Facing the threat of cyberattack: developing an activity continuity software for the production of anticancer drugs

Introduction
Recent cyber-attacks on healthcare establishments have highlighted the need to developing off-line informatic tools. Beyond the Activity Continuity Plan (ACP), more advanced and effective solutions are required to ensure optimal patient care in our establishments. The aim of this project was to develop backup software packages incorporating essential modules for ensuring activity continuity of anticancer drugs production, adaptable to most healthcare establishments.

Materials and Methods
The software development was planned in three stages: 1) definition of the specifications based on a Preliminary Risk Analysis (PRA), 2) software development using Power Query M^® for database backup management and VBA^® for the user interface, and 3) qualification of software modules with the involvement of medical and paramedical healthcare professionals at each step of the process.

Results
The PRA has identified 45 high-impact hazardous situations, most of which are related to the activity software. To deal with these situations, five main modules were selected, including prescription, pharmaceutical validation, prefabrication, post-fabrication tracking (including pharmaceutical release, dispensing, and administration).
Based on five databases backed up from Chimio^® activity software, the backup software was designed to operate off-line. The software enables the creation of patients, their inclusion in protocols, the tracking of treatment indications for the social security reimbursement, the entry of notes on a patient or specific prescription, the traceability of pharmaceutical validation, the generation of manufacturing sheets, the tracking of prescription numbers, the generation of care plans, and so on. Interfaces have been designed to guide users into a familiar and secure environment with numerous automated functions to facilitate and secure work.

Conclusion
PRA has identified the essential modules to be developed. In line with the specifications defined by PRA, the software is part of a global approach to crisis management, covering organizational, financial, and operational aspects. It provides a concrete solution for ensuring the continuity of activities related to the preparation of injectable anticancer drugs. There are plans to qualify the software and adapt it to other establishments in order to validate its effectiveness in the event of a cyber-attack.

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