Table of contents exchange of letters with the minister executive summary



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Report of the COI into the Cyber Attack on SingHealth 10 Jan 2019

COI Report – Part VII
Page 392 of 425

48.2.2
Drawbacks
1140. MOH representative Dr Yip gave evidence that ISS has not been implemented across the public healthcare sector in any other country. There is thus no case study on the long-term effects of ISS on the public healthcare sector.
1141. Dr Yip also testified that temporary ISS created challenges in the provision of patient care, lowered efficiency in frontline and backend operations, created impediments in meeting reporting requirements, and resulted in constraints on research, education and innovation activities, such as a)
Back-end administration and hospital operations i) The servicing and maintenance of hospital equipment has been affected, as remote troubleshooting and pushdown of software updates is no longer possible. Significant manpower and scheduling is required to perform troubleshooting and updates. There is also the risk of patches/updates being missed, which could in turn affect the quality of patient care and pose cybersecurity concerns. ii) Payment processing, as well as processes essential for business operations (e.g. procurement, payroll, staff claims processing. b) Reporting requirements i) National registries cannot be directly accessed, and staff have to transcribe the information onto internet-surfing devices, and causes delay. With temporary ISS, payments via EZLINK are no longer available. Patients have to use alternative modes of payment.



COI Report – Part VII
Page 393 of 425

(c) Teaching, research and education, and innovation i) Temporary ISS has made it more challenging to conduct literature research for statistical and epidemiological support. It has also impaired teaching opportunities. Due to the proliferation of personal and research organisation laptops, there is also anew challenge of how to safeguard and monitor the data being stored on such laptops.
1142. In the short period of time after temporary ISS was implemented, workarounds have been deployed for all the work streams affected by ISS, and there was little impact on patient care in the short term. In particular, a key workaround was providing sufficient separate devices for internet-surfing. While this was no doubt resource-intensive for the public health institutions, it is now a sunk cost. Another key workaround relies on human effort, where staff have to be more meticulous in (a) using internet-surfing devices to do their last mile checks before prescribing treatment and (b) transcribing data onto/from internet-surfing devices and (c) servicing and maintaining hospital equipment.
1143. On the implementation of ISS after the Cyber Attack, Prof. Ivy in her evidence said There has been some loss of productivity. People are working longer and harder. People are using their mobile phones and their own devices to do some of the work that they need to do, but there has been relatively little noise, I would say, about it. Even though I think there is hope that we will review it at some point, and, certainly, we work with MOH to look at this, but, you know, staff have taken it in their stride, because I think that the horror of our patients' data having been breached is an unacceptable risk at this point for us to even consider just opening to internet again. So we certainly hope the virtual browser platform, other solutions will come to play in the future. But I would say, at this point of time, there are



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