Disaster recovery

Recovery is one part of resilience

Incident response contains and investigates an event. Business continuity keeps essential functions running or safely pauses them. Disaster recovery restores technology and data. The plans connect, yet each has different owners, decisions, and evidence.

A backup is an input to recovery. Recovery also requires identities, keys, configurations, infrastructure, applications, vendors, networks, interfaces, procedures, qualified staff, and acceptance tests.

Rank systems by service impact

Conduct a business impact and risk analysis. For every critical function, record dependencies, maximum tolerable downtime, recovery time objective, recovery point objective, minimum safe operating mode, owner, fallback, and stop condition.

The recovery time objective is the planned maximum restoration time. The recovery point objective identifies the point before disruption to which data should be recovered. These are design targets rather than guarantees.

HIPAA names required contingency components

For HIPAA covered entities and business associates, current 45 CFR 164.308(a)(7) makes data-backup, disaster-recovery, and emergency-mode-operation plans required implementation specifications. Testing and revision procedures and application-and-data criticality analysis are addressable specifications.

The regulation concerns systems containing ePHI. A practice still needs to map payroll, facilities, communication, payer, workforce, and other requirements under their own sources.

Restore into a trustworthy environment

Identify the incident and safe recovery point before reconnecting data. Restore clean identity, network, endpoint, application, and logging foundations in the declared order. Verify keys, privileged access, configuration, patches, and monitoring.

CISA’s ransomware guide recommends offline, encrypted backups and regular testing. It also warns that connected backups can be deleted or encrypted by ransomware. NIST SP 1800-11 explores recovery from data corruption and destructive events.

A fictional recovery exercise

Caleb’s practice declares six systems due for exercise: identity, scheduling, clinical records, secure communication, billing hold queue, and payroll time capture. Five restore and pass their acceptance tests within target: 5 of 6, or 83.3%.

Scheduling becomes technically available but fails the acceptance check because 12 downtime changes have not reconciled. It remains open in the denominator. The exercise reports technical restoration, accepted recovery, records reconciled, and elapsed time separately.

No client session resumes solely because a server is online. Operations verifies scheduling and setting evidence; qualified clinicians decide case-specific clinical readiness; security validates the recovered environment within its role.

Define acceptance before the outage

Acceptance can cover authenticated access, record counts, content integrity, attachments, permissions, audit logs, interfaces, queues, alerts, performance, and downstream reconciliation. Name the approver for each domain.

Use the actual start and end events for every duration. Count systems accepted by target divided by systems due in the exercise. Keep failed, skipped, and blocked systems visible. Record corrective actions, owners, deadlines, and retest results.

Reconcile downtime work and communicate

Approved downtime records should capture actual service and entry times, author, client, location, and required evidence. After recovery, enter or attach them through the applicable late-entry or reconciliation process while preserving original history. Check appointments, authorizations, claims, payments, payroll, messages, incidents, and disclosures.

Tell staff, clients, families, vendors, and payers only what their role requires. Avoid promising restoration times beyond supported targets. Maintain alternate contact routes outside the failed system.

NIST SP 800-34 Rev. 1 Update 1 is final federal information-system contingency-planning guidance. A private practice may adapt its impact analysis, recovery strategy, testing, and maintenance concepts. The NIST Cybersecurity Framework 2.0 is voluntary general risk guidance.

Exercise decisions as well as technology

Tabletop exercises can test authority, communication, safety, downtime work, vendor escalation, and conflicting priorities. Technical exercises can test identity, infrastructure, data restore, integrity, interfaces, and performance. Use scenarios such as ransomware, regional cloud failure, corrupted records, lost keys, unavailable leaders, or a facility outage.

Predeclare which systems, records, people, and decisions are in scope. Start the clock from a defined detection or activation event. End it only when the stated acceptance condition is met. Availability, data restoration, business reconciliation, and safe service release may have different end times.

Include at least one failed dependency and require the team to use the fallback. Observe whether current contact lists, credentials, procedures, and external support routes work. Avoid exercises that expose real client data or create unauthorized clinical or restrictive situations.

Afterward, record actual results, missed assumptions, open risks, owners, deadlines, and retest dates. Trend corrective actions closed by due date and systems accepted within target. A fast exercise with skipped evidence should fail its acceptance rule even when the technology returns quickly.

Close each exercise with a release decision for every system: accepted, restricted, failed, or awaiting reconciliation. Preserve the evidence, approver, residual risk, temporary control, and retest date so technical availability never substitutes for safe operational recovery.