CIO Interview: The mahi starts now

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Kyle Forde, chief information officer, WellSouth

Kyle Forde became CIO of WellSouth Primary Care Network in January 2015, bringing a new set of eyes and perspective on delivering healthcare in a digital world. The arrival of Covid-19 has accelerated this transformation, particularly in primary care.

Telehealth

What better time to accelerate many years of poor uptake in telehealth services, but with a pandemic. As tragic as this may sound, the arrival of Covid-19 finally recognised the hard work of various people in many positions across the country (often out of scope of their practice) to implement the use of telehealth in primary care as a business as usual function for their patients. 

Over the lockdown period, general practice experienced 3000+ video consults in the southern district with the majority of consults undertaken over the phone with some practices experiencing up to 95% of daily consults using telephony.

The negative impact of this is the cost, calling from a practice to a patient’s mobile phone produced some bill shock for practices with reported increases in cost from $600 a month to $4000 a month. This is just a snippet of the challenges primary care organisations face through telehealth uptake. 

The Ministry of Health recognised the challenges facing primary care by responding with financial assistance during the Covid-19 period. Unfortunately, when we came out of Level 2 into Level 1 the use of telehealth in general practice dropped by about 80% in the Southern Region. From my own experience, telehealth was a great way to access primary care services when it was convenient for me as the patient. 

Telehealth isn’t a method which should be universally adopted for every discipline in primary care, but a good percentage can be. We need leaders in primary care to continue to demonstrate this to their peers for the benefit of their patients who are demanding this service.

Lockdown and access to technology solutions widened the gap in equity to healthcare services for people in the community. Telehealth options for patients to engage in primary care were by phone or by internet enabled telehealth solutions, however if a patient has no internet, no phone line and no minutes on their mobile phone then access is very limited. 

There is an immediate need for a solution, so all New Zealanders have access to a primary care facility for without the barrier of access and cost.

Testing and surveillance

Solutions for testing and surveillance needed to be deployed fast and securely to allow rapid processing of patients in Community Based Assessment Centres. Workflow for processing patients in CBACS and general practice was incredibly important when managing the pandemic in the Southern Region. Having an engaged executive enabled the leadership team to mobilise a solution for testing in our district before the Ministry of Health ordered rapid testing.

We developed an internet based secure electronic portal connected to health APIs for accessing patient information. This ensured a successful workflow process for managing patients. With the automation of lab results into the workflow platform we were able to provide a near live end-to-end solution for managing the patient journey through the Covid-19 process without a practice management system (PMS) in the community centres. 

WellSouth embedded the portal into general practice PMS systems in the new Covid-19 testing process, which practices use as part of their workflow today. Quick access to the data was crucial and provided stakeholders visibility throughout the entire journey daily via a published Business Intelligence platform. Southern Community Labs were crucial to the success of this solution.

Patient Portals

Patient Portals will be and are a key enabler for patients accessing health services in New Zealand here and abroad and this pandemic has proven that. Open notes are a significant discussion point with varying degrees of support and opposition across the health community. 

It is important if we open access to notes for patients that the quality of the data reflects an understandable language a patient can easily articulate: this isn’t something that can happen overnight, but we can work towards this. Patient Portals have been a key enabler for patient engagement during the pandemic and have allowed patients to leverage secure messaging and telehealth services through these platforms to access healthcare. 

It would be nice to see universal appointment booking access at a national level, so patients can make an appointment wherever they go, and the funding follows them wherever they go in the country.

PMS

Practice Management Systems are still operating in the health sector with little consideration to standards and interoperability pathways. The discussions in the past nationally have been “we should have a centralised model”, but how does this promote innovation if you have a single platform without a guaranteed pathway to interoperability?  

I recently sat down with the Geoff Sayer, the new Managing Director for MedtechGlobal, and I was encouraged by his approach to the sector, in his new world, and with a renewed focus on their core product. 

There was also a strategy focussed on enabling third parties to integrate with their product as an enabler to enhance Medtech’s core PMS offering.  These integrations and a joined-up approach to digital enablement can provide the benefits patients need when engaging with the health sector. It was very refreshing to have a PMS vendor with a genuine intent to enable the sector.

Security - let's work together to up our game

It’s something we take for granted and needs leadership from the centre to ensure we are protecting the integrity of patient’s information. Practices and PHO’s don’t have the luxury of having their own Chief Information Security Officer, so generally these services are contracted in New Zealand unless you are operating a large company. There is more work that needs to be done to raise awareness around the importance of protecting information and to further enhance security of information in primary care.

Wellsouth engaged the services of Medical IT Advisors and underwent a full cyber risk assessment which prompted us to up our game in this space. Ideally, primary care health agencies would pool their resources together across the country and centrally manage and monitor agencies at a national level, so we all benefit from the collaborative approach to sharing threat intelligence information. 

Medical IT Advisors have released a Health Threat Intelligence Sharing Platform, and my advice is we should all be sharing information on what risks are out there, so we learn and mitigate the risks based on real time information. Sharing is Caring!

Future

Depending on how the implementation of components within the Heather Simpson report goes and regardless of the outcome of that, the proposed National Health Information Platform (nHIP) will be a key enabler to digital transformation in the health sector.  The Simpson report acknowledged the under investment in digital across the health sector and nHIP supports the pathway forward for digital transformation in health. 

How we work together across hospital and primary care ecosystems aligns with the direction of travel the nHIP framework supports for a joined-up approach to patient visibility and integration. Now is the time for us all to come together to support a joined-up approach to digital transformation in the health sector. These opportunities do not come along every day, so we need to make the most of them to support better outcomes for patients.

The Mahi starts now!

Kyle Forde is the CIO of WellSouth Primary Health Network and adviser to West Coast Primary Health Organisation. Kyle sits on the Ministry of Health Digital Investment Board and Business Design Council with a strong representation for Digital health in Primary Care.

The Southern District covers a significant portion the lower South Island with the enrolled population currently sitting at 315,000 people. This district has a rural population at around 40% and the distance between primary care services and hospitals in a lot of cases is significant.

If you want to contact eHealthNews.nz regarding this View, please email the editor Rebecca McBeth.

Read more Views/CIO Interviews:
CIO Interview: Being the CIO of the smallest DHB in the country
CIO Interview: What does it mean to be a change-fit organisation?

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