Clinicians' experiences and reflections from a health system cyberattack

Universal Health Services experienced a cyberattack in September 2020 that impacted all hospitals in their system. Nearly all computer systems that store and communicate patient care information were shut down to prevent malware propagation. The impact of this attack was magnified by the ongoing coronavirus disease 2019 (COVID-19) pandemic. The objective of this paper is to describe the response of our intensive care unit (ICU) rounding team to the loss of all electronic health record (EHR) systems within our institution and to share lessons learned through the experience. Guidance is available on prevention of cyberattacks but does not effectively address the need to establish and train providers for alternative care mechanisms at the local level. Many providers and trainees have limited or no experience with manual patient care systems and had difficulty in transitioning to paper records, notes, and order writing. The transition also highlighted a number of unintended consequences that have occurred secondary to implementation and adaptation of EHRs over time. Institutional memory played a major role in addressing the crisis as providers who had utilized paper charting systems were more adaptive. Critical care pharmacists practicing as members of an integrated ICU health care team were an essential resource during the crisis, maintaining patient safety, assisting with order writing, troubleshooting medication issues, and providing education. The cyberattack provided an opportunity to re-evaluate processes and procedures that have developed over time through the use of EHRs. The crisis magnified the importance of team-based care and the integral role of the acute care clinical pharmacist.