Legacy electronic health record systems as culprit behind cybersecurity risks in public healthcare facilities of South Africa

The vulnerabilities of legacy EHR systems have become increasingly apparent due to the exponential growth of cyberattacks, threats, and data breaches in the healthcare industry. In South Africa, the continued reliance on these outdated systems poses serious risks to patient data security and operational efficiency. This qualitative study explores legacy EHR systems as culprit behind cybersecurity risks in public health facilities of South Africa. Semi-structured interviews were conducted with 16 IT managers, technicians, and network administrators, and data were analysed using thematic analysis with NVivo 13 software. The results showed that healthcare facilities fell victim to phishing scams, denial of service attacks, zero-day exploits, malware intrusions, and advanced persistent threats, which were intensified by their reliance on these systems. These security incidents resulted in severe consequences, including data loss, system errors and failures, operational disruptions, unexpected downtime, and sluggish system performance. To address these challenges, the study proposes comprehensive guidelines for modernising traditional EHR systems to effectively mitigating the risks posed by cyberattacks. This study underscores a pressing call to action for policymakers, government, and legislators to develop and enforce robust security policies that prioritise the adoption of modern, secured EHR systems, regular software updates, and effective cybersecurity practices to maintain a strong security posture. By prioritising system modernisation, South African healthcare facilities can build a resilient digital infrastructure to safeguard sensitive patient information against the ever-evolving cyber threat landscape.