Business Impact Analysis for IT Outages and Digital Care Systems Failure
IT outages and digital system failures are no longer “back-office” problems in adult social care. Rosters, care plans, eMAR, incident reporting, on-call escalation, and communication logs often sit inside a small number of platforms. When those platforms fail, teams can lose operational visibility within minutes. A robust Business Impact Analysis identifies what breaks first, how long services can tolerate loss of key systems, and what practical workarounds maintain safe care until recovery. This analysis also strengthens Business Continuity planning because it turns generic “downtime procedures” into tested, role-based workflows.
In practice, digital disruption tends to expose three common risks: loss of safe medication records, loss of real-time scheduling and call monitoring, and loss of reliable escalation documentation. BIAs help providers set realistic recovery priorities and ensure that “paper fallback” is not a theoretical policy but an operationally usable alternative.
What a credible digital BIA needs to cover
A digital-focused BIA should map the care-critical processes that depend on systems (not just the systems themselves). That includes: how staff access care plans in the field, how changes are communicated, how medication is verified, how missed calls are identified, and how safeguarding concerns are escalated and recorded. The output should define tolerable downtime windows (by process), minimum data that must remain accessible, and clear decision rules for switching to fallback procedures.
It should also define who is authorised to declare “downtime mode,” how that decision is communicated across settings, and how the service captures an audit trail while operating manually. This is vital because digital disruption often coincides with confusion and inconsistent practice.
Operational example 1: eMAR downtime and safe medication verification
Context: A supported living provider relies on eMAR for medication administration and relies on the system for prompts, PRN guidance, and missed-dose alerts. The BIA identifies that eMAR loss creates immediate risk for specific individuals on time-critical medication or complex regimes.
Support approach: The provider establishes a downtime workflow: printed “medication profile packs” are kept in sealed, version-controlled envelopes in each setting; a senior on-call lead authorises opening the pack and logs the trigger; staff use a standard paper MAR template for each administration; and a second checker process is introduced for higher-risk medicines. Pharmacist guidance and current prescriptions are stored in a separate, offline-accessible location (e.g., secure hardcopy plus a locally encrypted device where permitted).
Day-to-day delivery detail: At shift start, the senior reviews the last known eMAR sync time, confirms which individuals are due medication within the next 4 hours, allocates competent staff to those administrations, and sets a timed “manual review” every 2 hours to check for omissions. Any dose given is documented in the paper MAR with reason codes for deviations. If the system returns mid-shift, staff do not back-enter immediately; they reconcile at an agreed point with a senior checker to avoid duplicate entries.
How effectiveness or change is evidenced: The provider audits reconciliation accuracy after each downtime event (paper MAR vs restored eMAR), tracks medication incidents linked to downtime, and reviews timeliness of administrations for time-critical medication. Evidence includes reconciliation logs, incident trend data, and post-event learning actions.
Operational example 2: Rostering and call monitoring failure in domiciliary care
Context: A home care service uses a digital rota and call monitoring to confirm visit delivery, identify missed calls, and escalate welfare checks. The BIA identifies that loss of rostering and call monitoring risks missed visits, unrecorded doubles, and delayed escalation for no-access or no-answer situations.
Support approach: The provider maintains a “critical visits list” that can be exported daily and stored securely for offline use. Supervisors hold paper route sheets for each zone, and a central phone-based check-in protocol is activated during downtime. The BIA defines tolerances: critical visits must still be confirmed within defined windows; any uncertainty triggers escalation to a duty lead.
Day-to-day delivery detail: When downtime is declared, the office prints or accesses the offline list and phones each carer at a set time to confirm next two visits. Carers record arrival/departure times manually and phone the office immediately after high-risk calls (e.g., medication, meals support, falls risk). If a visit cannot be delivered, the office logs it on the downtime register and reallocates using a manual decision tree that prioritises time-critical care. A duty lead reviews the downtime register every hour to spot gaps.
How effectiveness or change is evidenced: The service measures missed/late calls during downtime vs normal operations, records the time from issue detection to reallocation, and audits whether “welfare check triggers” were applied consistently. Evidence includes the downtime register, reallocation logs, and a weekly governance review summary.
Operational example 3: Loss of digital care plans and risk information at the point of care
Context: In a residential setting, staff access care plans and risk assessments via tablets. The BIA identifies that loss of access increases risk of inconsistent support, restrictive practice drift, and missed safeguarding indicators (e.g., changes in presentation, triggers, or known risks).
Support approach: The provider maintains a controlled “essential information folder” for each person: one-page key risks, positive behaviour support summary, communication passport, restrictive practice authorisations, and emergency contacts. The BIA defines what must be in hard copy, how updates are controlled, and who is responsible for weekly verification.
Day-to-day delivery detail: Shift leaders confirm that essential folders are present and current during handover. If digital access is lost, staff use the essential folder for immediate decision-making and record changes on a paper addendum sheet. Any significant change (e.g., new trigger, deterioration, safeguarding concern) is phoned through to the manager/on-call lead the same day so interim controls can be agreed. When systems restore, the shift leader coordinates structured updating to avoid partial or conflicting entries.
How effectiveness or change is evidenced: The provider audits folder currency weekly, tests staff competence through scenario checks, and reviews incident logs for any link between information access and harm. Evidence includes audit results, scenario sign-offs, and post-incident reviews.
Explicit expectations that BIAs must address
Commissioner expectation: Commissioners expect providers to evidence that digital disruption does not undermine safe delivery. That means defined tolerances for care-critical processes, documented fallback procedures, and assurance that staff can operate safely in downtime mode (not just that a policy exists). Commissioners also expect clear lines of accountability for escalation and recovery prioritisation.
Regulator / Inspector expectation (CQC): CQC expects providers to manage risks to safety and continuity, including safe medication practice, accurate records, and effective oversight. Inspectors look for evidence that systems are resilient, that downtime procedures protect people from harm, and that governance learns from disruption events. A strong BIA supports “well-led” by demonstrating that risks are understood, controlled, and reviewed.
Governance: making digital fallback auditable
Digital BIAs must translate into governance routines: scheduled system resilience testing, downtime drills, reconciliation audits, and a clear post-event review process. The key is auditability: providers should be able to show what happened, what controls were used, what risks were identified, and what changed as a result. That is what turns digital resilience from a technical claim into operational assurance.