Immediately after a major earthquake, critical facilities need to remain operational, continuously providing healthcare services. Continued operability is dependent on the physical performance of healthcare facilities during the earthquake. Several earthquake resilience-rating systems provide a translation of technical building evaluation data into quick summaries of expected building performance and resilience. These ratings provide an approximation of the intended building performance in relation to safety, repair time, and repair cost. However, the translations between engineering assessments and rating systems is inconsistent, with the same technical inputs producing different resilience estimations. The lack of standardization across rating systems can cause confusion for accurately predicted building outcomes. Further, the level of recovery detail is broad with timeframes measured in weeks, months, or even years. While this may be sufficient for many facilities, it is insufficient for others. For example, critical facilities require estimates of building functionality within minutes, hours, and days of the event to support emergency operations. However, current rating systems and engineering evaluation methods lack the proper resolution to provide this level of detail, making the current rating systems inadequate for emergency planners and may provide communities with a false sense of general preparedness. This paper examines the effectiveness of various resilience-rating systems to predict the overall functionality in a hospital after an earthquake and the issues in converting building performance evaluations into resilience ratings. Further, it presents an additional methodology for addressing resolution gaps in estimating building functionality immediately after the event.