Healthcare in the Cloud: Building a stronger and more resilient Kiwi Health System

 |   Microsoft New Zealand News Centre

Photo of Stella Ward

In the wake of the Canterbury earthquakes, Canterbury District Health Board (CDHB) embarked on an intensive digital transformation programme with Microsoft, HPE, CCL and other partners to ensure uninterrupted healthcare service provision for Cantabrians no matter what the circumstances. Almost a decade on, it’s leading the way in the adoption of cloud technologies such as Microsoft Teams. It’s now helping other DHBs and healthcare providers around the country build their own resilience, boost access to health services and unlock better collaboration to improve patient outcomes across New Zealand.

Providing hospital and community-based healthcare to more than 500,000 residents across Christchurch and rural Canterbury,12 percent of New Zealand’s population, Canterbury District Health Board (CDHB) is a critical resource for the region.

When the devastating 2011 Christchurch earthquake struck, one of the many learnings it made was that relying on paper files and single sources of information that could not be accessed from elsewhere impacted the DHB’s ability to provide the standard of services residents deserved. With important records locked in filing cabinets or damaged on-site servers, many patients and clinicians were unable to access personal data for months. Canterbury Health system leaders were determined the future would be different, no matter what it might bring.

It launched a business recovery strategy, alongside an ambitious programme of cross-agency collaboration, to ensure history was never repeated.

Creating resilience through cloud technologies

“We knew moving to a cloud-based platform was the logical choice. This would not only create better resilience across the organisation, but vastly increase the insights we could draw from patient data and enable more sharing of these insights to improve ongoing service delivery and health outcomes. To achieve that, we needed to bring in the right technology capabilities from a range of partners,” says Stella Ward, Chief Digital Officer at Canterbury DHB.

“Microsoft has provided us with architectural and technical advice to help ensure best practice is being followed, migrating our applications to its Azure cloud environment and supporting full business recovery in crisis situations. It’s helped us create a highly secure and reliable infrastructure that provides access to all the information healthcare workers need, wherever they need to access it from, while also providing top-level protection for patients’ personal data.

And Azure allows us to monitor everything from security to costs more efficiently, leaving us more time to focus on our patients and their health needs.”

Microsoft Cloud Solution Architect, Peter Joseph, worked closely alongside the Canterbury DHB team and project partners to ensure the best outcomes were achieved, both for patients and clinical teams.

“Watching the capability and confidence of CDHB teams grow using cloud platforms has been so rewarding. With 70 out of the 126 Information Services Group (ISG) employees having received Azure training, my mission is to help them get even more value out of the Azure environment and explore what else it enables them to do,” says Joseph.

Leading cloud implementation partners Hewlett Packard Enterprise and CCL are continuing to unlock Hybrid Cloud migration projects in partnership with Microsoft across the country. CEO Andrew Allan says Canterbury DHB’s work is an example of how cloud isn’t only about boosting productivity and profits, but has the potential to benefit our daily lives.

“What we really value about our work with Canterbury DHB is the ability to support its aims to improve health outcomes not just for Canterbury residents, but the wider South Island community and beyond. Their innovation with platforms like Azure are now benefiting the whole health sector as they drive the conversation forward with their partners, and we’re excited to see what further benefits we can support with technology.”

A virtual emergency response

Canterbury DHB’s digital readiness paid dividends in early 2020. With COVID-19 sweeping the world, the importance of secure and reliable infrastructure to enable patients and clinicians to communicate effectively throughout lockdown was brought into the spotlight. No stranger to rapid crisis response, Canterbury DHB immediately rose to the challenge.

The pace of new innovations was brought down from days or weeks to mere hours through the swift adoption of collaboration software Microsoft Teams. Microsoft Cloud Solution Architect, Nic Bishop helped facilitate training for CDHB staff to use the new platforms and tools such as Microsoft 365 and Teams.

“At first we were planning to roll out Teams in a phased approach, but the pandemic accelerated our plans overnight. Within days, the DHB rolled out Teams to 4,700 of its support staff and clinicians. It was encouraging to see that number rising daily,” says Bishop.

Canterbury DHB’s Information Services Emergency Operations Centre used Microsoft’s Blackboard platform and Teams Tasks features to swiftly co-ordinate the re-deployment of buildings and staff to respond to new ways of working remotely as well as set up Community Based Assessment Centres (CBACs) where needed.

“During the COVID-19 lockdown, we were able to engage with our patients in real time and use the hybrid cloud environment to host virtual meetings. We truly are embedding Teams into our everyday working lives and making the most of the application,” says Ward.

