Study Identifies Lack of Preparedness for Ransomware Attacks in Emergency Departments
Ransomware attacks on hospitals cause major disruption to healthcare operations over several weeks. During the acute and recovery phases, access is often prevented to electronic health records and critical IT systems which can naturally have an impact on patient care. Ransomware attacks cause disruption to workflows, increase wait times, and slow patient flow, which can increase patient transfers and complication rates and negatively affect patient outcomes. Some studies suggest mortality rates increase following a ransomware attack.
Research on the impact of ransomware attacks on hospitals is limited, with studies often focusing on the technical consequences of ransomware attacks rather than the impact these attacks have on hospital staff, especially in emergency care. A recent qualitative study, Hacking Acute Care: A Qualitative Study on the Health Care Impacts of Ransomware Attacks Against Hospitals, which was recently published in Annals of Emergency Medicine, sought to explore the impact on staff in more detail and identify the challenges faced by healthcare professionals and IT staff during the acute and recovery phase of hospital ransomware attacks.
The researchers explored the effect of several large ransomware attacks on hospitals between 2017 and 2022 and conducted interviews with 9 individuals at hospitals that had suffered ransomware attacks, including emergency department staff and IT professionals. The study confirmed that ransomware attacks cause significant disruption to emergency department workflows and acute care delivery, and indicate the attacks have a detrimental effect on the well-being of healthcare providers. The low number of participants was due to the “profound hesitancy” of hospitals to participate in the study; however, valuable information was obtained from the interviews that allowed the researchers to gain an insight into the impact of the attacks and make recommendations to improve preparedness and limit the adverse impacts on workflows and staff well-being.
While hospitals often have incident recovery plans, the study highlighted a lack of preparedness for ransomware attacks within emergency departments and highlighted several challenges that are encountered during the acute and recovery stage of the attacks. The lack of access to digital radiology systems following ransomware attacks made ordering and obtaining diagnostic imaging a challenge. The inability to communicate electronically meant forms had to be carried back and forth to the radiology department and medical images often had to be reviewed in person at the radiology department. Non-clinical staff members were found to serve as runners between the point of care and the radiology department, collecting and delivering imaging results, and due to the disruption, diagnostic imaging had to be reserved for the most urgent situations.
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Ransomware attacks will naturally have an adverse impact on hospitals; however, that impact can be minimized with better preparedness. The researchers recommend temporarily diverting emergency department personnel in the first few hours of an attack to reduce pressure on acute care services and to use reverse triage, where the most seriously injured patients already in the emergency department are transferred to healthcare facilities unaffected by the attack. Patient care protocols should be established for when critical systems are offline and training should be provided to employees on paper-based charting and recording of patient information, and hospitals should ensure that paper charts and diagnostic order forms are on hand for emergencies. The researchers also recommend transparency with hospital staff, patients, and partners to help mitigate cyberattack concerns.
