FYI ________________________________ From: Gavin Maguire <docbailie@gmail.com> Sent: 17 May 2021 17:56 To: Gavin Maguire <gavin.maguire@centrichealth.ie> Subject: Fwd: Medisec- Guidance to members in light of cyber-attack on HSE/Department of Health ---------- Forwarded message --------- From: Ruth Shipsey <ruthshipsey@medisec.ie<mailto:ruthshipsey@medisec.ie>> Date: Mon, May 17, 2021 at 4:51 PM Subject: Medisec- Guidance to members in light of cyber-attack on HSE/Department of Health To: <docbailie@gmail.com<mailto:docbailie@gmail.com>> ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ [https://medisecireland.newsweaver.com/v2files/shard4/83041/47/06cc7baa2aeff36d732595.jpg] Important Notice to Members We look after you 17 May 2021 m Guidance to members in light of cyber-attack on HSE/Department of Health We are conscious of the stress the serious cyber-attack on the HSE and Department of Health will impose on an already stretched GP community and wish to offer our support. We note you are receiving regular bulletins and guidance from the ICGP, IMO and HSE and we offer the following suggestions that you might take at this time to help reduce risk to patients and for your ease in the days and weeks ahead: Record keeping * GPs should not underestimate the importance of record keeping, especially while ordering tests/bloods is delayed and referral and discharge pathways continue to be compromised. Do ensure to reference the cyber-attack if relevant in records. * GPs will need to ensure electronic patient records are up to date after this episode especially if results / updates are coming back in hardcopy or email formats and not by the usual Healthlink pathways. Investigations In addition to clearly noting the reason for the delay in the patient’s records, GPs must ensure they have a robust system for following up on non-urgent investigations and referrals when the system opens up again. * Many samples submitted in the days immediately prior to Friday 14th May, may no longer be suitable for processing when systems recover and it may be necessary to resubmit samples if still clinically relevant. The HSE will provide updates in that regard. * If it is essential to submit a sample such as a blood count or basic biochemistry, GPs should provide a mobile phone number on which they can be contacted directly with the result as there is no other effective way to reach them with an urgent result at this time. * Radiology services have been particularly badly affected and GPs should be cognisant of this when considering the need to refer patients for radiological investigations. * We advise keeping a log of patients due to attend for routine blood tests in order to reschedule them when the system is restored. Recent referrals * To ensure that recent referrals were both successfully sent and received, we recommend a ‘look-back’ exercise to a point in time some days prior to the attack on Friday 14 May 2021. * This exercise should include identifying and creating a log of all referrals sent, whether by Healthmail, Healthlink or hard copy. * Creating a log will assist in ensuring that the status of all referrals can be checked and appropriately followed up if necessary. * It is difficult to confirm safe receipt of a referral made in hard copy and sent by ordinary post, so we suggest diarying the referral for follow-up by telephone within a reasonable timeframe. * The HSE may be able to give comfort as to the integrity of electronic acknowledgements received shortly before / after Friday 14 May 2021, but pending same, it would be helpful if a log was kept. * We appreciate that this may be an onerous task but it is very important from a patient safety and risk mitigation perspective. GPs are now on notice of potential breakdowns in referral pathways, so we consider it advisable to undertake this risk-mitigation exercise. Facilitating hospital colleagues * In the interest of patient safety and in line with normal practice, GPs should continue to make themselves available for taking calls to assist secondary care. * Consultants ordering High Tech medications will need to seek alternative pathways to ensure that pharmacies order appropriate stocks and may seek assistance from GPs on dosages they previously prescribed etc. as they will not have access to this on the hospital IT system. * Hospital patients may be managed as in-patients with no access to their records (allergies, meds etc.), so GPs, when referring patients in urgent need of care, should include as much detail as possible, including previous discharge information. * As we understand it, discharge letters for patients leaving hospital are being handwritten by NCHDs – in some instances possibly from memory. GPs should be extra vigilant in reviewing treatment plans, discharge prescriptions, and any proposed change in medication. Mistakes and transcription errors are more likely without the author having access to the hospital records and a patient’s full history. If a GP has a concern, they should contact the hospital by telephone to discuss and keep a record of that conversation. Healthmail * It is our understanding that Healthmail email is still working as normal, and while no HSE email addresses are accessible, e-prescribing, and the emailing of prescriptions to pharmacies is continuing as before. Communication with patients * We recommend putting a message on the practice website/phone lines advising that due to the ransomware attack, GP practices are experiencing delays and disruptions to normal service and to ask for understanding at this time. * Patients querying hospital appointments should be advised to check HSE.ie for latest information – time critical appointments will continue. See https://www2.hse.ie/services/hospital-service-disruptions/hse-it-system-cyber-attack.html<https://medisecireland.newsweaver.com/1vl8jqe1mc/1hxz4r2cwbx7im8ag2eemw/external?email=true&a=5&p=7405029&t=2372777> * As many hospital appointments will be cancelled, patients may be asked to attend their GP regarding any exacerbation of symptoms. It may be a good idea to set aside some consultation time to facilitate urgent appointments over coming days. Practices must remain vigilant about the continued implementation of appropriate Covid-19 infection control protocols and precautions. Practice IT / general issues * Seeking advice from the practice IT providers as to how the practice software can assist with logging and following up outstanding action points may be helpful. * All passwords to systems and emails should be regularly updated and robust (12 characters, including upper and lower case, numbers and symbols). * Online PCRS claims should not be submitted at the moment. * COVID-19 Vaccination deliveries will continue to General Practice and the practice relationship manager should be contacted by phone (not email) for the time being. GPs are strongly advised to keep abreast of the up to date guidance via HSE.ie, the ICGP and the IMO. In this unprecedented situation Medisec would like to remind you of our 24/7 advisory support. No query is too small, so please reach out to me or one of my medico legal colleagues if you have any queries. All our contact details are on the website. With best wishes, Ruth Shipsey & The Medisec Team Get in touch Call us on: 1800 460 400 or +353 1 6610504 for all your advisory, membership, ethical or medico- legal queries. 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