FWIW, I don't work in a hospital, but I have relatively recently taken on as a client a small rural practice (8-15 employee range) and it's helped further open my eyes and give me more perspective. Big places should at least have dependably competent teams in principle, even if they have tons of expensive legacy, lots more strain/demand, and more perverse incentives and so on. But I think these challenges go up and down the stack in the medical world, and I don't think the available options are as friendly or as good as they should be. This place still only has quite limited internet options (though at long last fiber may come in the next few years), having everything be cloud-based isn't realistic on an unreliable 10 Mbps DSL connection. They had no "IT", just random locals (like us in fairness), which can be decent but also can be... less optimal (one set of intermittent issues they'd been having for years I traced to the previous guys who installed their ethernet not bothering to actually qualify it). And what the doctor had been able to figure out himself. It's a bunch of practitioners and then one front desk person who does all the billing and such and that's it. There was a mixture of windows 7/vista and Mac OS 10.10/10.11. But also a $30k panoramic Xray machine and a bunch of other smaller but still expensive systems that obviously they needed to have work and can't just "oh yeah just buy a new one!" This is a critical local resource in an area where there are towns with a total population of as little as 65.

It was doable on a budget with some work to put together a vastly improved setup for them with data going to a ZFS system with constant snapshotting and then that too getting further backups in a few ways to off site, but it took way more technical knowledge/metaknowledge then it should have. If I think about all the various components, this could and should be a lot easier. And even with what we went with I still can't say I'm truly satisfied. Like, why don't TrueNAS or everyone else in the space long since have watch dogs for signs of ransomware? Encrypted files are readily discernible from unencrypted files by computers, so why isn't there just a GUI option to "alert on threshold of change in encrypted files|filesystem entropy"? Or even "radical deviation in snapshot size"? The key thing about ransomware is deviation from norms, by definition it must suddenly make changes to a massive set of files in a way totally different from typical patterns. If all of a sudden a NAS/SAN observes any hints of that why in 2023 isn't that universally a red alert? Why is Webauthn not everywhere for admin pages? Hiding everything behind an internal VPN is good practice, but further layers would be good too. Etc etc, no doubt endless stuff I'm not even thinking of or don't know myself.

It's a huge societal drain to lose medical services over such events and fantastically inefficient. The cost to ensure everyone has at least some final fallback WORM recovery or the like, even if a month old, has to be a tiny fraction of the damage that even a single hospital shutdown (or slowdown even) causes. Somehow it's not getting priced in and responded to in a uniform manner. I really feel like I should be long since 100% out of a job on this sort of thing because there should be easy options for non-technical types, and that government should have universal help and guides for all medical providers from sole practitioner on up nationwide to get into a known good state.