Objectives Our institution was affected by a multi-institution, systemwide cyberattack that led to a complete shutdown of major patient care, operational, and communication systems. The attack affected our electronic health record (EHR) system, including all department-specific modules, the laboratory information system (LIS), pharmacy, scheduling, billing and coding, imaging software, internet access, and payroll. Downtime for the EHR lasted 25 days, while other systems were nonfunctional for more than 40 days, causing disruptions to patient care and significantly affecting our laboratories. As more institutions transition to network EHR systems, laboratories are increasingly vulnerable to cyberattack. This article focuses on the approaches we developed in the anatomic pathology (AP) laboratory to continue operations, consequences of the prolonged downtime, and strategies for the future. Methods Our AP laboratory developed manual processes for surgical and cytopathology processing, redeployed staff, and used resources within the department and of nearby facilities to regain and maintain operations. Results During the downtime, our AP laboratory processed 1,362 surgical pathology and consult cases as well as 299 cytology specimens and outsourced 1,308 surgical pathology and 1,250 cytology cases. Conclusions Our laboratory successfully transitioned to downtime processes during a 25-day complete network outage. The crisis allowed for innovative approaches in managing resources.

Objectives Our academic health care institution was the victim of a cyberattack that led to a complete shutdown of major patient care, operational, and communication systems, including our electronic health record (EHR), laboratory information system, pharmacy, scheduling, billing and coding, imaging software, internet, hospital shared computer drives, payroll, and digital communications. The EHR remained down for 25 days, significantly affecting our clinical pathology (CP) laboratory operations. Methods During the downtime, our CP laboratory incorporated manual interventions for patient specimen testing, recruited additional staff for reporting results, and employed multiple communication modalities to support patient care. The crisis required a swift response, employing innovative approaches to mitigate patient harm; regular, multidisciplinary engagement; and consistent, broad-reaching communications. CP leadership worked with hospital administration, staff, and our referral clients to provide the timely laboratory results needed for acute patient care. Results During this downtime, the laboratory lacked accurate information about the number of patient samples diverted to other laboratories, the number of specimens processed, and the number of test results reported. Conclusions This paper focuses on the approaches the CP division took to develop and maintain downtime operations. Laboratories should consider these strategies in preparation for a prolonged downtime.

Objectives Our institution was subject to a multi-institutional, systemwide cyberattack that led to a complete shutdown of multiple major patient care, operational, and communication systems for more than 25 days. The electronic health record computer system was taken offline, as was the hospital email and authentication systems, internet access, and the laboratory information system. The impact on the hospital and patient care was substantial, and our laboratories were crippled. Methods Our laboratory endured challenges in communication because of the loss of connectivity and difficulties in laboratory management, and we recognized a need to restructure leadership to maintain operations during the crisis. As an academic institution, residents and trainees were also significantly affected by the disaster. Results We developed an incident command team (ICT), alternative methods of communication, and innovative management strategies to remain operational. Trainees were incorporated into the disaster-relief efforts, with negative impacts on resident education. Conclusions This paper focuses on the challenges in communication and lab management as well as the need for an alternative leadership structure during the crisis. We also highlight the unique experience of our trainees during this prolonged downtime, underscoring the importance of incorporating resident trainees into the daily ICT’s administrative activities as an invaluable lab management experience.