Background: Electronic medical records (eMRs) are essential for managing medication, coordinating patient care, and streamlining clinical workflows. In September 2024, Sydney Local Health District (SLHD) undertook a significant migration of its eMR system to Amazon Web Services (AWS) Cloud, aligning with New South Wales's 'Cloud First' strategy. This transition required a 14-hour planned eMR downtime. Despite the growing reliance on eMRs, there remains a substantial gap in the literature regarding the broader implications of such downtimes. This study addresses this gap by exploring the effects of a significant downtime event, providing critical insights into the need for enhanced procedural resilience and preparedness.

Objective: The study investigated the preparedness of SLHD healthcare staff for eMR downtimes and evaluated the effects of a planned, prolonged downtime on staff preparedness, and staff perceptions.

Methods: Pre- and post-downtime surveys were conducted with staff across the district to evaluate staff preparedness Interviews/focus groups were undertaken with staff following the downtime to explore staff experiences and perceptions of the downtime.

Results: 407 staff completed the survey, and 21 participated in interviews and focus groups. Survey and interview findings indicated improved staff preparedness post-downtime with participants valuing proactive communication and informatics support. Challenges arose from manual processes, notably in medication administration and patient flow. Recommendations included department-specific training, clearer role definitions, and enhanced procedural standardisation for smoother operations during future downtimes.

Conclusions: The study reinforces the need for ongoing training, clear role definitions, and adaptable policies to effectively manage eMR downtimes. Staff-reported insights emphasised proactive communication and flexibility within procedures, supporting operational resilience. Future downtime policies should consider staff factors to balance procedural consistency with responsive decision-making during high-stress situations.