When word of the pandemic first spread globally, East Metropolitan Health Service (EMHS) Chief Executive, Liz MacLeod, said she was confident that she that the right teams to rise to the challenge during these unprecedented times.
“I instinctively knew I could count on the Data & Digital Innovation team to deliver quality outcomes on a day to day basis – but during a global pandemic, was going to be a new test,” she said.
“I’m pleased to say however, that within 60 hours of liaising with EMHS Area Director of Data & Digital Innovation, Adam Lloyd – back in March this year – and outlining my vision, a practical and cost-effective solution was developed.”
In essence, COVID testing was about to ramp up to identify people with the virus. WA Health urgently needed a system to capture all the information collected and keep it secure – while also providing up-to-the-minute insights to the WA Government to inform its decision making.
Included in the requirements, was a system that had capability, once a patient’s COVID test results were available, they would be communicated to them and if it was negative, preferably by SMS. Further, the system needed to address the fact that there would be results from multiple testing sites across the vast State of Western Australia.
Mr Lloyd recalls that initial stressful 60-hour period, when the system needed to be developed, but says that he knew that he had the right team and technology partners to make the deadline and fill the brief.
“We had 60 hours to develop an entirely new information system and during that time frame, it needed to be designed, tested and deployed,” he said.
“Achieving this over such a short time frame was unprecedented but we knew that it needed to make it happen as we were a key link to preserving the wellbeing of Western Australians.”
The task set was not easy. Further, while being developed by the EMHS team, it was required as a State-wide solution with approvals and input from key decision makers within WA Health. All of WA Health depended on the right solution.
Adam Lloyd is the Area Director of Data & Digital Innovation at the East Metropolitan Health Service (EMHS) which operates a series of hospitals and health services and employs more than 8,000 personnel to support the wellbeing of 725,500 Western Australians. It was his team’s role to develop the State’s needs.
Despite his title, Mr Lloyd says “in this role, it’s not my job to build digital solutions or build IT things; it’s to build value.”
When it came to building value during the pandemic Mr Lloyd asked himself; “What’s the most finite resource we’ve got? It’s time.”
Looking back on the start of the pandemic, Mr Lloyd said the most challenging aspect was the “time”.
“Time was very short in supply, and I knew we needed a system that would free up clinicians where possible to maximise their time with patients,” he said
“We also needed to consider how to ensure that patients were spending as little time in the clinic as possible and getting their results as fast as possible.
“We needed to do this against a backdrop of making sure that our Operations Hub was getting real-time visibility of what was happening in the clinics and keeping tabs on where the COVID hotspots were popping up in the State.
“The data needed to provide real answers to questions Health leaders and decision makers needed to know – and know quickly in an ever-changing environment.”
“This also needed to happen while mindful of the new socially distanced way of working.
“Fortunately, EMHS had already embraced cloud computing and modern workplace technologies – including Office 365 and Teams – and they were deployed. Basically, I had the scaffold in place to build around.”
Mr Lloyd explained how A COVID Webform was designed on user-centric principles and stood up rapidly. It was tested and refined based on clinician feedback. The system was launched at Royal Perth Hospital initially and then rapidly rolled out to all COVID clinics across the State within a fortnight.
The solution captures all the details of people presenting for a test – including their mobile phone details – an important detail because; “When the pathology request comes back with the results, (if it’s negative) you get that SMS straight away,” he explained, “An intelligent bot determines whether a patient meets the criteria to receive an SMS with their results based on issues like age, and whether or not the test was conducted on an inpatient. Where someone is ineligible to receive their results via SMS, they get a telephone call from someone able to provide clarification or follow up details.”
EMHS also stood up special call centres – one to respond to queries from staff and another for the public.
The COVID Webform is now used at COVID clinics across WA, in Emergency Departments outside of clinic hours, and to manage people in mandatory quarantine in hotels. Live data and real-time dashboards track the number of people in quarantine, which helps ensure the right number of staff are rostered on for swabbing people when required, and screening them prior to the end of their quarantine.
Leveraging the Azure cloud as well as APIs to a range of corporate and clinical systems, allowed EMHS to develop real time dashboards for the Operations Hub established at Royal Perth Hospital in order to view the statistics, ensuring complete visibility of wards, operating theatres, and any health hotspots.
With such a system, if someone wanted to know what stage a patient who had COVID, or suspected cases of COVID, was at, the system was able to answer the question – it was the engine room for key decision making.
All the data was fed into Azure Data Lake, and Microsoft Teams is the collaboration platform. Teams was also the backbone communications platform for all staff.
