The National Health Laboratory Service (NHLS), which provides laboratory services to every single public sector health provider countrywide, reported a major disruption to its information system, TrakCare, on Monday evening – creating an immediate crisis like the one two years ago, when a cyber attack brought the entire system to a grinding and chaotic halt and resulted in patient deaths.
Daily Maverick reports that rather oddly, and despite bitter experience, the NHLS – the sole provider of diagnostic pathology services to more than 80% of South Africa’s population, with more than 300 laboratories across the country – has no emergency UPS or uninterruptible power supply back-up system in place.
So when the system goes down, it has a major impact on the ability of healthcare providers in the public sector to administer patient care.
Ntobeko Ntusi, President and CEO of the South African Medical Research Council, told Daily Maverick that the interruption in the NHLS services was apparently linked to a power outage affecting the organisation’s head office in Johannesburg, where the servers and computers holding patient results are housed.
“The NHLS doesn’t seem to have a UPS or any other back-up system, so if there’re issues with energy, the whole system goes down, and everybody in the country in the public system cannot access results, which is just, frankly, unacceptable,” said Ntusi.
NHLS working to restore system
On Tuesday, the NHLS confirmed its TrakCare system was unavailable, and that technical teams were “working urgently to restore full functionality”.
“The disruption is attributed to erratic power supply challenges in and around Sandringham, where the NHLS head office is located. This is an infrastructure-related issue and not a cybersecurity incident. The integrity of NHLS information systems remains intact, with no compromise to data security, and all other systems continue to operate optimally,” the NHLS said.
In June 2024, a devastating cyber-attack, caused by ransomware that targeted selected parts of its IT systems, disrupted patient care and medical decision-making, rendering the organisation’s systems completely inaccessible, resulting in a months-long restoration effort.
“These outages have been happening from time to time. ..That big outage (in 2024) where clinicians couldn’t receive results for a number of days… you effectively cannot manage patients if you don’t have insights into their physiology, and quite a lot of patients died,” said Ntusi.
The latest outage affected health facilities countrywide. None of the health professionals who uses the NHLS system could access patient results – a situation Ntusi described as “utterly ludicrous”.
“The NHLS is the arm of our South African government, nested within the National Department of Health, that provides all the laboratory investigations in health, and so every patient seen in a primary healthcare clinic or in a secondary hospital, or in a tertiary or quaternary facility, that has any kind of laboratory investigation in the public sector, almost all of those are performed by the NHLS,” he said.
“When their systems are down, it means new investigations have to be deferred, but importantly, it means, for those that have already been done, the doctors are not able to access those results, and so cannot use laboratory investigation as a standard of care to guide management. It obviously impacts profoundly on care, on patient outcomes, as well as survival.”
The NHLS said TrakCare underpinned the laboratory service’s operations nationally, meaning its unavailability had a widespread impact countrywide, affecting health facilities in varying degrees, “depending on local contingency measures”.
“The primary impact has been on specimen registration processes, which is likely to result in delays in testing workflows and turnaround times for results. This may, in turn, affect clinical decision-making timelines at the facility level,” said the NHLS, adding that it was “implementing interim contingency processes across its laboratories to maintain continuity of critical services and to minimise disruption to healthcare facilities”.
It said technical teams were working “around the clock” to restore the systems.
Communication breakdowns
A doctor at a hospital in Cape Town told Daily Maverick on Tuesday that although the system had been down since Monday evening, staff had yet to receive any formal communication from the laboratory service about the problem.
“We have had no IT laboratory system for almost 24 hours in the entire country. Crazy,” he said.
He added that the impact of the outage on hospital functions was “massive”.
“The hardest hit are emergency services, because blood results are usually required soonest to make management decisions. So, we start relying on proxies. Within the wards, you cannot access results on the system. You have to go down to the laboratory and get printouts,” he said.
“The problem is (these outages) happen periodically, but usually on a regional basis. This is the laboratory service that would underpin the National Health Insurance, heaven forbid.
“The problem isn’t within the labs themselves – we have fantastic staff who are held to ransom by the complete ineptitude of management in Johannesburg.”
See more from MedicalBrief archives:
Provinces owe billions to struggling National Health Laboratory Service
NHLS cyber hack continues to cause chaos in hospitals
Cyber attacks create havoc in state hospitals in SA, and globally
NHLS must hand over cyber attack info, says regulator