Hurricane Ida and the IT dependencies that sit under the EHR
After Hurricane Ida, Louisiana hospitals ran for days on generators while the grid and carrier networks were down. A week like that tests three layers beneath clinical applications, each owned by a different team: power, connectivity and hosting.
Looking Back revisits one week at a time, from January 2020 to today, and asks what it meant for the banks, health systems and public agencies we serve. The series was written in 2026, with the benefit of hindsight, and each article says which week it looks back on.
The week
Hurricane Ida made landfall near Port Fourchon, Louisiana, on August 29, 2021, as a Category 4 storm, sixteen years to the day after Hurricane Katrina. Damage to the transmission system cut grid power to New Orleans and much of southeast Louisiana, in many areas for more than a week. Hospitals ran on generators, and some in the hardest-hit parishes moved patients elsewhere, while the region’s hospitals were already crowded with patients from the Delta wave of COVID-19. Cellular, landline and internet service failed across much of the region as cell sites lost power and lines were damaged. Louisiana authorities opened investigations into the deaths of nursing home residents who had been evacuated to a warehouse. On September 1, Ida’s remnants caused deadly flash flooding in New York and New Jersey.
Hospital IT resilience planning usually starts with applications: EHR downtime procedures, backup and recovery, ransomware scenarios. Ida tested something underneath. For days, the question in affected hospitals was not whether the EHR was healthy but whether there was electricity to run the equipment that reaches it and a network to carry its traffic. Three layers sit beneath every clinical application, and a week without the grid tests all three at once: power, what keeps devices running; connectivity, what links the hospital to everything outside it; and hosting, where the systems themselves live. Each is typically owned by a different team, which is why gaps between them go unnoticed until a storm finds them.
Power: what the generators actually feed
Hospitals are required to have emergency power, and the CMS emergency preparedness rule requires planning for alternate energy sources, including fuel. Generators are usually maintained well. The questions that matter over a week of grid failure are more specific: how many days of fuel are on site, whether resupply contracts hold when roads are blocked and every facility in the region is calling the same suppliers, and which loads are actually connected to emergency circuits.
That last question belongs to IT as much as facilities. Hospital electrical systems separate emergency power into branches for life safety, critical care and essential equipment. Network switches in wiring closets, wireless access points, nursing station workstations, badge readers, and the cooling for server and network rooms may or may not be on those branches, depending on decisions made when each area was built or renovated. A data center running on generator power with failed cooling will shut itself down within hours. An EHR that is running but unreachable from a unit because the closet switch has no power is down for that unit.
The fix is a joint map, maintained by facilities and IT together, showing which IT components sit on which emergency branch, verified by load tests that run with the IT equipment actually drawing power. The map should also record battery runtime for each closet, because the gap between grid failure and generator transfer, or a generator fault, is bridged by batteries nobody has tested in years.
Connectivity: the network outside the walls
The second layer is everything that connects the hospital to the outside. During Ida, carrier networks failed widely as cell sites ran out of backup power and lines were damaged. Hospitals depend on those networks for links to other facilities in the system, for internet access to hosted applications, for telephones, for contact with emergency medical services, and for staff trying to reach work or check in.
Resilience here means diversity that is real, not just contractual. Two carriers whose fiber enters the building through the same conduit, or shares a path down the same road, offer one route. Physical path diversity has to be checked on maps, not assumed from invoices. Beyond terrestrial links, satellite connectivity sized for essential clinical traffic, and radio systems for coordination with emergency services, cover the case where every wired and cellular network is down.
The other half is knowing which clinical functions need outside connectivity at all. E-prescribing, interfaces to reference laboratories, remote radiology reads, payer eligibility checks and telehealth all stop when the hospital is cut off. Each needs a written fallback, such as local printing of prescriptions, courier arrangements, or on-site reading of critical imaging.
Hosting: where the systems live
The third layer is location. Over the previous decade, many health systems moved their EHR and other clinical applications into vendor-hosted or cloud data centers far from the hospital. That protects the systems from local disasters, a real benefit when the hospital’s own building is at risk of flooding. It also makes every hosted system depend completely on the connectivity layer. A hospital with a remotely hosted EHR and no working network link is in the same position as one whose data center flooded.
Bringing systems back on premises is rarely the answer. Matching the hosting model to the other two layers is. Remote hosting needs diverse, resilient network paths and a local, regularly refreshed read-only copy of critical patient information, available on emergency-powered devices when links fail. Local hosting needs protected power, cooling and a server room above flood level. Both need tested procedures for working without the primary system for days, not hours.
Underneath all three layers is a regional reality. Hospitals compete for the same fuel, the same carriers’ repair crews and the same transfer beds during a regional disaster. Healthcare coalitions, utilities and emergency management agencies are part of the dependency map, and their contacts belong in the plan. A practical exercise is to trace three critical workflows, such as medication administration, laboratory results and imaging, down through application, network path, hosting site and power, and list every single point of failure found. Gaps found on paper cost far less than gaps found in a storm.
With hindsight
From 2026, Ida reads as one in a series of events that pushed infrastructure dependencies up hospital agendas. In 2022, the FCC adopted rules making wireless carriers’ disaster roaming and coordination commitments mandatory, citing Ida among the disasters that had exposed weaknesses. In 2024, Hurricane Helene damaged a major IV fluid manufacturing plant in North Carolina, causing national shortages and showing how one regional event reaches hospitals far away. In July 2024, a faulty security software update crashed Windows systems worldwide, including at many hospitals, a reminder that the hosting and endpoint layers can fail without any storm. Health systems have since paid more attention to path diversity, satellite backup and joint facilities-IT dependency mapping. The three-layer view has held: clinical applications are only as available as the power and networks beneath them, and those layers have to be planned by teams that rarely sit together.