like we saw during the AWS outage, even global cloud providers aren't immune to cascading failures. As we know, relying on one cloud region or provider creates single points of failure.
Extra Things to Consider
Continuity planning shouldn't live only in IT or supply chain. Consider forming a Business Continuity Working Group that includes supply chain or materials management leads, clinical operations, security, legal, and risk management.
Once your Business Continuity Working Group is formed, you can then take the following steps.
Inventory your systems: List every application related to supply chain — purchasing portals, inventory management, ERP system, vendor contact directories, Periodic Automatic Replacement (PAR) level sheets, etc.
Map integrations: Define how data flows between each system and identify where key information passes between each one.
Identify mission-critical functions: Work with clinical, operations, finance, and IT teams to agree on what “must continue” during an outage (e.g., placing POs, tracking inventory, receiving shipments, internal requisitions).
Document and prioritize: Create a mission dependency matrix that shows, “If System X is down, which function fails and what’s the impact?” Then, use that matrix to prioritize recovery strategies.
Once you know your dependencies, you need to make sure your most critical data is accessible even when your systems go offline. This means building back-ups for where you store that data and how.
Why It Matters
During outages, teams may not be able to access cloud-based dashboards, spreadsheets in personal or shared drives, or portals. Without alternate access, you may lose access to critical data.
It’s a standard practice for regulatory and disaster preparedness to have “vital records” available in multiple formats.
For healthcare, that means access to data that’s used to manage inventory is mission-critical to deliver patient care even when routine systems are down.
Extra Things to Consider
Of course, there is risk when you set data aside and leave it exposed “just in case” you need it. The last thing anyone wants is to package up data and leave it around to collect dust.
To mitigate this risk, you can create an Emergency Access Data Package. This is a very specific collection of essential information that’s accessible offline. The first step, like your operational dependencies, comes down to people.
You should assign someone specific to be responsible for refreshing and validating Emergency Access Data Package. You can assign this responsibility to a lead contact and then have multiple back up resources to support that one person.
Next, with your Business Continuity Working Group, decide how often these parallel data sources need to be updated (e.g. daily, weekly, monthly). The mix of what should be included will depend on your care setting.
For supply chain data — especially inventory levels, cross-references with Item Master Data, PAR level sheets, and vendor contacts — a weekly or biweekly schedule strikes a good balance between freshness and maintenance overhead.
Now that you have a designated resource, back-ups, and determined the update schedule, it’s time to look at your storage format options.
You can maintain data on local servers, secured USB drives, or offline file shares.
For critical forms like requisition templates or vendor contact sheets, maintain printed versions that are stored in controlled and secure physical locations.
Last, you can also store monthly or weekly exports of your item master, PAR level sheets, and order templates in a secured local environment that’s backed up regularly.
You’ve identified what systems depend on other systems and you have an alternate way to get critical data. The next step is to define how your healthcare supply chain operations work during a downtime.
Why It Matters
When systems are unavailable, especially for an extended period, your team still needs to order, issue, track, and potentially receive inventory. Without a clear fallback workflow, you run the risk of creating more unforced errors than you need.
This is especially true under stressed conditions because manual processes can lead to errors, miscommunication, and delays. And without proper practice, the risk of these errors goes way up.
Thoughtful downtime workflows help maintain continuity without overwhelming staff or compromising security or safety. It’s like the airport example we started with. When done right, the way your staff acts will be second nature because they’ve practiced.
Extra Things to Consider
There are a few key elements of a manual supply chain workflow you should consider during a downtime.
Why It Matters
We rely so heavily on systems like email and ordering portals. If they go down, teams need to have clear backup channels to keep operations running as smoothly as possible.
In healthcare, supply chain disruptions directly impact patient care. Delays in placing or receiving critical supplies can have real, life-altering consequences.
Vendors themselves may be affected by the outage, but prearranged protocols can help maintain coordination and continuity of care.
Extra Things to Consider
We don’t suggest you go all the way back to the pigeon post system, but you should design a phone, SMS, fax, and/or radio-based escalation plan. You should know exactly how to reach everyone in your supply chain ecosystem, like staff, vendors, distributors, and even manufacturers.
As “outdated” as these channels may be, they’re incredibly reliable in specific situations because they may not all be impacted by an outage at the same time.
The next thing you should plan for is what to say. The last thing you want to do in a stressful situation is the wrong thing. You can create templates on paper for common downtime messages. For example:
“We are currently experiencing a system-wide outage. We will place our orders via phone/fax using our standard ordering template. Here is our PO number: ____. Please confirm receipt.”
