CIO50 2020 #23: James Allison, healthAlliance
healthAlliance is New Zealand’s largest shared digital services organisation in the public health sector, supporting Northland, Auckland, Counties Manukau and Waitematā district health boards (DHBs) with services including IS Strategy and Planning, supporting and maintaining the region’s IS technology landscape, cyber and security services, digital and IS clinical advisory, and delivering project and programme services.
Health information systems are an underpinning foundation to the Northern Region’s ability to deliver a collaborative whole-of-system approach to health service delivery, says healthAlliance chief information officer James Allison.
A key clinical driver for our region is to improve the continuity of care for patients across primary, secondary and tertiary care, says Allison.
This relies on consistent and reliable access to core clinical information for all involved in a patient’s care. Our information system developments are a key enabler for us to achieve our clinical and business objectives.
“We are working with local, regional and national stakeholders to ensure the four DHBs’ shared vision of a data-driven, digital healthcare future that supports new models of care,” he states.
This direction comes to life in the Northern Region Information Systems Strategic Plan (ISSP) that has comprehensive supporting road maps and investment plans.
“Naturally there is alignment to central government and Ministry of Health strategies and directions which further strengthens the outcomes we’re aiming towards,” he says.
Allison is forthright about the challenges his team faces.
“Whilst we have a solid plan to transform the region’s technology, there are the normal challenges that you would expect in maintaining today’s IS landscape in a financially constrained environment”.
“We have a great team that manages these day-to-day challenges and equally supported by the region’s DHB CIOs that forms a great working and team-based approach to problem solving and risk management,” says Allison.
“Doing this together strengthens the technology proposition and safeguards the ability to deliver the end goal of ensuring the continuity of safe, high quality healthcare services and to deliver improved health outcomes for DHB communities.”
Te mahere (the plan)
He says healthAlliance, in partnership with the DHBs, has for the previous two years been delivering the Northern Region ISSP, one of the largest digital transformations in New Zealand.
The programme is part of a wider 10-year investment to establish a more integrated, digitally-connected, and accessible healthcare system that puts people at the centre of it.
“Creating the plan in a very collaborative way supported by DHB management was amazing,” Allison says.
“This isn’t just about healthAlliance, but the region together leading and delivering a comprehensive and well-structured programme safely. The entire region plays a part in governance, delivery, and the outcomes.”
“When you consider the sheer scale of our environment, it’s massive,” he says.
The integration involves four DHBs, including NZ's biggest (Auckland) and most populous (Waitematā), 14 metro and regional hospitals, 360 primary care and dental sites and 26,000 healthcare workers. The latter service a population closing in on two million.
The ISSP’s vision is a more joined up region that helps its population to live well, stay well and get well. Supporting it are detailed roadmaps and architecture, a delivery charter, an enhanced governance model and a financial plan - all focussed on delivering the ISSP to support improved healthcare outcomes.
He says it has four themes: modernising and strengthening core ICT foundations, simplifying the complex applications landscape, improving data sharing and interoperability, and increasing the capability and performance of the region.
“As with all new digital technologies, the issue of information security ratchets up,” notes Allison.
“Personal information is always sensitive, but when it comes to people’s health and medical information, that level of sensitivity increases several degrees.”
Over the past year, healthAlliance has markedly strengthened and expanded its cybersecurity programme to safeguard people, systems, and data.
He notes how healthAlliance now has a sector-leading cyber security operation that’s leading the charge against cybercrime in the public healthcare system.
Innovations include a dedicated security team within their operations centre with threat intelligence that can alert healthAlliance to potential cyber-attacks.
“We’re also doing our bit to grow the capability of the wider information security profession,” says Allison.
Last year, healthAlliance hosted a “Black Saturday” hackathon attended by 60 information security experts, ethical hackers and amateur enthusiasts.
It also designed and delivered a Cyber Security Boot Camp, a first of its kind for the region, which attracted globally recognised security experts to NZ.
The two-day event also involved many of the region’s key clinical IT leaders collaborating on ways to protect health information and people. It was an extremely valuable exercise.
