Day-to-day operations for healthcare organizations rely heavily on uninterrupted communication. Whether planned or unplanned, communication downtimes can disrupt necessary functions. Even brief interruptions, such as planned 90-minute outages, can disrupt continuity of care by forcing clinicians back to manual workflows that no longer align with modern clinical practice.
A BMC Medical Informatics and Decision Making study notes how hospitals attempt to compensate during these periods by deploying emergency query programs and Microsoft Teams-integrated prescription tools. Although the system allowed 282 users to issue 22 prescriptions across departments, the workaround exposed clear inefficiencies and risks. Prescription verification and execution slowed noticeably, with nurses spending an average of eight minutes confirming orders and nearly 18 minutes completing them.
According to a Digital Health study, a three-week electronic pathology system failure at a UK NHS teaching hospital showed no documented patient harm. Staff reported unnecessary treatments and several near misses that were avoided only through staff improvisation and extended working hours.
Since the 1990s, healthcare staff, from clinicians to administrators, have adopted email because it was fast and inexpensive. Organizations came to depend on it for routine business functions as its core functions support collaboration across departments while creating a clear record of communications.
Email messages can be read and responded to outside normal office hours, and delivery costs are negligible compared to physical mail. This makes email especially effective for referrals, lab result requests, and day-to-day organizations. Although messaging systems can assist with these communications in present day.
As one Occupational Health Sciences indexed study explains in full: “The proliferation of smartphones, tablets, and other portable communication devices has made it easier for employees to work from anywhere at any time. Email, in particular, has revolutionized the workplace by facilitating expeditious communication of information, with its saliency even more evident during the coronavirus disease (COVID-19) pandemic.
As many United States (U.S.) employees have now shifted to working from home (U.S. Bureau of Labor Statistics, 2020), workplace communication is occurring more often through email. For many individuals, this ‘new normal’ is likely to persist for months into the future, with some organizations making the decision to permanently adopt a virtual work environment. In this context, the increased reliance on email communication calls for further exploration into its implications on employee health and wellbeing.”
That observation captures why email remains so central to healthcare operations today. The medium is no longer optional or peripheral. It functions as a backbone for coordination, documentation, and compliance.
Email provider downtime turns into operational chaos for healthcare organizations because it cuts off channels that sit at the center of everyday clinical workflows. Electronic health record (EHRs) and system outages shows how quickly routine processes unravel when digital communication is unavailable. In one study, ‘Continuing Patient Care during Electronic Health Record Downtime’, during a large-scale EHR downtime, laboratory turnaround times increased by 62% as staff were forced to revert to manual processing. Paper requisitions were incomplete, which slowed result transmission.
Physicians continued ordering full panels of tests, overwhelming laboratories that normally processed roughly 6,000 tests per hour under automated conditions but could not sustain anything close to full capacity manually. What this shows is the way that decision support systems breaks down when staff have to revert to manual processes without the support of email for collaboration.
Organizational blind spots leave institutions underprepared for the moment digital systems fail. These blind spots reflect an over-reliance on automated workflows without workable manual alternatives.
An Oxford University Press study on EHR downtime events explains in full: “Patient safety report data offer a lens into EHR downtime–related safety hazards. Important areas of risk during EHR downtime periods were patient identification and communication of clinical information; these should be a focus of downtime procedure planning to reduce safety hazards.” When those risks are not addressed in advance, training and resource gaps intensify the damage.
Training and resource allocation gaps further intensified the impact. Staff unfamiliar with paper-based workflows or unclear about how outages are triggered defaulted to slower, less reliable care processes. The result was delayed diagnostics, canceled elective procedures, and higher exposure to adverse events.
Effective downtime planning consistently includes clear alerts for affected departments, deliberate workload reduction for manual-heavy services such as laboratories, and regular staff drills. Without those measures, as seen in previously mentioned study labs that normally process thousands of tests per hour may only manage a small fraction by hand, driving turnaround delays and increasing downstream risks, particularly around medication dosing.
Paubox operates as a HIPAA compliant email gateway with built-in failover capabilities. When primary providers such as Microsoft 365 or Gmail experience outages, Paubox routes outbound messages through independent relays, allowing communication to continue without forcing staff to adopt improvised tools. Encryption, inbound and outbound filtering, and automated queuing preserve compliance during disruptions.
Paubox's failover mechanisms (e.g., server instance switching, backups) support business continuity and align with those in the BMC Medical Informatics and Decision Making study. If the primary service experiences a full outage, outbound sending would likely still depend on it, though Paubox could queue/filter incoming mail and restore queued messages post-recovery via its gateways.
Email downtime occurs when an email system is partially or completely unavailable, preventing the sending or receiving of messages.
Common causes include server outages, provider maintenance, network failures, cyberattacks, and misconfigurations.
Organizations can implement failover email gateways, backup systems, automated queuing, and clear communication protocols to maintain continuity.