How the Microsoft and CrowdStrike Outage Impacted the Healthcare Industry

Thousands of flights around the world were canceled, including 106 at Logan International Airport, and many more flights were delayed. 911 lines in several states were down, and several state and municipal courts were closed all day.

Mass General Brigham, the state’s largest hospital group, canceled all non-urgent surgeries and hospital visits on Friday. Tufts went into “full downtime” for part of the day, forcing staff to perform administrative tasks and manually communicate between departments. Dana-Farber Cancer Institute posted a message on its website advising patients to “stay home until further notice.”

The disruption started for many within the vast network of hospitals and medical providers just after 1 a.m., when data on computer screens across the city simply disappeared, replaced by what some frontline workers call “the blue screen of death,” a blue screen with an error message that locked users out. Frontline workers described the unfolding confusion as deeply disorienting, occasionally frightening, but ultimately manageable.

“This is extensive and dramatic and devastating — we’re so dependent on computers,” said Dr. Sarah K. May, a Dana-Farber hematologist-oncologist who practices at South Shore Hospital in Weymouth. “We can (still) assess patients and provide care, but it’s primarily emergency care and other care that’s less complex. … As far as regular care for subacute issues, that can’t really be provided because we’re so dependent on computers.”

Boston Emergency Medical Services chief James Hooley was awakened from a deep sleep at his West Roxbury home by an urgent phone call: The central computer system that dispatchers use to coordinate the city’s ambulance responses to medical emergencies was down. Backup computer systems were also down.

Now, hospital emergency departments across the city were calling, requesting a “Code Black” status, which instructed dispatchers to send ambulances elsewhere.

Hooley arrived at the system’s South End headquarters within an hour to find a scene straight out of the 20th century: messengers running back and forth between switchboards, delivering call records on scraps of paper, call log cards taped to desks with medical tape, and IT technicians crawling under desks to diagnose the problem.

In hospitals, the sudden crash took out everything from the computers used to check in patients and record medical billing information to the wheeled bed systems that doctors and nurses rely on to guide patient care. Lacking electronic medical records, clinical staff were forced in some cases to call home doctors or patients’ families to make sure they weren’t allergic to their prescribed medications.

“It’s old-fashioned,” said Megan Mahoney, 29, of Dorchester, a nurse in the neuroscience department at Brigham and Women’s Hospital. “I may be in the last generation of nurses who have experience with paper records.”

The outage also forced clinicians to work without the benefit of digital test results and patient medical records, and caused some hospitals to postpone and cancel procedures. Most kept operating rooms open to treat the most urgent cases.

“It had a huge impact,” added Terry Hudson-Jinks, chief nursing officer and chief experience officer at Tufts Medical Center in Boston. “It took down our electronic health records, which are the heart and soul of our operation here.”

For EMS services in the region, the outage knocked out the digital system most rely on to track the progress and location of ambulances and facilitate seamless transfer of information between dispatchers. Like Boston EMS, Armstrong Ambulance, which provides EMS services to 13 communities outside the city in Massachusetts, turned to pen and paper to track calls and provided address instructions verbally.

Ultimately, many hospitals that had initially declared Code Black were able to admit patients. Neither Boston EMS nor Armstrong had to forward calls.

UMass Memorial Health, Boston Medical Center and Boston Children’s Hospital reported that scheduled appointments were not affected and all three hospitals remained fully operational.

However, the real impact on patient care may not be immediately apparent.

Megan Ross, a cardiac sonographer at Brigham and Women’s Hospital, said she couldn’t do ultrasounds without access to electronic medical records. She worried that doctors would miss patients with urgent conditions, including heart problems, that needed to be diagnosed quickly.

“I mean, that could happen right now and we have no idea,” Ross said. “Some doctors are calling us nonstop and asking if we can come in, but we can’t because we can’t see their (patient) records, which is very important for us to diagnose the patient.”

Kelsey McCandless, 28, brought her husband to Brigham and Women’s Hospital Thursday night with a persistent migraine. He was examined without much difficulty and given a CT scan. Then came the crash, leaving staff unable to read the full imaging results on computers.

Without a full diagnosis, she said, doctors could not prescribe him anything stronger than over-the-counter painkillers. He was then forced to sit on a gurney under the fluorescent lights of a busy hallway for more than 12 hours, waiting for hospital staff to figure out what to do with him, without the benefit of any IV fluids, she said.

“They are still concerned about his symptoms, but they are not actively doing anything to treat them,” she said.

McCandless eventually had to leave to care for her young child. And although she kept in touch with her husband via cell phone, she was unable to get updates from hospital staff, who were temporarily unable to locate him.

“They can’t find him,” she said. “They put me on hold. I get transferred to another department, the phone rings, and they hang up.”

By late Friday afternoon, the hospital had contacted her and given her an update, and some computers were starting to come back online.

Some suggested that the timing of the outage was a silver lining, allowing hospitals to implement contingency plans and get some services up and running, and giving emergency services time to adapt.

“Luckily it’s 2am, because that’s the quietest time for a dispatch centre. But if it had been 2pm, it would have been a different story. It could have been a thousand times worse,” said Richard Raymond, CEO of Armstrong Ambulance.

Globe correspondents Thomas Lee and Jessica Bartlett and Globe correspondents Camilo Fonseca and Helena Getahun-Hawkins contributed to this report.

Adam Piore can be reached at [email protected]. John R. Ellement can be reached at [email protected]. Follow him @JREbosglobeYou can contact Travis Andersen at [email protected].