Increasing awareness within healthAlliance and across the region has helped to maintain a safe environment, he states.
healthAlliance ran an internal staff awareness campaign called the Security Champions League, a gamification exercise that pitted teams against each other which had excellent engagement.
Staff completed a series of online quizzes to win points for their team. Another challenge had the IT security team planting blank USBs around the office to see what people did with them.
They extended this campaign to the DHBs in the form of the healthAlliance Cyber Hero Award, which recognises healthcare workers for simple (but heroic) deeds that contribute to cyber safety, such as correctly spotting and reporting phishing emails.
Their information security projects have since received national recognition.
The Northern Region Secure USB Project delivered security policies to 22,000 PCs across the region without disruption, while thousands of new encrypted USB devices were procured for clinicians to further enhance information security.
This project has dramatically decreased the chances of a privacy breach and it won the Best Security Initiative at the 2019 New Zealand Information Security Awards (iSANZ).
“It’s a little known fact that 85 per cent of all healthcare interactions are provided outside hospital settings,” says Allison. These interactions include DHB community services, primary health services, in-patient mental health and NGO services.
To support this, another ISSP programme underway is Regional Collaborative Community Care (RCCC).
This project will help to transform the care of people in the communities with complex healthcare needs, including mental health.
It involves rolling out a digital system in Northland initially that will support a transformation to a more integrated, collaborative health system centred around the patient and their whānau, as well as providing more effective population health reporting.
The focus is to enhance consumer experience and safety by supporting care closer to the home and whānau and breaking down artificial boundaries between care settings, says Allison.
Another major project will see the region shift to a Government-mandated private cloud storage model.
This as-a-service initiative will see servers and other technology moved out of hospitals and into a modern, secure third party datacentre, significantly lowering risk in the process.
The region has also installed an API engine which will further accelerate digitalising and sharing data across the region and nationally. This is providing dividends in enabling the DHBs to innovate faster, says Allison.
Te Hangarau (the technology)
A recent ISSP innovation is the region’s digital telehealth service.
This cloud-based offering is already proving its worth on the frontlines of patient care and is helping to remove barriers and improve access to health services, says Allison.
Using a digital solution in partnership with Zoom video communications, clinicians in the region are now able to perform online consultations securely with patients, regardless of location.
A big benefit with this technology is it provides more convenience for people in remote locations who might otherwise find it difficult to get access to the care they need, and that’s powerful, he adds.
The system can be accessed from a workstation, tablet or mobile phone which allows for greater flexibility for both clinicians and health consumers.
In Northland, the DHB has leveraged the solution to develop a new acute care telehealth network linking all of its rural Hospitals in Kaitaia, Bay of Islands, Dargaville, and in 2020 Rawene, to the Intensive Care Unit at Whangarei Hospital.
Allison says this means less travel for patients and clinicians and saving valuable clinical time.
In some cases, helicopter transfers have been stood down on the advice of medical experts during video consults, resulting in cost savings and freeing up of resources.
More importantly, it enables faster team-based decision making and support that contributes to improved patient experience, he states.
Allison says healthAlliance also worked with the DHBs and technology provider Orion to implement another innovation, the Regional Clinical Portal, that will become the largest patient health information ecosystem in NZ.
“This is a patient-centric digital dashboard that went live at two Northern DHBs in the last year, with the other two scheduled for early this year,” says Allison.
He says the portal improves the way patient information is viewed across the region and results in better sharing of information within and between the Northern DHBs and across care providers.
It also provides a better way for clinicians to follow their patients’ journey across all care settings, from GPs, hospitals or community sites.
Single-sign on functionality means it is easier and faster for clinicians that regularly move between hospitals or across DHBs to access the information they need.
For patients, it means not having to keep explaining their health history or answering the same questions every time they visit a different provider.
“Most of that information will already be available to the clinician treating them,” says Allison.
He says the portal is already being used by 15,000 healthcare workers in the region. When fully released this year, up to 26,000 will have access to the same system and the same information.
“It’s a significant milestone toward a more connected health system and a key enabler toward improving patient care in our communities.”