Beyond the Firewall: A Multistakeholder Simulation for Cybersecurity Response in Health Information and Informatics Practice.

Background: Cybersecurity incidents, particularly ransomware attacks, pose significant threats to health care systems by disrupting operations, compromising protected health information, and undermining patient trust. Health information management and informatics professionals play a central role in responding to these incidents; however, educational preparation often emphasizes theoretical knowledge with limited opportunities for applied, practice-based learning. This study aims to describe the design, implementation, and evaluation of a multistakeholder tabletop simulation to enhance competencies in cybersecurity incident response, regulatory compliance, and interdisciplinary collaboration. Methods: A simulation-based educational intervention was implemented in 2 settings, namely, a national professional conference workshop and an undergraduate health information management classroom at a large public research university. The simulation was designed as a multistakeholder tabletop exercise set in a 350-bed acute care hospital experiencing a ransomware attack affecting key systems, including the electronic health record and patient portal. Participants assumed interdisciplinary roles representing leadership, clinical, technical, compliance, and vendor perspectives. A postsimulation survey assessed perceptions of realism, clarity of objectives, debriefing effectiveness, and learning outcomes. Descriptive statistics were used to summarize the responses. Results: Participants in both groups strongly agreed that the simulation was realistic, well structured, and effective at reinforcing key learning objectives. The simulation enhanced participants' understanding of cybersecurity response processes, privacy and security principles, and interdisciplinary roles and responsibilities. Although responses were consistently positive, variation between professional and student participants reflected differences in experience and familiarity with health care operations. Conclusions: This study demonstrates that tabletop simulation is an effective, practice-oriented approach to preparing health information management and informatics learners to respond to complex cybersecurity incidents. By integrating technical, regulatory, and leadership perspectives within a realistic health care context, the simulation supports applied learning and workforce readiness. Simulation-based approaches offer a scalable strategy for strengthening cybersecurity preparedness in health information management and informatics education.