A virus has caused a "major incident" at Barts and The London NHS Trust where some networks were still unavailable today [Wednesday 19 November], nearly two days after the problem was discovered.
Computer Weekly has learned that a virus caused a plethora of spurious messages to overload the trust's network. Barts and The London said the virus had caused a "major incident".
Barts, which has installed the "Cerner" Care Records Service under the National Programme for IT [NPfIT], diverted ambulances to neighbouring hospitals for several hours while IT specialists shut down the networks and tried to find out how the virus penetrated the them.
The problem was discovered on Monday afternoon and by this morning there was still only limited access to the trust's networks.
A spokesman for Barts said today that parts of the network are being brought up gradually. He said it was still not known how the virus got into the networks. It affected networks at the trust's three main hospitals: St Bartholomew's in the City, the Royal London in Whitechapel and the London Chest in Bethnal Green. Barts has England's biggest centre for treating heart attacks, and also has specialist treatments for cancer. It is one of the capital's leading trauma and emergency care centres, and is home to London's air ambulance.
By early evening yesterday the trust began taking in ambulances again. Hospital officials were telling the media, on the basis of their guidance notes, that the Care Records Service was working normally. They said the Care Records Service was unaffected by the virus.
But one official at Barts conceded that, with the network overloaded because of the virus, staff "might" have been unable to access to the Care Records Service. He said that in that event staff would have reverted to accessing paper-based records.
Although this is a normal backup procedure it can cause backlogs of work and reduce the number of patients that staff and clinicians can see and treat.
The Care Records Service allows access to patient records. The hospital's networks also handled requests for x-rays.
In a statement yesterday the trust said: "The Trust's well rehearsed emergency procedures have been activated to ensure that key clinical systems continue while network access is being established.
"We have maintained a safe environment for our patients throughout the incident.
Manual backup systems are in use and we are in the process of restoring the computer systems with priority being given to the most important areas for maintaining patients services
"Operating theatres and outpatients departments have remained operational throughout the incident, though some non essential activities have been scaled back. A&E remains open to walk in patients and ambulances are being diverted to neighbouring hospitals in the short term."
Julian Nettel, Chief Executive at the trust said yesterday: "This has been a difficult day, but by using back-up systems, manual procedures and working flexibly, we have continued to provide high quality care to our patients."
The trust says that medical staff have been able to make paper-based requests for laboratory tests and x-rays. Nettel said: "I would particularly like to thank all our staff, patients and other NHS colleagues for their hard work, help and support during this incident."
The incident raises questions about how a virus was able to infect a network which has been upgraded to serve the NPfIT Care Records Service.
Also the incident shows that increasing reliance on centralised systems to support the running of hospitals means that network downtime can quickly cause large backlogs of work. But a third aspect of the major incident at Barts is particularly interesting.
I spoke to two officials on different days about the virus at Barts. They were polite and open - except when it came to explaining the effect of the downed networks on the NPfIT Care Records Service. My difficult conversations with the officials were, to me, another sign that the NPfIT is now governed more by politics, play-acting and spin than common sense.
This was a summary of my conversations with the trust's officials:
Me: Can Barts' hospital staff access the Care Records Service, despite the virus on the network?
Trust: Yes. The Care Records Service is unaffected.
Me: But if the networks are down how is it possible to access the Care Records Service?
Trust: Our information is that the Care Records Service is unaffected.
Me: I accept the Care Records Service is unaffected by the virus. But can users access it when the networks are down?
Trust: I am not technical. We're still investigating how the virus got in. It says here that the Care Records Service is unaffected.
Eventually, after I'd asked the same question in a few different ways, a press officer conceded that users had reverted to paper-based medical records because they had been unable to access the Care Records Service.
But the next day I spoke to another press officer at Barts who insisted that users had always been able to access the Care Records Service. He couldn't explain how this was possible, given that the networks were down. "I've instructions that the Care Records Service is unaffected," he said.
These conversations give a hint of how difficult it is to find out the facts when anything goes wrong with IT in the public sector, and particularly when the NHS is involved, and particularly when the NPfIT is - or might have been - affected. I wonder how the NPfIT can ever succeed, trapped as it is inside the world of the government's PR bubble.
Computer virus takes down Barts and The London - E-Health Insider, November 2008
Statement on computer virus - Barts' website
Hospital systems hit by virus - SIlicon.com
Computer virus affects hospitals - BBC online