Caring for cancer patients after cyberattack 'like working with your hands tied behind your back'

Caring for patients as a cancer doctor after the cyberattack on HSE systems is like "working with your hands tied behind your back", says Dr Miriam O'Connor, a consultant oncologist at University Hospital Waterford.

Oncologists have to be sure they are giving the right drug in the right dose by the right route to the right patient at the right time. With so much background information about patients not available, it was difficult to proceed during the shutdown with any confidence.

On the first day, staff knew they had a full diary of day ward patients due in but had no idea who they were because the electronic diary was inaccessible.

“It was like putting a jigsaw together piece by piece, trying to work out who was coming in at what time,” O’Connor says.

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Radiology is critical in the treatment of cancer patients so the growth of tumours can be measured. In the absence of scan information and linked reports, many appointments had to be cancelled.

Another casualty last week were the multi-disciplinary team (MDT) meetings where up to 30 staff might examine the cases of 40 patients in one session. Again, with no patient histories or X-rays available, formulating a plan for future treatment was near impossible, and so these meetings were cancelled.

MDTs are back on again this week “as best and as safely as we can”, according to O’Connor.

Anxiety

Patients reacted to the disruption with a mix of anxiety, frustration and some annoyance, she says.

Despite the difficulties it has caused, O’Connor believes the HSE acted correctly in immediately shutting down its IT system once the data breach became apparent.

“We’ve learned a lot about crisis management in the past year or so. The right thing was done, to let speed beat perfection by locking things down and gradually reopening them.”

The shutdown forced the cancellation of outpatient clinics in the hospital and in satellite clinics across the southeast. With no scan or test results available to patients, there was little point in going ahead with them.

Things have started to improve. A small number of other hospitals have restarted the Nimis system for radiology, and it is apparent now that old images will be available.

Workarounds

The disruption won’t end when the immediate crisis is over, because all of the temporary records created as workarounds over the past weeks will have to be inputted into the electronic system.

All of this in happening on the back of a 15-month health emergency. Cork-based oncologist Prof Seamus O’Reilly points out that the Covid-19 pandemic could increase cancer mortality “for the next decade”.

Already during the pandemic, services had to be curtailed for social distancing and due to the redeployment of staff, he says.

“Our health service still has not returned to normal. This has enormous implications. Our concern as cancer oncologists is of delayed cancer diagnoses following as a result.”

But at least the cyberattack crisis won’t last as long as Covid – or will it?

“It will be shorter, though nobody thought Covid would go on as long as it did,” O’Connor says. “I hear people say ‘this is worse than Covid’ but maybe that’s because we’ve had almost 18 months to come to terms with the virus.”

And, although staff are doing their best, “there will be casualties,” O’Connor acknowledges.