Sitting glumly at the desk of his surgery in Rathfarnham in south Dublin, Dr Shane McKeogh is certain of one thing: last month's cyberattack on the Health Service Executive is going to have an impact on the health of some of his patients.
Five weeks after the catastrophic assault, the GP is struggling through a huge backlog of diagnosis tests while trying to rally his weary staff, careering towards burnout following 16 months of the pandemic.
“Delayed diagnosis,” says Dr McKeogh. “That is our worry. Something we would have picked up on. GPs see people every day with symptoms that concern them and require looking into.
“The vast majority of the time, it is nothing serious. But a number of them will be serious. This is the problem. You don’t want delays at that stage and there will be delayed diagnosis as a result of this attack.”
The Conti cyber-crime group’s ransomware hack in the early hours of May 14th froze Ireland’s almost 3,500 family doctors out of vital systems they daily rely on for ordering diagnostic tests, receiving results and communicating with the HSE.
Blood tests, X-rays and imaging results all just stopped. GPs and hospital laboratory medics were catapulted back 40 years, having to arduously handwrite everything and able only to cope with the most urgent cases.
Many surgeries just cancelled tests altogether, such was the uncertainty. Fears of contagion from the HSE hack left GPs reluctant to even access their own laptops and desktops containing patient records.
While “about 80 to 90 per cent” of systems are back up and running, according to Louth-based Dr Conor O’Shea, national co-ordinator of the Irish College of General Practitioners’ IT group, restrictions remain.
Only certain types of blood tests can be requested, and there are limitations on X-ray availability, with huge variations becoming common in different hospital groups around the country.
In a circular to family doctors last week, HSE chief clinical officer Dr Colm Henry said diagnostic laboratories' backlog had "improved significantly" in the east, while those in the northwest, west and southwest were still "significantly constrained".
Even where “critical” systems were back up and running, Dr Henry admitted there was “limited access” to testing, forcing GPs to “carry additional clinical risk”, which adds “significantly” to “challenges and stresses”.
‘It crippled us’
Rob Landers, a University Hospital Waterford pathologist heavily involved in cancer diagnostics, says: "When the cyberattack happened it completely crippled us. It was like being asked to drive a motor car without seatbelts, without airbags.
“So if anything went wrong there was no protection. All of our systems have double, triple, quadruple checks to make sure it is the right diagnosis for the right patient. If we get that wrong, it is catastrophic.
Usually his laboratory deals with 150 tests a day. Immediately after the attack, they could do 10 a day, or even fewer.
"Initially, the seriousness and impact of this didn't seem to be recognised," he says. "It wasn't being admitted to by senior HSE management and the Department of Health. It took a while for them to acknowledge the level of risk."
Dr Landers, who is vice-president of the Irish Hospital Consultants Association (IHCA), says consultants have for years repeatedly urged investment in IT infrastructure and cybersecurity, but it did not happen.
“There is no doubt the Irish healthcare system is lagging behind its counterparts in terms of IT capability and security. There are a number of legacy systems, nothing joined up. It needs massive investment.”
Dr Landers says it will take months, not weeks, to recover from the hack.
“It will be September or October before we work through the diagnostics backlog,” he warns. “The big worry is delayed diagnosis in the meantime. It is a real, significant risk. If diagnostics are delayed, the whole process is delayed – delays in getting to surgery, delays getting radiotherapy, chemotherapy.”
An internal survey of about 150 consultants by the IHCA this week, seen by The Irish Times, shows that almost half (47 per cent) still cannot make electronic referrals while four in 10 still cannot t access patient-record systems.
Where they can, most report the system being “adversely affected”. Three in 10 are waiting for access to imaging systems and the National Medical Laboratory Information System. More than a quarter (27 per cent) are still not allowed to open their PCs.
Public patients
Cork-based GP Mary Favier, former president of the Irish College of General Practitioners, says the backlog created by the cyberattack, on top of a "pent-up demand" as Covid restrictions ease, is hitting poorer patients most.
“It is largely only affecting public referrals,” she says. “For those in private healthcare it continues to function as normal. Yet again, our most-in-need patients are being most disadvantaged.”
Dr Favier agrees the “inevitable” delays in diagnosis will cut lives short.
“We would often get low-suspicion cases, when you only order a test to be thorough, but you can get a surprise,” she says. “If that comes back a week late, that is one thing, but if it comes back five weeks late, that is another thing.
“It could be a life-limiting situation, or life-shortening. I think we are on the right side of that risk right now, but the difficulty is there is now such a backlog of referrals and there will be a deluge into the system.
“Every week of delay from here on in is increasingly concerning.”
In Rathfarnham, Dr McKeogh says many of those waiting on tests are elderly patients who were afraid to visit surgeries until they were vaccinated against Covid-19.
“The ransomware attack has been very hard on people who are very vulnerable,” he says. “Many had already been waiting a significant period of time because of the pandemic, afraid to come out, and they are obviously worried.
“They were already worried about whatever medical complaint they had, that it could be something serious, and we are saying we have to delay tests further again, as had happened multiple times during the pandemic surges.”
The strain is taking its toll on his fellow GPs and nurses, too, who see up to 100 patients every day.
“Staff are very, very weary,” he says. “More so than I have ever seen in 15 years of practice. The whole country needs a holiday but we can’t get the locum cover. It is pure workload issues . A lot of GPs are touching burnout.”