Cyberattack sets central Israel hospital back decades

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The cyberattack that shut down a Hadera hospital’s computer system last week has sent the medical center back decades in time, to the days when all information was recorded and transmitted by hand, its director said.

Dr. Mickey Dudkiewicz, the director of Hillel Yaffe Medical Center, said the transition to handwritten notes was “swift and successful.”

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“This is a scenario we’ve simulated in the past,” he said. “We have all the necessary forms, and we know how to do this.”

To use a medical analogy, the cyberattack was like a traumatic injury – it requires immediate stabilization followed by a lengthy rehabilitation process.

“We’re making progress slowly every day and cautiously resuming some of our activity,” Dudkiewicz said, adding that all “urgent, essential treatments” are being performed, including catheterizations, operations, births and imaging tests. “We’re also working to expand our non-urgent activities, some of which are already taking place.”

A Magen David Adom ambulance carrying injured patientsJalaa Marey/AFP

The Health Ministry and the National Cyber Directorate are in charge of managing the attack’s practical impact, while the police’s cybercrime unit is investigating its criminal aspects. However, what exactly these agencies are doing remains shrouded in secrecy, since a gag order has been placed on some of the technical details.

“We’re in contact with these agencies and informed of everything involving the hospital’s computer operations, but this was clearly an incident at the national level,” Dudkiewicz said.

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In the five days since the attack, medical staffers have become resigned to the fact that it will be many more weeks before the computer system is back in full operation.

“We treated patients before even computers existed, but the current situation is very strange,” one staffer said. “All the medical records are done by hand these days. All internal communications were naturally computerized, and now we have to physically walk around the hospital or work with a fax to send or receive information or collect patients’ test results.”

Prof. Ariel Roguin, who heads the hospital’s cardiology unit, said the staff is working as usual and so is the medical equipment. But when it comes to information, “we’ve gone back to the days of yore, like the days when I was a resident, with paper files and handwritten instructions.”

Dudkiewicz thinks some computerized functions will be restored soon, but others will be out for many weeks. The hospital has therefore brought in laptops that can connected to printers, enabling printed forms to start replacing the handwritten ones.

Ambulance bay at Assuta Hospital in Central IsraelIlan Assayag

The computer systems governing essential imaging tests like CTs and MRIs weren’t damaged, so these tests can still be performed. But the images can no longer be sent to the doctors who ordered them. Instead, the doctors must physically go to the imaging department to view them.

The hospital hasn’t performed elective operations since the attack, aside from a few that were approved by the exceptions’ committee it set up for this purpose. Outpatient clinics have also been shuttered.

“We wanted to curtail the elective activity to reduce pressure on the hospital,” Dudkiewicz said, adding that there have also been fewer people coming to the emergency room. “In urgent cases, some patients have their operations at other hospitals. But most ask to wait and have the operation here.”

Last Wednesday and Thursday, the Magen David Adom ambulance service was told not to take patients who needed catheterizations to Hillel Yaffe.

Medical staff work in the COVID-19 isolation ward of Sheba Medical Center in Central IsraelGil Cohen-Magen/AFP

“We initially decided that we’d only do urgent catheterizations for people who had heart attacks,” Prof. Roguin explained. “We did two of those, and after we saw that everything was working okay, we expanded our activity to less urgent catheterizations. We did six or seven catheterizations just today, and we’ve improved from catheterization to catheterization.”

One of the biggest problems is the lack of access to patients’ medical histories, including records of previous treatments at Hillel Yaffe. “Some come from home with their records, but beyond that, we have no access to the system that enables us to see information about patients who were operated on or catheterized in the past,” Roguin said.

The system connecting the hospital to the health maintenance organizations is also down.

“Every department has made an effort to ensure that work continues,” Roguin said. “Things are moving, but it isn’t pleasant. It’s as if they had hacked our personal computers.”