J. Zhao1, E. Kessler1, C. Cooper1, J. Brewer1, S. Schwaitzberg1, W. A. Guo1 1State University Of New York At Buffalo,Buffalo, NY, USA
Introduction: A ransomware attack during the spring of 2017 shut down all hospital-wide health information systems at an academic-affiliated tertiary referral and adult level I trauma center for two months. We used this unique opportunity to investigate the adaptability of modern day general surgery residents when faced with an abrupt shutdown of access to electronic medical records (EMR) and internet.
Methods: All surgical residents who had rotated at the affected hospital during the cyberattack were invited to complete a survey about their experience. Participants responded to 15 Likert scale format questions regarding their attitude toward medical record documentation, order placement, communication, and information access during the downtime. Semi-structured interviews were also conducted with 10 residents with representation from all year groups and with 5 attending surgeons to explore the downtime impact on surgical education in greater detail. A grounded theory approach was used to analyze the transcriptions.
Results: A total of 18 residents responded to the survey with a response rate of 85.7%. As shown in the table, face-to-face communication significantly increased, while access to online educational resources significantly decreased during the cyber attack. The ordinal logistic regression model revealed that level of post-graduate years (PGY) was a predictor of stress in daily order placement without an order set (OR 2.55, 95% CI 1.24-5.25, p=0.005). However, there is no significant association between the PGY level and medical record documentation. Interviews with residents and attendings revealed that surgical residents adapted better than expected to the abrupt loss of EMR access. Recurrent themes were that surgical residents worked excellently as a team, were proactive, and managed their time well at baseline; these skills came to the forefront during the downtime. Furthermore, attendings continued to view surgical residents as competent, since operative ability was gauged exclusive of the EMR.
Conclusion: Our study demonstrated that surgical residents adapted well to an unexpected shut down of the hospital computer system due to a ransomware attack, despite the necessary increase in face-to-face communication and dearth of online educational resources. Our study refutes the common misconception that digitally-native Millennials lack the adaptability to handle a paper-based system. With the increasing level of cyber security threats in healthcare, preparedness should be included in the GME curriculum.
