The television show “The Pitt” has earned praise from viewers, critics and even emergency physicians who credit it for portraying the frenzied reality of emergency departments. But that action grinds to a halt when the doctors are faced with a simple but ominous on-screen message: “network offline.” For most of this season, they’ve served patients without the internet—plunged into “digital darkness” and cut off from the electronic systems that are a mainstay of patient care.
Although the Pittsburgh Trauma Medical Center (the Pitt) is fictional, the dangers of digital darkness events are catastrophically real. These events, defined by a loss of access to electronic systems and patient information, can stem from cyber and ransomware attacks, vendor outages and natural disasters. They cause massive operational disruptions and patient safety concerns that may lead to deaths. These events will only become more common as systems across finance, national security and healthcare increasingly integrate and move online, and as climate change fuels weather-related disasters.
Many medical devices’ key functions rely on network connectivity to transmit information, increasing the potential for a digital darkness event to significantly disrupt patient care and creating new points of vulnerability for hackers to exploit. As more people receive care at home, a whole host of digital technologies help clinicians remotely monitor and treat patients. When networks go dark, so do these vital components of modern medicine.
Take something as simple as the Pitt’s emergency room board—a digital interface that displays each patient’s name, room, condition and status. When the Pitt goes dark, the doctors must scramble to recreate it, but several patients still find themselves overlooked or their care delayed in the chaos.
Underneath it all is a more existential question: Do doctors still know how to practice medicine without devices supporting them? I remember the days of handwritten charts and paper records (especially in remote areas of Africa where I practiced medicine early in my career), but a growing segment of healthcare workers have spent their entire careers—and for some their entire lives—operating primarily in the digital sphere. Suddenly shifting to an analog environment, particularly amid a crisis, is a tall order for even the most competent, cool-headed clinicians.
Digital will ultimately prevail—regardless of clinicians’ experience with analog versus digital systems. Advances in backup systems, redundant connectivity and digital twin technology will push healthcare's tolerance for downtime toward near-zero, making analog competency feel increasingly like knowing how to drive a stick shift: a quaint skill, rarely needed, easily forgotten. But healthcare organizations have a responsibility to prepare their people and their systems for the analog reality that a cyberattack, an outage or a cascading infrastructure failure can still occur at any moment.
Hospitals and health systems must treat digital darkness events like an expectation, not a far-fetched TV plot point. This involves developing standard operating procedures for digital darkness events, incident response planning and staff training, performing regular downtime and disaster recovery drills, business continuity drills, developing data security protocols and creating backups of critical clinical information. Hospital and health system leaders can also partner with medical schools to ensure the next generation of physicians are adequately trained to operate without the latest technologies if and when needed.
Policymakers and regulators also have a role to play in preparing for digital darkness events. This includes ensuring timely access to state and federal resources during disaster recovery and regulating digital health products and vendors to ensure patient data is protected. This is even more important, amid a flood of new health IT devices coming to market and mounting pressures to deregulate. Regulators must balance promoting innovation and safety.
By the time connectivity is restored in the fictional world of the Pitt, digital darkness has wreaked havoc, causing delays in diagnoses, medications, labs and numerous tracking failures—culminating in a patient death. A university English lecturer died in surgery because the doctors didn’t know about a previously diagnosed abdominal aortic aneurysm—something one of the characters notes they “would have known” if the computers were working.
Their experience serves as a reminder of just how fragile the digital sphere is. Healthcare stakeholders and policymakers must be clear-eyed about the benefits and vulnerabilities of the digital age and band together to ensure patients are protected from threats—whether they originate from a clandestine hacker, Mother Nature or somewhere else entirely.
Marcus Schabacker, M.D., Ph.D., is president and CEO and ECRI.