In the latest episode of The Pitt, we watched a modern Level Trauma Center voluntarily go dark to preempt a cyberattack. While characters like Dr. Abbott seemed to thrive in the chaos of it all, for those of us in nursing informatics, the episode was a reminder of why our preparation might be the only thing keeping the hospital upright—and why we must train for these events.
The Lost Art of the Order
The episode highlighted a terrifying reality: the Order in
Triplicate.
I might be dating myself here—in my bedside experience, I
rarely had to use triplicate orders, and when I did, I struggled to get my
writing to go all the way through the layers. I had to press hard enough to
switch my pen. I love gel pens (specifically, I’ve switched to the Sharpie
S-Gel and I love it), but even if I pressed as hard as I could on triplicate
paper today, it simply wouldn't work. The second and third copies would be
blank.
Beyond the physical struggle, there is the syntax of the
order itself. Modern providers are digital natives; they’ve always had a
search-and-click EHR to provide clinical decision support. If the EHR doesn't
prompt you, do you remember the exact lab code or the specific nursing
instructions for a complex protocol?
In my organization, we’re currently redesigning downtime
processes with this safety net in mind. We are moving away from blank lines and
toward checkbox-based order sets. These forms mirror the EHR’s logic, providing
pre-printed options for common protocols to maintain standardized care when the
database is offline. We’re also trying to manually capture alerts—though
replicating digital logic on paper is a massive undertaking.
What’s a Fax Machine?
It was hilarious to see that clunky piece of equipment being
brought out while Dr. Abbott laughed and explained what it was to the
residents. But it highlights a core truth of cyber-resilience: Sometimes the
most secure tech is the stuff that isn't on the network. When the internal grid
is compromised, those analog lines become our only lifeline for data.
The Radiology Static Problem & the Human Bed Board
Discussing how radiology results would be delivered on paper
was one of the most striking visuals. We’ve become so used to PACS systems that
let us zoom and 3D-render that we forget how challenging it is to diagnose
based on a static, printed report.
We also saw Joy use her photographic memory to recreate the
patient board. While that makes for great TV, in informatics, we know we can't
rely on memory. This raises the most stressful question for a dirty network
scenario: How do we get a census?
When IT pulls the plug to stop a virus from spreading, you
have a short window to hit Print on every unit's census. If you miss that
window because the network goes dark, your Bed Board becomes a manual
walkthrough—physically checking every room to see who is in the bed, what their
code status is, and what meds are hanging.
The Big Question: Are We Prepared for a Marathon?
The episode focused on the immediate sprint of a lockdown.
What happens if the screens don't come back on in a day? Have we ever truly
prepared for such a length of downtime before?
In the U.S., a lockdown like the one in The Pitt triggers a
massive regulatory and legal cascade. Between HIPAA data integrity requirements
and the NIST Cybersecurity Framework, a preemptive shutdown isn't just a
dramatic choice—it's a calculated move to protect patient data from being held
for ransom.
This requires a fundamental shift in how we think about the
Marathon:
- Supply
Chain: Do we have enough physical toner and paper for a month of
manual charting?
- The
Clean Build: IT isn't just rebooting; they are often building a
completely new, uninfected network from scratch.
- Data
Entry Backlog: Who enters weeks of paper charts back into the EHR once
uptime begins?
Managing the crisis for the long haul requires a Hospital
Incident Command System (HICS) approach—tracking every resource, every paper
MAR, and every manual lab result to ensure we don't lose the patient's story in
a mountain of paper.
Final Thoughts
Whether you’re channeling your inner Dr. Abbott or you're
the one frantically trying to find a working fax line, The Pitt reminds us that
technology is just a tool. The process is what saves lives.
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