In healthcare, every login is a link in the care chain. From triage to discharge, clinical workflows depend on reliable, secure access to systems that move faster than patients. During mergers, those systems are under stress—replatforming, migrating, consolidating. IT downtime in this context isn’t just an operational inconvenience; it’s a clinical risk. Orders are delayed. Diagnoses slow. Care teams scramble. And patients notice. Yet too often, downtime during M&A transitions is treated as a tolerable side effect of progress. It isn’t. It’s a breakdown of continuity at the moment continuity matters most.

1. When Access Breaks, Patient Flow Breaks With It 

Clinical systems are not standalone apps—they’re a web of interdependent tools built on identity. EMRs, PACS, scheduling software, pharmacy systems, and secure communications all rely on real-time authentication. That authentication often depends on Active Directory and IAM policies. 
When systems are down or access is interrupted, it slows or halts: 

• Triage and registration workflows 
• Order entry and results retrieval 
• Bed management and patient movement 
• Discharge coordination and follow-up scheduling  

According to the Ponemon Institute (2023), healthcare organizations experience an average of $7,900 per minute in financial impact during IT system downtime, with additional non-financial costs in care quality and staff efficiency. 

Downtime during M&A events—when multiple systems are in transition—magnifies these effects. 

2. Identity Is the Hidden Layer of Clinical Continuity 

While infrastructure, networks, and application availability get most of the attention during M&A planning, identity is the dependency that often fails first. When a user can’t authenticate, the rest of the system is irrelevant. 

Key failure points we see during post-merger transitions include: 

• Broken GPO inheritance after domain collapse 
• Delayed provisioning for new staff in combined entities 
• MFA token mismatches due to hybrid identity environments 
• Overlapping usernames or conflicting UPNs across domains 
• Role-based access mismatches that block app visibility or permissions 

These identity errors don’t just result in help desk tickets—they delay clinical action. A physician unable to access imaging. A nurse unable to chart a medication. An on-call specialist locked out of secure messaging. These are real-world consequences of invisible IAM misalignments. 

3. Manual Workarounds Increase Cognitive Load and Risk 

When identity fails or systems are down, care doesn’t stop—but it does get riskier. 

Paper documentation, phone-based handoffs, and verbal orders may work in a pinch, but they: 

• Increase risk of transcription errors 
• Reduce traceability for compliance and audit 
• Break workflows designed for digital verification 
• Slow down clinical throughput and care coordination 

During a domain transition project in a large academic medical center, Hekima observed that clinician documentation time increased by over 30% during a partial outage of the IAM system. Nurses were manually tracking MARs, and physicians delayed notes until systems were restored—resulting in backlog, miscommunication, and increased post-discharge clarifications. 

4. Downtime Impacts More Than Operations—It Erodes Trust 

In M&A scenarios, frontline staff are already coping with new leadership, unfamiliar processes, and organizational uncertainty. IT disruption in this context sends a clear signal: “We weren’t ready.” 

The consequences are cultural as well as operational: 

• Staff lose confidence in new leadership 
• Adoption of new systems slows due to fear of failure 
• Workarounds become normalized, undermining governance 
• Patient satisfaction declines as visible delays emerge  

According to a HIMSS survey (2022), 42% of clinicians report lower confidence in IT systems for at least six months following a major disruption, especially if it occurred during a transition like a merger. 

In competitive healthcare markets, where reputation and HCAHPS scores drive reimbursement and loyalty, even small failures can have long-term impact. 

5. Real Continuity Requires More Than Infrastructure Uptime 

It’s not enough to keep servers running or applications available. Continuity is about access—and that means identity. 

Organizations that avoid disruption during M&A invest in: 

• Cross-domain authentication bridges 
• SID history retention to preserve access to legacy systems 
• Version-controlled RBAC policies for app-layer alignment 
• Tested failover pathways for IAM services 
• Real-time access monitoring dashboards to flag failures early 

Hekima has implemented these strategies in high-stakes clinical environments where downtime is unacceptable. In one engagement, we simulated a full domain failure and recovered access to 200+ clinical systems in under 45 minutes—because the cutover plan had been validated under load before go-live. 

This is what continuity looks like: not just high availability, but operational assurance that care will not be interrupted by identity failure. 

6. Leadership Must Center the Patient in IT Transition Planning 

Too many IT integration plans are built around systems—databases, applications, licenses. Few are built around what clinicians actually do hour by hour, or how identity friction affects care in motion. 

A patient-centered IT continuity strategy includes: 
Mapping identity dependencies for every clinical system 

• Mapping identity dependencies for every clinical system 
• Stress-testing login flows during peak shift handoffs 
• Including bedside users in cutover planning 
• Embedding real-time support at the point of care during migration windows 
• Treating IAM as a clinical dependency, not just an IT concern 

When clinical staff are involved early—and continuity is a visible priority—confidence goes up. Disruptions go down. And the merger feels less like an IT project, and more like a healthcare transformation done responsibly. 


Conclusion: Patient Impact Is the Only Metric That Matters 

In healthcare M&A, infrastructure doesn’t matter if access is broken. Apps don’t matter if identities are misaligned. And progress doesn’t matter if care is delayed. 

IT teams must move beyond checklists and SLAs. They must adopt a new metric: Was care uninterrupted? Did the system support clinicians when it mattered most? 

Hekima’s approach puts that question at the center of every IAM and AD integration project. 

Because if we fail at access, we fail at care. 

Sources: 

• Ponemon Institute, 2023. “The True Cost of Unplanned Downtime in Healthcare.” 
• HIMSS, 2022. “IT Access and Identity Challenges During M&A.” 
• AMIA, 2021. “Health IT Disruptions and the Clinician Experience.” 
• Hekima Internal Case Data, 2023. “IAM Cutover Strategies in Clinical Domains.”