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In some instances, patient safety is compromised or data exposed to parties seeking profit. This review provides a foundational perspective of the current state of downtime readiness as organizations prepare to handle downtime events. A search of technical news media related to healthcare informatics and a scoping review of the research literature were conducted. Findings ranged from theoretical exploration of downtime to empirical direct comparison of downtime versus normal operation. Overall, 166 US hospitals experienced a total of 701 days of downtime in 43 events between 2012 and 2018. Almost half (48.8%) of the published downtime events involved some form of cyber-attacks. Downtime contingency planning is still predominantly considered through a top-down organizational focus. We propose that a bottom-up approach, involving the front-line clinical staff responsible for executing the downtime procedure, will be beneficial. Significant new research support for the development of contingency plans will be needed.<\/jats:p>","DOI":"10.1177\/1460458220918539","type":"journal-article","created":{"date-parts":[[2020,5,14]],"date-time":"2020-05-14T04:45:58Z","timestamp":1589431558000},"page":"2660-2672","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Understanding the scope of downtime threats: A scoping review of downtime-focused literature and news media"],"prefix":"10.1177","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6599-4577","authenticated-orcid":false,"given":"Ethan P","family":"Larsen","sequence":"first","affiliation":[{"name":"Houston Methodist Research Institute, USA; Children\u2019s Hospital of Philadelphia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arjun H","family":"Rao","sequence":"additional","affiliation":[{"name":"Texas A&M University, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farzan","family":"Sasangohar","sequence":"additional","affiliation":[{"name":"Texas A&M University, USA; Houston Methodist Research Institute, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,5,14]]},"reference":[{"key":"bibr1-1460458220918539","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp0912825"},{"key":"bibr2-1460458220918539","unstructured":"Henry J, Pylypchuk Y, Searcy T, et al. 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