Safe and secure
To support personnel working in the COVID clinics, EMHS leveraged Azure and Windows Virtual Desktop (WVD) to provide secure access from any device to critical applications. WVD has also been used to provide access to systems needed by personnel monitoring people who have been billeted in hotels during 14-day mandatory quarantine periods after arriving in Australia from overseas or interstate.
Security is assured through Azure Active Directory and multifactor authentication with additional control of mobile devices through Intune.
EMHS has also developed and deployed an app, called iVisit that keeps track of which patients are eligible for visitors, and also logs any visitor details. This limits access to the hospital, helps maintain cleanliness, keeps patients and staff safe, and also provides a contact tracing service if required. Through the pandemic iVisit helped to prevent non-essential, or potentially contagious people from entering EMHS facilities.
The app is used to track visitors that come to see inpatients, we take the visitor’s name, date of birth and contact number, this is linked to the person they are visiting. It’s a crucial component of our Visitor Management Process, as part of our COVID Response Plan. – Hospital clerk who uses iVisit.
Connect and collaborate
Microsoft Teams established the digital communications and connection pathways for clinical staff, patient support services, facilities management, project management and data and innovations. This proved a highly effective platform to support collaboration when physical distancing was required, and is proving the platform of preference to host interstate and international meetings.
“One shared environment, providing transparent communication and planning process. Once COVID clinics started, it was a quick way to communicate any changes, quickly and efficiently – with all members of the team seeing the communication, negating the need for clunky shared mailboxes. The COVID clinic and its processes could be lifted from one site and replicated at any other site, including for the research project for asymptomatic (Snapshot) test.” – Dr Sumit Sinha-Roy, Deputy Director of Clinical Services, RPBG
The ability to use Teams to communicate both within EMHS and further afield was also important, according to EMHS Project Director, Helen McLeish.
“From MVP through daily iterations, using CICD, Microsoft Teams provided round the clock collaboration with vendors and stakeholders to achieve the aspirational timeframes for the launch of the COVID Webform,” Ms McLeish said.
“One of the benefits of Teams is that you can be a member of a team that isn’t within your own organisation.
”That allowed Teams to be used to connect WA Health with technology vendors, as well as with WA Police, fire and emergency services, and transport.”
Foundations and futures
The EMHS Data and Digital Innovation team says that while the last few months have been challenging for everyone within WA Health, there has been a silver lining from the pandemic in terms of the heightened appetite for reform and transformation, and greater interest in leveraging data and digital technology to boost efficiency and improve patient experience.
They are confident, for example, that the ability to send certain medical test results to patients via SMS will be useful across multiple clinical areas in the future. EMHS’s digital platforms (utilised to inform the whole State) integrate to the HL7 messages, which is the language that clinical applications use, meaning that there are no technical barriers to being able to extend the SMS test result service in the future.
EMHS’ own workplace has reported a positive experience with the new system, and the Operations Hub. Significantly, it has proven that cloud platforms are scalable, robust and secure – and ensure personnel can operate efficiently wherever they are located.
The sustainability credentials of cloud computing have also been welcomed as it allows people to work flexibly, digitally – without the need for vast troves of printed materials – and allows them to attend meetings virtually, without long commutes or flights.
The data collection that has been amassed in EMHS’s Azure based data lake is also whetting appetites for increasingly advanced real time analytics, particularly predictive analytics that might give clinicians early warning about outbreaks of disease in the community. Mr Lloyd also anticipates new customer services being developed that allow people to engage with EMHS through a single digital location.
Clinicians who have traditionally used desktop devices have now also discovered how easy, efficient and convenient it is for them to have mobile access remotely.
Ms McLeish reports “Already, the DDI Team is getting lots of queries from different wards, wanting to have, A) a mobile option in place, because it’s more modern, contemporary, friendly, easier to use, and B) get rid of having to interface with multiple different systems, because they’ve seen with the COVID form that we can pull from a lot of the existing systems and put all of the information in a single location.” This will provide a valuable platform to leverage for the future.
“Right now we’ve got a really engaged clinical and corporate workforce in the digital space, “Mr Lloyd said.
“I think the timing is right to really push the digital culture. They’ve seen what can be done in a really short period of time, and there’s a great appetite now for that to be pushed further. We’ve got hundreds of ideas being thrown at us at the moment.
“I always say I’m trying to teach the generation that can’t type to communicate with the generation that can’t write. So right now, the timing is kind of perfect to get all these people in a room and push the digital platform to people.”