Naturally, you’ll also want to share your plan with supply chain partners and involve them in your training exercises. These can be tabletop exercises where you run through your downtime communication plan together. The main goal is for each party to understand how you will reach them in an outage.
Of course, like anything in healthcare, ensure you only use secure, HIPAA-compliant messaging tools that can function offline or through minimal infrastructure if authorized by your IT and security and compliance team.
Up to this point, we’ve focused exclusively on the steps you can take to keep your healthcare supply chain running during an outage.
These steps don’t stay isolated. The goal is to fold your downtime plan into your standard Business Continuity Plan. Then, you can regularly rehearse downtime procedures and adjust it to make sure it’s usable under pressure.
Why It Matters
Practicing downtime scenarios will make your teams stronger if they’re faced with a real situation. Everyone will learn what works, what doesn’t, and what was missed when you’re not in crisis mode.
During a real outage, people need to know exactly what to do without second-guessing. Practice is the best way to gather feedback to refine your plan, update your offline data packs, and strengthen your communication approach.
Extra Things to Consider
Like any emergency preparedness exercise, it’s all about designing realistic scenarios and unplanned situations that can come up during those scenarios.
Use scenarios like “regional cloud outage,” “power failure at main site,” “network-wide downtime,” or “vendor portal unavailable.”
Don’t forget, as a rural healthcare organization, your surrounding environment is unique with limited IT staff, reduced network redundancy, lower internet reliability, and power interruptions.
Once you’ve designed realistic scenarios, run them during tabletop and live drills.
Tabletop exercises let you walk through your plan step by step in a more calm and controlled setting.
Live drills simulate a real outage where you’d disable systems within a test environment and force teams to rely on your Emergency Access Data Package paper templates, offline data, and manual communication channels.
As you go through your scenarios, capture key points such as time taken to place orders, volume processed manually, discrepancies during reconciliation, communication breakdowns, and anecdotal pain points.
Hold a debrief immediately after the drill. Find out what the big surprises were, what felt slow or clunky, what went well, and what failed.
Lastly, don’t forget to include partners in your supply chain ecosystem in your practice sessions and schedule regular drills at least annually (or more often, depending on risk).
It’s one thing to plan for downtime in a large urban hospital system. It's another in a rural clinic or hospital. In more remote settings, the resilience challenge is even greater, but so is the impact of failure.
For one, rural sites often lack strong systems to back up power or internet, making them more vulnerable to outages. Things like power interruptions, unstable networks, and outdated systems are more common.
Additionally, there are fewer IT personnel and supply chain experts. During a disruption, those available may be stretched thin. As a result, rural sites may rely more heavily on non-specialized resources and paper-based processes when systems fail.
Your Next Step is to Build a Downtime-Ready Supply Chain Today
If you're ready to take action, here’s a roadmap to bring downtime incidents into your healthcare supply chain and Business Continuity Planning.
Form your Business Continuity Working Group
Include IT, supply chain or materials management leads, clinical operations, security, legal, and risk management. Use this group to map dependencies and agree on mission-critical processes.
Audit your current approach
Do you have offline copies of your Item Master Data?
When was your last downtime drill?
What backup communication channels are in place with vendors?
Take a good look at what you have to work with. Find out what areas you have covered today and where you have gaps.
Develop your Emergency Access Data Package
Choose a format, assign owners, set refresh cadence, and distribute it to relevant teams and sites (especially rural ones).
Document manual workflows
Create standard operating procedures for ordering, receiving, issuing, and reconciling during an outage.
Run your first downtime drill
Start with a tabletop exercise, then scale to a live simulated outage. Capture feedback from participants and use it to refine your plan.
Review and update
Revise your continuity plan, data package, and workflows based on feedback from your tabletop exercise and live drill. Repeat annually or more frequently if your risk profile changes.
These days, disruptions come in all shapes and sizes. Some leave a physical trail while others happen more quietly.
The tough part is so much is out of our control. We don’t get to decide when disruptions happen, but we can control how prepared we’ll be when they do.
Operationally, you should plan for downtime scenarios just like you plan for peak demand or supply shortages. Running continuity plans is just as important as documenting them. Practices reveal gaps, surface outdated assumptions, and reinforce responsibilities. Your team should know what to do when disruptions happen whether that's for an hour or a week.
Hospitals can’t pause patient care when technology goes down. When you’re prepared for downtime across every layer of the supply chain, you give yourself a better chance to source supplies, distribute them, and support clinical teams when it matters most.