1. Define the change and its boundaries
Name the transition, affected systems, planned change window, and accountable program owner. Describe what is changing and what must remain available. A vague scope makes it difficult to distinguish an accepted limitation from an unexpected failure during the rehearsal.
Build a dependency inventory that includes identity, network services, interfaces, laboratory workflows, and the teams receiving the output of each system. Record which dependencies are directly controlled by the cutover team and which require coordination with another owner.
2. Assign the decisions before the incident
Agree who can start the transition, pause it, request a rollback, review an exception, and authorize a recovery step. Technical ownership alone may not cover the clinical and operational decisions involved. Use named roles and a defined escalation route.
Confirm how the team will communicate when its normal tools are unavailable. The plan should identify where the incident record lives, how status changes are recorded, and how the next shift will receive outstanding work.
3. Define downtime capture and handoffs
List the workflows that continue while the EHR is unavailable. For each, agree on the context required to review the record later: identifiers, times, status, originating workflow, and the person or role responsible for the next action.
Specimens require attention to identification and movement as well as the order itself. Define the handoff points, how status changes are linked, and what happens when an order and specimen cannot be confidently associated. Keep these decisions within your approved clinical procedures.
- Document how downtime orders are recorded and reviewed.
- Assign ownership of specimen handoffs and uncertain links.
- Define how duplicate, incomplete, or conflicting information is held for review.
4. Rehearse the exceptions
A normal-path exercise is not enough to explain recovery. Use synthetic records to test missing fields, uncertain mappings, duplicate concerns, and an unavailable interface. State what the receiving team should be able to see and which decisions require manual review.
For each exception, identify how it enters the review queue, who owns it, and what evidence permits it to move forward. A mapping confidence indicator can support triage, but it does not replace the designated review process.
5. Agree on recovery acceptance
Restoring technical service and completing reconciliation are different milestones. Specify the checks for each one. Confirm how reviewed records reach the authorized restoration step and how unresolved exceptions remain visible after normal operations resume.
The rehearsal record should show which checks passed, what remained unresolved, and who accepted the outcome. Review the evidence with clinical, technical, and program owners before deciding on a production transition. Environment-specific acceptance is essential; a reference workflow cannot establish readiness on its own.
6. Turn findings into an owned plan
Carry the rehearsal findings into a short action register. Each item needs an owner, the evidence required for resolution, and a decision about whether it blocks the transition. Keep the architecture assumptions and continuity findings connected so a change to one can trigger review of the other.
SynArch's synthetic walkthrough can help structure discovery for a pilot. It does not replace approved downtime procedures, an EHR vendor's integration requirements, or your organization's transition acceptance process. Begin with one bounded workflow and a clear review group.