Rebecca McBeth

New Zealand’s Northern Region simulated a major cyberattack on its health system, saying it is a case of “when, not if” an attack will eventually occur. healthAlliance systems operations manager Simon Long presented at the HiNZ Conference 2018 in Wellington on 23 November on the mock incident, called ‘hot chilli’, which was run by the shared services agency. healthAlliance is one of the most significant shared services organisations for the health sector in New Zealand and jointly owned by the four Northern Region district health boards (DHBs) : Northland, Waitemata, Auckland and Counties Manukau Health. Long said low-scale cyberattacks on the health system happen on a daily basis and the mock incident escalated the scenario into a major attack that affected a number of systems. “The objective was to create, test and improve a regional view of business continuity and the recovery capability,” he told attendees. The exercise involved the four northern DHBs – Waitemata, Auckland, Northland and Counties Manukau – and was designed to be as close to real life as possible, so staff were not forewarned. Around 27,000 people work across the DHBs and healthAlliance. The mock attack involved the email systems being unavailable due to hacking, no wi-fi access on the sites and the data integrity of the clinical systems being untrustworthy, meaning National Health Index numbers were not validated. Webinar: The Future of Medicine: Protecting Privacy Without Impacting Quality of Care The simulation started at 9am and finished around 4pm followed by a debrief and “it was a really interesting day for everybody involved,” said Long. Key learnings were that one can never over-communicate in a crisis situation and the huge value of practice to get better and become more efficient. Long said other organisations had since asked healthAlliance for help in this area and the agency is happy to share its learnings. Ministry of Health chief security adviser Nick Baty presented with Long on his involvement with ‘hot chilli’ and how the experience has fed into the development of a health sector cybersecurity event response plan. In the article “Ethical hacking: What to look for in a pen tester”, author Jessica Davis notes that simulated attacks on a healthcare organisation can help infosec leaders assess their security posture, but not all pen testers are created equal and not every provider is ready to be tested. Pen testing is the practice of simulated cyberattacks on an organisation’s network or a specific function, such as IoT devices or web apps. The goal is to identify any system flaws or weaknesses and just how likely it is that a hacker can exploit these vulnerabilities. Lee Kim, director of privacy and security for HIMSS North America, said that a pen tester should have “real world experience and experience in business environments like [healthcare].” A version of this article first appeared on eHealthNews.nz.

Dunedin, the second largest city in the South Island of New Zealand and the principal city of the Otago region, is currently making plans for a new digital hospital. The Southern District Health Board’s (DHB) Executive Director People, Culture & Technology, Mike Collins said that the new hospital will be largely paperless and will leverage technology to save time for both staff and patients. Collins is responsible for the technology infrastructure for the new hospital, which will be built on the former Cadbury factory site, and says the focus is currently on the ambulatory care block. “We are trying to implement new technologies and solutions well before the hospital opens. From a change management perspective, I want staff to be comfortable working in that digital environment before the doors open,” he added. His team is running workshops with clinicians and the community and taking a persona-based approach to designing the technology needed to enable better experiences for patients and staff. A key question asked when looking at patient journeys is whether the person really needs to go to hospital or whether they can be cared for closer to home. Webinar: How Chief Digital Officers Can Boost Digital Transformation This planning is not based solely around the DHB, but around the southern health system as a whole, and incorporates the region’s new Primary and Community Care Strategy. Dr John Adams, the new Chair of the Clinical Leadership Group – the senior clinical staff guiding the clinical direction of the New Dunedin Hospital, also emphasised the importance of an integrated approach to healthcare in the Southern region in an interview: “It’s certainly clear to me that this is not just about building a physical hospital. It’s about building on the moves that have already been made around how the hospital works, and how it relates with primary care and the whole plan of health services in the region and the South Island. The New Dunedin Hospital is going to be a really important cog in the whole of the health services in the South Island. Part of the planning will be about how the clinicians continue to develop those exciting new ways of collaborative functioning, both internally and externally.” The region has developed a digital strategy and is working with the Ministry of Health to identify key strategic goals, such as the implementation of interoperability standards. The strategy plans for the next five to six years and is in line with the South Island Alliance’s regional strategy and the Ministry’s Digital Health Strategy, which is still in draft form. A version of this article first appeared on eHealthNews.nz.