Canterbury DHB’s Radiology service had been piloting Teams for use in major incident responses. The service has staff in multiple locations and embraced using Teams as part of its COVID-19 response, using it for collaboration on planning, daily briefings, meetings, sharing information and messaging. It also used Teams’ screen sharing function to support its Radiologists and trainee Radiologists continuing to review and report imaging together, and for virtual consultations with colleagues caring for patients.

“We are a big service that had staff working different hours, over multiple sites, including some from home. Teams really enabled us to stay connected and keep caring for our staff, our patients and supporting our clinical colleagues,” says Dr Sharyn MacDonald, Chief of Radiology at Canterbury DHB.

Radiology leveraged its experience with Teams to help colleagues rapidly switch to using the platform for virtual multi-disciplinary meetings where experts confer on complex medical cases. This allowed care to continue when physical distancing meant face to face meetings could not. Although face to face meetings have now resumed, Teams continues to be used in parallel to give people the ongoing option to join virtually, reducing travel times and increasing flexibility around attendance.

A working oncology lecture theatre that broadcasts real-life lectures via Teams was also created to provide medical staff with the same experience whether learning remotely or in person.

Ward says: “Once people had a chance to use Teams and fully embrace functions like Blackboard and Tasks, they realised how much this allowed them to collaborate and communicate despite many working from home. Now they’re asking what else they can do.”

Creating a fast and efficient infection monitoring platform

Both Teams and Azure were also instrumental in helping Canterbury DHB prepare to monitor the spread of COVID-19. Canterbury DHB recently migrated the ICNet application into Azure.

ICNet is a sophisticated patient data system that can track and manage all types of information on infections. The CDHB Infection Prevention and Control team relies a lot on ICNet data, as they can see results instantly and are alerted to positive cases for infectious diseases. With COVID-19 rapidly breaking out, the faster deployment and greater reliability enabled by Cloud could not have come at a better time.

Dr Sarah Berger, Nursing Director at CDHB, says: “We’re really excited about the new features the cloud-based ICNet adds, such as performance dashboards so we can start utilising data more efficiently. Having the ability to also test various scenarios to pre-empt IT issues and gain insights into how the application performs will help us moving forward with ICNet in the future.”

The use of ICNet has made the need for using slow, inefficient spreadsheets to record infection rates redundant as data is now entered directly into the ICNet software. Now staff can monitor where patients with infections are within the hospital. As time progresses, the benefits will become more apparent, such as improved performance and cost efficiencies. While there were challenges in completing the migration during Alert Level 4, Dr Berger says Microsoft Teams helped the Cloud Transformation team perform thorough testing before the application went live.

“While the lockdown meant that 90 percent of the cloud delivery team was working remotely, that didn’t stop us getting the application live and ensuring it worked comprehensively. Using Microsoft Teams gave us an excellent platform to collaborate in real time and to stay connected from our bubbles.”

The vision for New Zealand healthcare

The days of sitting around in a waiting room for your doctor’s appointment may soon be over. Future appointments will be scheduled using shared cloud platforms, and consultations could routinely happen over applications like Microsoft Teams. Not only does this make healthcare more accessible, it makes a patient’s entire journey through the health system much easier to monitor, and treatments easier to integrate and follow up.

Ward’s vision is for the rest of the New Zealand health care system to benefit from Canterbury DHB’s cloud experience.

The Canterbury health system has been working alongside other healthcare organisations in the South Island to develop the HealthOne platform, facilitating the sharing of crucial patient notes between providers and helping improve treatment across the region. It stores everything from patients’ prescribed medications to test results and GP records, with users ranging from GPs to pharmacists, nurses, clinicians from rehabilitation services and authorised hospital employees.

The transparency enabled by document-sharing and conferencing applications such as Teams will be integral to rolling these sorts of platforms out further.

“Having the ability to share progress in real time and collaborate in an open environment not only means we can perform our jobs more efficiently, but it enables better buy-in from other DHBs and the key decision makers across the country as they have confidence in what we can deliver,” says Ward.

Robert Christiansen, Vice President and Chief Cloud Strategist at HP Enterprise, is full of praise for what the partners have already achieved.

“Stella is a ground-breaking woman who isn’t afraid to step outside the box and be confident about what New Zealand can do in the healthcare sector. She’s making it clear that backend health systems can no longer be ignored and significant resources need to be allocated if we’re to adapt to a changing environment where everything is being digitised and made accessible.”

Says Ward: “Our experience has given us an opportunity to help accelerate the journey for all of New Zealand’s healthcare systems to digitise and move to the cloud. This isn’t only about being ready for future crises. It’s about removing barriers to accessing health services and improving the wellbeing of all New Zealanders, while also supporting healthcare workers to do their jobs better.

“I want to see this become the standard.”

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