New York-Presbyterian’s Linsangan Says Live Simulations Expose What Tabletop Exercises Miss

Why It Matters

The revelations force health systems to address hidden dependencies on digital tools, reducing risk of care disruption during cyber incidents. Implementing realistic simulations strengthens operational continuity and safeguards patient safety.

Key Takeaways

• Live simulations expose paper charting skill gaps.
• Medication dosing errors rise without EHR decision support.
• Communication fails when EHR unavailable.
• Simulations run during peak hours reveal real workflow issues.
• Workgroups formed to address downtime training and governance.

Pulse Analysis

Healthcare cyber‑attacks have surged, making downtime preparedness a board‑level priority. Traditional tabletop exercises map decision trees but rarely test hands‑on clinical workflows. By staging live simulations during normal operating hours, New York‑Presbyterian forced staff to confront the realities of paper documentation, manual order entry, and ad‑hoc communication, providing a more authentic stress test of system resilience. This approach mirrors the unpredictable nature of real outages, offering valuable data that static drills simply cannot capture.

The simulation results were stark. Less than half of nurses had ever used paper charts, leading to hesitation and reliance on senior staff for basic documentation. Physicians stumbled over medication dosing without electronic order sets, and the loss of automated allergy alerts exposed a critical safety gap. Moreover, teams discovered no fallback for locating on‑call consultants or coordinating bed assignments, especially at larger campuses with 600‑900 beds. These deficiencies highlighted how deeply clinical processes depend on integrated health‑IT, underscoring the need for robust manual alternatives and targeted training.

In response, New York‑Presbyterian established ten cross‑functional downtime workgroups to redesign forms, standardize training, and create enterprise‑wide governance. The initiative offers a blueprint for other health systems: start small, scale deliberately, and conduct drills during peak activity to surface true workflow challenges. By embedding continuous debriefs and actionable after‑action reports, organizations can transform simulation insights into sustainable operational improvements, ultimately protecting patients when digital systems fail.