Editorial - Future proofing health care

Welcome to the latest edition of Health Care and Informatics Review “Future proofing health care”. This edition considers the critical area of disaster planning from a health care perspective.

Preparedness for potential crisis events involves management of risk and assurance of business sustainability. Organisations with management and response frameworks in place to respond to a crisis have been described as “resilient” and able to safeguard the interests of key stakeholders, key activities and reputation.^[1]

Technology and health informatics in disaster planning and risk management is considered from two important angles: that of technology providing a tool box for emergency response planning and that of technology as a consideration in planning, in that technology itself needs to be future proofed for ongoing effectiveness.

Primary care will play a pivotal role in the coal face management of an influenza pandemic or other disaster situation. Ensuring an effective primary care response, from individual patient care through to organisational business continuity, is vital to an effective response to such an event.

John Cameron, Medical Executive Officer, ProCare Health and Chairman, Auckland District Health Board (DHB) Primary Care Emergency Response Group, details the response of ProCare, one of the largest primary care organisations in New Zealand, to these potential threats and the remedial actions undertaken.

Cameron highlights differences in readiness at different levels of primary care organisation. He notes that systems to ensure data security and reliability are generally more rigorous and structured with limited risk of information loss or corruption at the primary health organisation (PHO) or Independent Practice Association (IPA) level. In contrast, business continuity planning at GP practice level is weak to non-existent and lacks a high quality framework for operation.

On a more positive note, Cameron highlights some of the positive actions that have arisen from work undertaken in planning for a potential infectious disease epidemic. Planning for controlled centralisation of medical resources to so-called “Key Practices” in an emergency situation is one such example. Critically, he highlights the requirement for significant further work to ensure robust capability in emergency situations and the need for sufficient resources and effort to bring this to fruition.

Still with a focus on pandemic planning, Ray Delany, Management Consultant, Auckland discusses some of the information management issues that might be significant in a pandemic emergency.

Delany provides a useful summary of the four colour-coded states in pandemic emergency and the broad information requirements during the different stages. He highlights that systems requirements for pandemic planning should dovetail into other initiatives and not be something separate to that which exists already. Critically, systems must be practical and relatively uncomplicated to ensure reliability. Further, any preparation of information systems for pandemic management should be consistent with a general improvement of public health surveillance systems in general.

Delany presents pragmatic suggestions for emergency management preparation, noting the need for careful, practical steps able to be implemented immediately rather than “grand plans” where lack of completion is a risk.

In “Business Continuity Planning in the New Zealand Public Health Sector” Karolyn Kerr, Manager, Information & Analysis, Central Technical Advisory Services, highlights that the increasing dependence on technology infrastructure in health care delivery makes it critical to preserve that infrastructure in an emergency situation.

With a focus on larger health care provider organisations, Kerr reviews business continuity planning processes for the management of a significant outage of technology resulting in the unavailability of critical business systems.

Kerr highlights the need for business continuity planning to become commonplace throughout the health sector given increased organisational vulnerability in technology emergencies and the shift to almost entirely paperless systems. She notes that the development of such plans can be complex and time consuming, requiring appropriate dedicated resource for that development and any implementation of possible mitigation strategies.

In our last paper this month, Malcolm Battin, Auckland City Hospital and Department of Paediatrics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, explores the potential merit of and possible barriers to the use of an informatics approach to the analysis of neonatology data. He argues that the analysis of large volumes of data generated by the care of neonates would lead to improved outcomes in this area. His paper provides a useful contribution to the debate on the effect that informatics can have on health outcomes in general.