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So you think you’ve seen everything in medicine?

To say this year has tested our resilience is an understatement! We’ve adapted to Covid screening procedures, face masking, department closures and both employee and patient Covid illness. Crazy!! Early in the pandemic I felt as though we were pivoting monthly on screening procedures, who can come into the department, who cannot, what to do when an employee feels ill. 
Work began to adjust to our “new normal” after the first six months of this pandemic. Patients seemed to be willing to give up restaurants and live music, but not their medicine! Patient appointments started to reflect our normal volume…ah at least work began to feel familiar.
Enter the unexpected tornado!  In early May, on a random Saturday night, while I was off in Hawaii on my first post vaccinated vacation, our entire EMR system went down. Reports from our large organization began cascading in, systems down at all five hospitals, then the 20 or more outpatient clinics. What at first seemed like a transient Pacs issue turned out to be a systemwide computer hack.
Now comes the hard part..if you’ve worked in medicine for more than 10 years, you will remember the days of “paper”. And thank god for them! I remember the days of “superbills”, ICD9 codes, CPT coding. For me the pivot was a walk back in time that I had familiarity with. For the organization, re-inventing itself backwards was daunting. Reverting to paper and manual processes also takes more time! Our patient visits dropped at least 50%. I became the designated “runner” for the radiologists, matching up dictations with paper orders, and faxing them back to the referring clinicians…most of whom I could identify, some of who I could not. Bad phone numbers, bad fax numbers, fax machines that were overwhelmed and would not take a report. One day I clocked in over 2.5 miles walking between the radiologist reading room and the fax machine, which are about 10 feet apart. 
Our local paper ran the story, stating that healthcare hacks are up over 10,000% since 2018. Why is that you ask? Because historically healthcare organizations are financially stable, and have heaps of private information, which makes us a prime target to be held financial hostage. Today I received notice that the “other” large healthcare organization in town had a data breech. While it did not disable the EMR system, data was in fact compromised. 
In retrospect, I found patients to be generally understanding, and I think the fact that the oil pipeline hack on the east coast was going on at the same time helped conceptualize that this is a global problem, not specific to my organization.
Takeaways..both organizations say that the hackers gained access to computer systems via email, not by opening the email but rather opening an attachment. I was really worried about losing access to all the webpages I need to perform my job as clinical educator, but that didn’t happen. The IT department placed security patches on every single computer in use, and now all outside emails come with a warning about website recognition. So, I still have google!!! Or Dr. Google as we say! 
I also think us “veterans” who have seen a superbill may have had some kind of leg up, we recognize them and understand the value of a correct diagnostic code. It was not easy, but we made it!!
Candace Goldstein
Sonography Educator San Diego, California