With the largest population in Australia, New South Wales also has the biggest healthcare scope: 150,000 staff looking after 8 million geographically dispersed people. When COVID-19 concerns hit Australia, NSW Health CIO Dr Zoran Bolevich said the state department found itself at the very centre of the country's response.
Speaking with media virtually on a panel session run by Amazon Web Services (AWS), Bolevich said in such circumstances, the state's health system was designed to switch to a different mode of operation, mirroring an emergency response model.
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Vastly different from business as usual, Bolevich said in the first few days of its pandemic response, NSW Health had to ensure "emergency response was IT-enabled".
That meant all the tools and information decision-makers needed was on hand. eHealth NSW was behind the transition and was stood up to provide guidance on IT-led healthcare to state-run health organisations.
Around 80 Health staff moved into the Rural Fire Service Operation Centre in Homebush. They also had to be fully connected to health infrastructure and have access to every system and all of the state health service's data.
"The time was of essence … there was a range of activity in the first few days, would have probably taken three to four months under normal circumstances," he said. "Making sure that that kind of initial organisational response was effective, smooth, fast, was our first focus."
The next focus, Bolevich said, was ensuring business continuity.
"What that means in the world of eHealth NSW is ensuring that critical ICT infrastructure, systems, services will always [be aligned], available, performing well," he said.
REMOTE WORK AND THE NEW BAU
Like many others, Health had a large number of staff shift to working from home. It focused on ensuring its network was functioning and that it had ample server and storage capacity to deal with the surge in activity.
"By and large, all the investments and hard work that we put into digitising NSW Health in the previous five to six years have really paid off, our networks, data centres, back-office systems, clinical systems, like the electronic medical record, and others, all performed exceptionally well and just enabled the health system to continue functioning," he explained.
However, given the sharp increase in the use of digital tools, Health had to look outside of its usual practices, sending its increased traffic into the AWS cloud.
Bolevich hopes some of the current flexibility will be retained in the post-COVID era.
"I have 1,400 staff in eHealth and we switched to working from home overnight seamlessly and just continued operating and providing a great service to a large health system," he said.
"While working from home is not necessarily an option for [clinical staff], there's still a lot we can do with digital tools to improve their experience."
One example was around personal protective equipment, both the availability of it and the education of its appropriate use.
The Health Education and Training Institute and Clinical Excellence Commission quickly put together training modules that were available through NSW Health's online learning platform, which uses a software as a service, cloud-based platform.
Bolevich said within a week, 75,000 staff went through that training.
SMS TEXT BOT AND THE COMMUNITY
Bolevich said it was important to create a flow of reliable, timely information to the community.
"In times of crisis, reliable, accurate information is provided to community, to consumers, to patients, so that they have an ability to make the right decisions for themselves," he said. "We were able to quickly scale up our call centres using Amazon Connect. We've also created a number of new call centres in those areas of the business that found themselves under particular pressure."
An example of such a service was NSW Health Pathology, the state-run pathology arm.
"They're really an organisation that has done most of the COVID-19 tests in Australia by a wide margin. And so they had to streamline a lot of their interaction with consumers," he explained.
"The key tool in the battle against this pandemic is testing, tracing, and contact management, so we focused on where can we use technology to enhance those."
NSW Health Pathology wanted to get positive COVID-19 results into the hands of patients and public health officials quickly, to allow for quarantine and appropriate medical care. But waiting to hear even a negative result was also an experience that generated anxiety.
Pathology worked with AWS to stand up a call centre, and alongside eHealth and a number of other industry partners, Pathology enabled its laboratory information systems to feed negative results through an SMS text bot engine
"Patients are able, once they get swabbed in a clinic, they're invited, should they wish to do so, to subscribe to an SMS text bot service. They go through a simple registration process and once the result is available, if it is negative, they get an SMS text message. And that is an entirely automated process," Bolevich said.
"It cut down the waiting time from days [to] two hours, which is a fantastic thing for patients, but also health workers, because pathology estimates that they've saved thousands of hours … that healthcare workers would have otherwise had to go through the system manually, contact each individual patient, have a conversation, etc."
Bolevich said capabilities such as video conferencing became very important in providing consultations to a number of patients that were no longer able to access services face to face.
"Our state-wide video conferencing platforms have seen an 18-fold increase in use compared to the pre-COVID era," he said.
While some of those have been internal meetings, most have been telehealth consultations. To Bolevich, the most significant legacy from the current method of operation will be the shift to virtual care.
"Telehealth has been around ... in health for probably a couple of decades and Australia has been acknowledged as a global leader in telehealth because of our large distances and remote parts, but what we are seeing now is telehealth really moving into the mainstream," he said.
"I think COVID, as disastrous as it has been, has been a really useful leverage point and a really useful trigger for health to seriously consider how we can embrace virtual care and telehealth and never go back again."
Pointing to one example, Bolevich said Sydney Local Health District were remotely monitoring COVID-19 patients in their homes, through video consultation and "some pretty simple biometric devices" that measure the oxygen levels in blood, which is an important parameter for coronavirus treatment.
"[They] have been able to very, very safely look after these patients in the comfort of their home, at the same time ensure the safety of healthcare workers," he said. "So we think that these types of applications, video consultations, remote monitoring, and also clinical teams supporting one another -- for instance ICU team from a metropolitan area, supporting their colleagues in regional centres … those are the sorts of things that I think will be the lasting legacy of this otherwise pretty terrible situation."
At the time of writing, the World Health Organization reported that there have been over 4.5 million confirmed cases, with over 307,000 fatalities as a result of the virus. Australia has reported just over 7,000 cases and 99 deaths.
There have been over 1 million COVID-19 tests undertaken in Australia and the country has seen social distancing restrictions lift in direct response to the positive response nationwide in efforts to contain the spread of COVID-19.
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