Infrastructure resilience gap: The system is up, but care can’t resume

Note: This is the first of three articles, sponsored by Spectrum Business®, examining how healthcare organizations can strengthen infrastructure resilience across an increasingly distributed care environment. Subsequent articles will explore distributed care infrastructure and AI readiness. 

Picture a hospital in the hour after a major outage. The EHR is back. The servers are green. The status dashboard shows all systems operational. And yet on the floor, nurses can’t authenticate consistently. Secure messages lag. Wireless coverage in one wing is unreliable enough to stall the mobile workstations clinicians depend on. 

The system is technically “up.” But care has not resumed. 

This scenario highlights a persistent blind spot in healthcare infrastructure planning: the gap between system recovery and clinical usability. 

Healthcare organizations have made real progress on the fundamentals. Nearly all now maintain disaster recovery (DR) and business continuity plans. Core clinical systems are more resilient, and downtime events are increasingly well managed. Organizations can often restore critical applications quickly and predictably. 

But even when systems return, care does not always resume. 

This is the last-mile clinical usability gap — the difference between a system being available and a clinician being able to work. 

In telecommunications, the “last mile” refers to the final stretch that reaches the end user, often the hardest segment to get right. Healthcare has its own version: Everything a clinician depends on after a system comes back online: authentication, connectivity, communication, and access at the point of care. 

When that last mile falters, the clinical impact is immediate. 

When “up” isn’t enough

For years, infrastructure performance has been measured through system-centric metrics: uptime, outage duration, recovery targets. These still matter, but they no longer tell the full story. 

Modern care depends on a chain of interdependent services. Identity platforms, wireless networks, secure messaging tools, and device connectivity all sit between the clinician and the application. If any one of these elements falters, even after core systems are restored, workflows stall. 

The 2025 Digital Health Most Wired (DHMW) Infrastructure findings reflect this shift. While nearly all organizations have DR plans, the real divide lies in execution. About nine in ten very large health systems conduct zero-impact DR testing, compared with roughly six in ten small organizations. Those that rehearse recovery regularly report faster restoration and fewer gaps during real events. 

But most DR programs still validate systems in isolation. They confirm that applications fail over and infrastructure recovers. What they often don’t test is whether a clinician, in a specific unit, can log in, access a patient record, send a message, and place an order. 

That’s the last mile. And it’s often the last thing tested. 

Introducing clinical uptime

A growing number of healthcare leaders are reframing resilience around a more practical question: Can clinicians actually use the systems that are running? 

This shift introduces a more meaningful metric: clinical uptime. 

Clinical uptime reflects the moment when care delivery can fully resume. It captures the full experience of care, from login to workflow completion, across identity, connectivity, and communication layers. 

Measuring it requires moving beyond system checks to end-to-end validation. It means confirming that clinicians can log in, access data, communicate, and coordinate care without friction. 

Traditional metrics fall short here. Most organizations still track uptime and outage duration, but more advanced organizations are beginning to measure what drives those outcomes: alert efficiency, redundancy performance, and root cause resolution. These indicators better reflect whether infrastructure supports real-world care delivery. 

The hidden dependencies of care

The last-mile gap persists because supporting infrastructure has often been treated as secondary. 

Identity platforms may have longer recovery targets than clinical systems. Wireless networks may not be included in DR exercises. Communication platforms may be validated separately rather than as part of a full workflow. 

Individually, these decisions make sense. Together, they introduce compounding risk. 

Three areas are especially prone to last-mile friction: 

1. Identity and authentication: Multi-factor authentication (MFA) and single sign-on (SSO) are now standard, but they also create dependency. When identity services lag or become unreachable, clinicians are locked out even if applications are running. Identity elevates from security layer to a clinical continuity requirement. 

1. Wireless connectivity at the point of care: Care delivery is mobile. Nurses chart at the bedside. Physicians round with tablets. Teams access imaging across care settings. Wireless performance is now a clinical capability. The Most Wired findings reinforce this: more than 90% of large organizations have in-building cellular coverage, compared with about 60% of smaller hospitals. Reliable connectivity is no longer optional — it is foundational to care coordination. 

1. Secure clinical communications: Secure messaging has replaced fragmented communication channels, improving coordination. But it also concentrates risk. When messaging slows or fails, consults are delayed, workflows fragment, and teams revert to workarounds. 

These dependencies rarely fail in isolation. They compound, slowing recovery even when systems appear stable. 

From system recovery to workflow readiness

Closing the last-mile gap requires rethinking how resilience is designed and tested. 

The Most Wired findings point to a clear trend: leading organizations are moving beyond system validation toward workflow validation. Through zero-impact DR exercises, they build what the data describes as operational muscle memory. The difference is what gets tested. 

Instead of confirming that systems are online, these organizations simulate real clinical scenarios: 

• Can a nurse authenticate at a bedside workstation?  

• Can a physician receive and respond to a consult?  

• Can a patient be registered, triaged, and treated without delay?  

This approach, called clinical continuity testing, surfaces vulnerabilities that traditional DR exercises miss. The gaps tend to appear not in core systems, but in the connective tissue linking clinicians to those systems. 

Addressing these gaps requires coordination beyond IT. Clinical informatics, nursing leadership, and operations must help define what “usable” looks like in practice. 

Three priorities stand out: 

• Expand DR testing to reflect real workflows, not just system recovery  

• Align recovery targets across dependent systems, so identity, connectivity, and communications recover in step with clinical applications  

• Establish cross-functional ownership, ensuring testing reflects real-world care delivery  

The goal is simple: confirm that care teams can operate, not just that systems are online. 

Strengthening the connective tissue

As care becomes more distributed across hospitals, clinics, and home settings, the last-mile challenge grows. Each location adds another layer of dependency. Modern networking approaches are helping address this complexity. 

Software-defined architectures, including SD-WAN and SD-Branch, allow organizations to prioritize traffic based on clinical importance. EHR sessions, identity services, and secure communications can receive preferential treatment, maintaining performance during disruption or peak demand. 

These approaches also improve consistency across environments, ensuring clinicians experience reliable access whether they are in a flagship hospital or a remote clinic. 

Managed connectivity services add visibility and proactive response. Detecting and resolving degradation before clinicians feel the impact becomes a form of clinical continuity. 

Reliable in-building connectivity is just as critical. Wireless performance and cellular coverage now underpin secure messaging, alerts, and team coordination. When these services lag, recovery stalls even when systems are technically available. 

The network is no longer background infrastructure. It is an active enabler of care. 

Redefining resilience at the point of care

Infrastructure resilience has traditionally been defined by how quickly systems recover. That definition is evolving. 

In a distributed, mobile care environment, resilience is measured by how quickly clinicians can resume care. It is defined at the point of care, not in the data center. 

Closing the last-mile clinical usability gap requires organizations to rethink how they design, test, and measure infrastructure. It demands alignment across identity, connectivity, and communication systems that have historically been managed separately. 

The organizations that succeed will not stop at “systems up.” They will ask a more meaningful question: Can clinicians work? 

And they will build the infrastructure and the testing culture to ensure the answer is yes. 

About Spectrum Business

Spectrum Business empowers healthcare organizations to transform the patient experience with networking, security, communications, collaboration and TV solutions. Our certified healthcare IT solutions experts serve 90% of the largest health systems in the US with a network engineered for exceptional performance, end-to-end accountability and 100% US-based support, available 24/7.  For more information, visit www.spectrum.com/business/enterprise/solutions/industries/healthcare.