Proceedings of the

The 33rd European Safety and Reliability Conference (ESREL 2023)
3 – 8 September 2023, Southampton, UK

An Analysis of Resilience and Risk Assessment in Digital Healthcare Systems

Georgia A. Tzitzili1,a, Stergiani Spyrou2 and Agapios N. Platis1,b

1Department of Financial and Management Engineering, School of Engineering, University of the Aegean, Chios, Greece.

2Lab of Medical Physics & Digital Innovation, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3rd Regional health Authority, Macedonia, Greece.


Resilience assessment of a digital healthcare system is important to maintain continuity of critical operations, downtime of which may affect even patient's life. A resilient Hospital Information System (HIS) or subsystem should maintain its interoperability with other subsystems despite challenges such as technical failures, data breaches or natural disasters. This resilience is critical in ensuring that the HIS can continue providing accurate and timely information to healthcare providers and patients, even during times of crisis. The complexity of multiple Information Technology (IT) systems in hospitals and the interaction of subsystems with HIS, electronic patient records and national e-order systems for e-prescriptions or clinical orders highlight the importance of ensuring interoperability. The use of Markov models in reliability block diagrams is an approach that takes into account the weaknesses of IT equipment and infrastructure over time. With this approach, the reliability of the multidimensional functioning of the different subsystems in the health field can be assessed. The failure probability of a subsystem can be estimated, and the overall resilience of the systems can be highlighted. Limited literature in this area is notable. However, many additional steps need to be taken to improve resilience, since low resilience investments, problematic or incorrect employees' training on safety issues, lack of cybersecurity resilience strategies and risk management frameworks of healthcare organizations were identified as significant gaps in the digital healthcare system's resilience.

Keywords: Critical infrastructure, Dependability modeling, Healthcare IT systems, Healthcare services, Information technology, Resilience, Reliability, Risk.

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