The four Northern Region district health boards (DHBs) in New Zealand have started rolling out a cloud-based telehealth service. Northland, Waitemata, Auckland and Counties Manukau DHBs have developed the new service in close collaboration with their clinical teams. The technology is provided by Zoom Video Communications as a safe, secure and unified video, audio, content sharing and chat platform to help facilitate virtual patient care workflows, remote specialist visits, population health management and education and care coordination. Counties Manukau health director of hospital services and regional telehealth programme sponsor Phillip Balmer says telehealth is a vital cog in the DHBs’ goal of having a more joined-up region with improved access to healthcare and more equity. “The new service will help us realise our aim of seeing a more integrated health system in the Northern Region over the next decade,” Balmer says. Webinar: Fall Prevention and Fire Departments: Telehealth from Setup to Application   “Our vision is that telehealth, via Zoom, will be widely available for real-time consultations between hospital-based clinicians, primary care and community clinicians, and between patients and their team of care providers, whether in a hospital or community setting.” In July, a one-year-old patient from Kaikohe with severe respiratory distress was taken to the Bay of Islands Hospital in Kawakawa by ambulance with the attending GP. Once there, using the new regional telehealth service, the patient was assessed by Whangarei Hospital’s intensive care unit paediatrician and clinical flight team for a possible helicopter transfer. The teams from the different sites were able to stabilise the patient, with real-time coordination via telehealth contributing to the young patient having a successful outcome. This also meant that the ICU team was able to stand down the helicopter transfer, saving costs and keeping it available for other potential calls. Hospital and community-based clinical teams have also started using the new service’s secure instant messaging feature, which is improving their clinical and administrative communication. The Northern DHBs’ shared IT service provider, healthAlliance, has supported the clinically led implementation of telehealth in partnership with Zoom’s New Zealand reseller, Connect NZ. healthAlliance chief clinical information officer Karl Cole says, “telehealth is convenient and potentially life-saving, particularly for people who live in remote locations or who are unable to reach health services”. According to the NZ Telehealth Resource Centre website, the Zoom link to Bay of Islands Hospital is a predecessor to a Mobile Clinical Cart, which is being developed by the DHB Telehealth and Mobility team in collaboration with Zoom, the University of Queensland and HealthAlliance. The Zoom link is also available in the newly launched Accident & Medical Department and hospital wards as part of the Bay of Islands Hospital expansion, which was officially complete in September 2018. A version of this article first appeared on eHealthNews.nz.

The Ministry of Health (MoH) of New Zealand has chosen MidCentral and Southern District Health Boards (DHBs) as pilot sites for implementing digital maturity assessments. The pilots will include three HIMSS Analytics maturity assessments: the electronic medical record adoption model (EMRAM), outpatient-EMRAM (O-EMRAM) and the continuity of care maturity model (CCMM). MoH group manager digital strategy and investment Darren Douglass says the assessments cover digital maturity across multiple care settings, which will create useful information to inform where DHBs focus in terms of digital investment.  HIMSS EMRAM scores hospitals internationally on their adoption and use of electronic medical records on a scale from 0–7, and O-EMRAM is used to evaluate services provided outside of a hospital or acute care environment. CCMM focuses on the capabilities needed in order to “seamlessly coordinate patient care across a continuum of care sites and providers,” the HIMSS website says. Douglass says the two DHBs were chosen as pilot sites because they have both recently developed digital health strategies and have strong linkages within their districts across hospitals, primary care and community services. The timing of pilot programmes to implement HIMSS digital maturity assessments has yet to be confirmed. The success of the pilot programmes will inform whether the assessments are rolled out nationally. All DHBs have previously completed the EMRAM hospital inpatient maturity assessment. According to MoH’s eHealth website section on Digital Hospitals, HIMSS Analytics provided a report on the findings within New Zealand in June 2016. Evidence from implementations overseas has shown a strong correlation in improvement in productivity and quality as hospitals move up the EMRAM model to Stage 7. A version of this article first appeared on eHealthNews.nz.