Executive Summary
In 2024, a major cybersecurity attack brought the operations of a large health system to a halt. With EMR systems down nationwide – including in multiple Indiana hospitals – providers lost access to critical patient data for over a month. The Indiana Health Information Exchange (IHIE) emerged as a pivotal partner, stepping in as a real-time clinical data access point to help maintain continuity of care across the Indiana facilities.
IHIE’s ability to act as an electronic medical record (EMR) surrogate during a crisis demonstrated the essential role Health Information Exchanges can play as part of a hospital’s disaster recovery and cybersecurity resilience plan.
Setting the Stage: About IHIE
The Indiana Health Information Exchange (IHIE) is a nonprofit, statewide HIE that enables healthcare providers across Indiana to securely share real-time clinical data. IHIE’s network receives and organizes data from hundreds of hospitals, clinics, labs, and other providers—helping ensure timely, comprehensive care and reducing fragmentation across the healthcare system.
The Incident: A Health System Crippled by Cyberattack
In the spring of 2024, a large national health system experienced a devastating ransomware attack that disabled EMR access across its entire network— including multiple hospitals in Indiana. For more than 30 days, clinicians faced significant disruptions, losing access to the systems they rely on for patient histories, lab results, imaging, and medication lists. Providers in emergency departments, operating rooms, and specialty clinics had to make decisions with limited information, putting added strain on patient safety, scheduled procedures, and clinical workflows.
“We saw it in the news. The health system’s email systems and VPNs were down, so outreach and coordination were extremely difficult – but as soon as we made contact with their team, we knew we had to act fast.”
IHIE’s Response: A Rapid and Scalable Solution
IHIE had already been developing a lightweight clinical viewer for smaller, less-resourced organizations—a mobile-friendly solution that didn’t require VPN access or intensive IT support. That solution became the foundation for their emergency response.
What happened next:
- Thursday – IHIE learned of the outage.
- Tuesday – A test group of users from the health system was onboarded.
- Within Just a Few Days – Usage scaled rapidly from 300 to 700+ clinical users.
IHIE’s tool was nimble, intuitive, and focused on surfacing essential clinical data in a familiar, Google-like interface to a traditional EMR, providing critical information to clinicians allowing continuity of care.
“We designed it to require minimal training. It was clear, searchable, and required no complicated clicks. That ease of use made all the difference.”
What IHIE Provided to the Health System to Fill Clinical Gaps
IHIE functioned as the health system’s surrogate EMR for the 30+ days of the outage. The platform provided clinicians with:
- Real-time clinical data
- Access to lab results, imaging, diagnoses, and care summaries
- Support across multiple specialties, including cardiology, oncology, and emergency medicine
- Workflow flexibility, enabling some teams to print and hand-deliver information, while others accessed it digitally
- Minimal technical setup, removing VPN barriers and allowing remote use
- Scalable onboarding, accommodating a large group of users on short notice
“Care teams were able to maintain surgeries and scheduled visits. For many patients—especially in rural areas with no other nearby hospitals—this was a literal lifeline.”
Why IHIE’s Backstop Solution Worked: Strong Partnerships and Trust
While IHIE was not part of the health system’s formal disaster recovery plan, existing relationships and mutual trust enabled rapid collaboration.
“We were viewed as a partner, not just a vendor. When their team reached out, they didn’t ask for a specific product. They said, ‘Can you help us?’ And because they knew what we could do, we could respond right away.”
That trust—combined with an intuitive product and a team ready to pivot—was critical to IHIE’s successful deployment.
Not Just a One-Time Solution: IHIE Provides Long-Term Impact
The incident had lasting effects on how health systems across Indiana think about emergency preparedness and the role of HIEs.
Key outcomes:
- Expanded IHIE adoption: The large health system is interested in continuing to use IHIE’s tools post-outage as part of their regular workflows – conversations about this are ongoing.
- Increased engagement: IHIE saw higher utilization of other services from the affected organization after the event.
- Surge in demand: Within a week of the incident, IHIE received outreach from 6–10 other health systems wanting to proactively onboard the solution in case of future emergencies.
- Collaborations with state partners: IHIE began working more closely with the Indiana Hospital Association to help standardize disaster preparedness and support statewide response capabilities.
What IHIE Learned in the Process
The experience offered several important lessons that IHIE has since used to enhance its product and processes:
- Pre-configuration is essential: Test users, legal agreements, and technical configurations must be in place before a crisis strikes.
- Simplicity is key: In an emergency, clinicians don’t have time for complex interfaces or retraining. IHIE’s user-friendly tool lowered the barrier to adoption and proved essential for time-sensitive care.
- Prepare for new use cases: Though originally designed for small clinics, the solution was quickly adopted by major health systems. Flexibility and scalability became central to product design.
- Post-crisis data workflows matter: Once the health system’s EMR came back online, IHIE supported reprocessing of missed messages and re-synchronization—an often-overlooked but essential part of recovery.
- Cybersecurity insurance requires redundancy: Many health systems’ insurance policies now mandate redundancy and access continuity. IHIE’s solution can help organizations meet these requirements.
The Bigger Picture: HIEs as Cybersecurity Partners
As cyber threats become more sophisticated and frequent, health systems must rethink traditional backup systems. EMRs alone are not failproof, and in a worst-case scenario, community-based, trusted HIEs may be the only available safety net. There are multiple other examples of HIEs serving this critical function in other states and geographies.
“Hospitals saw what happened and immediately called us to say: ‘We don’t want to be next. How do we sign up?’”
IHIE’s swift and effective response to the 2024 cybersecurity crisis showed what’s possible when health data is interoperable, accessible, and supported by a trusted statewide exchange. By serving as the emergency EHR for thousands of clinicians during a month-long outage, IHIE helped protect patient care when it mattered most.
As one hospital executive put it:
“We didn’t realize how vulnerable we were until the moment our EMR went dark. IHIE gave us the ability to keep seeing patients—and now, we won’t move forward without them in our disaster plan.”
Interested in learning how your local HIE can support your emergency response strategy? Get in touch with Civitas today by emailing contact [at] civitasforhealth.org – we will put you in touch with the Civitas member HIE in your area.