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"The cause of the outage was internal communications between our systems," Gillian Howard told °µÍø½ûÇø.

There were problems between the connectivity of the various hospital network's digital systems that exchange information, she said.

"There was speculation this was a cyberattack, but it was not a cyberattack," Howard said.

All systems are expected to be fully operational by end of day Tuesday, she said.

Around 11:45 a.m. Monday, most of the hospital network's systems went down.

It is one of the largest networks in North America and operates Toronto General Hospital, Toronto Western Hospital, the Princess Margaret Cancer Centre, as well as a number of other health-care facilities.

"It very quickly became clear that it was almost all systems and across the whole network of hospitals," Howard said.

By early afternoon, the hospital declared a "code grey" -- hospital code for system failure.

The hospital's information technology team found the problem and then resolved it by 2:30 a.m. Tuesday and began rebooting all the systems, Howard said.

The hospital's in-patient computer system was not affected by the outage, but nearly everything else went down.

Most importantly, outpatients' electronic records were not accessible.

Clinicians had to collect information manually and that work will now have to be input into the system, likely creating more delays Tuesday and more work for staff, Howard said.

They also had "downtime computers" that allowed clinicians to access some information.

The hospital network cancelled six surgeries because crucial images weren't available to surgeons. Those surgeries will be rescheduled as quickly as possible, Howard said.

"We're extremely sorry because our patients and our clinical teams really went through a difficult day yesterday," she said.

Other hospitals jumped in to help, Howard said, allowing the network to send some patients elsewhere.

"That helped a great deal," Howard said.

Virtual appointments couldn't be done because accessing a patient's phone number was not possible, she said.

Emails and video conferencing only worked through phones, not computers, but that was also sporadic.

Patients also could not access test results from home through the network's platform.

Initial reports about the outage sparked concerns about a possible cybersecurity breach after Toronto's Hospital for Sick Children suffered a ransomware attack last month.

SickKids said last week it had restored 80 per cent of its priority systems and lifted its code grey first issued on Dec. 18 in response to the cyberattack.

LockBit, a notorious ransomware group, apologized after it claimed one of its partners was behind that attack and offered the hospital a decryptor. SickKids said it had not used it, while its technology teams continued to work to restore the remaining systems.

The outage at UHN has taken a toll on hospitals' staffers, Howard said.

"We've been through this pandemic and people rise to the occasion, but it's tiring and this was not the way to start 2023," she said.

This report by °µÍø½ûÇø was first published Jan. 10, 2022.