Data and Digital Futures: Shayne’s View

eHealthNews.nz: National Systems & Strategy

Sunday, 6 December 2020

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VIEW – Shayne Hunter, Data and Digital Team, Ministry of Health

In the final column from the Ministry of Health’s Data and Digital team for the year, deputy director-general Shayne Hunter reflects on 2020’s achievements and lessons for the future.

A key learning from 2020 has been the ability to do things at speed, which is fundamental for transformation.

This means you cannot necessarily specify exactly what you're aiming for, but you know the direction of travel and you can get on and iterate.

This rapid pace was enabled by people's willingness to collaborate because we had a shared common purpose, amongst other things.

The pendulum swing

Doing things at speed does not mean you forget about important aspects such as privacy and security. At the Ministry of Health, we have shown we can still do these things and ensure our thinking is documented, while working at pace.

But while we maintained rigour, we did not overthink things. We had a common understanding that we had to make the right decisions and a confidence and willingness to just get on and make those.

One of the challenges we have is that we slip back into old ways. In emergency situations the pendulum swings very heavily towards getting on with things and we cannot operate under that model all the time.

Where the pendulum will land on this post-Covid, I do not know, but we cannot go back the other way too far.

Procuring on platforms

There are a lot of learnings from this pandemic that we in the centre can contribute back to the wider sector.

In response to Covid-19, we were able to build on what we had, especially in the Cloud. While I believe it is not good for us to be too reliant on a too few suppliers, we cannot deny that there are cloud platforms that enabled us to work at a much higher value level.

We had already used Salesforce for our National Screening Solution, which is now used for our National Contact Tracing Solution and will be used for our immunisation programme.

We need to accept that the likes of AWS, Azure, Salesforce, Service Now etc will be part of our ecosystem and work out how to procure differently on top of the platform level.

That is something we need to work on next year, because it is really important that we have the agility to be able to respond to the needs of the system.

Too much is based on interpretation and there is a fair amount of what I call ‘myth and legend’ in the procurement world. We need to do a better job of demystifying and helping people understand what they can and cannot do.

The same is needed in regard to data sharing. We were able to make significant progress through COVID-19 by making sensible pragmatic decisions and focusing on the outcome, rather than the process, while ensuring privacy and security were factored into the design.

Transformation?

If you think about what transformation truly looks like, I think this was limited during COVID.

There is a lot of discussion about the switch to virtual care, but research locally and internationally has shown the vast majority of non-face-to-face interactions were over the phone, rather than via video.

Many of the barriers that were there pre-Covid, are still there. We did address some important areas. Importantly, we have gained a sense of our ability to get on and do things differently, which is a great basis for us to move forward and transform.

The pandemic gave people an opportunity to try out technologies that may have previously seemed daunting and see that in fact, this stuff generally works and works really well.

A key takeaway is that well-designed, easy to use systems, reduce the barriers to take-up.

A different mindset

The events of this year have driven an acceleration mindset, catalysing a range of investments and different ways of doing things.

We have accelerated an inevitable change in the way that people work, as well as maturity in systems for business continuity.

Most significantly, people have been forced to do things in an iterative way and that has been huge in terms of a shift in mindset.

Locking in those gains is very much around leadership, which needs to be clinical, business and technical working hand in hand.

We cannot return to the old ways of doing things so if, for example, we are going to allow patients to book their own appointments, in-person or virtual, at a time that is convenient to them, that means clinicians have to give up some control.

That to me is an example of transformation and will require both enablers and a culture change.

Change will be consumer-driven. During lockdown people discovered they could have a virtual appointment and have a prescription delivered to their door. They want this to continue…and they want more.

That works well for people who are digitally literate and have the technology to interact digitally, but we must never lose sight of those who do not have that advantage and in some cases were not able to get the health services they needed.

This is so important because oftentimes they are most vulnerable people who probably need more help from the system than those that are digitally enabled.

What became clear to me over the past year is that if we are not careful we can lose sight of our vulnerable and digitally excluded people. While we have done our best, that has reinforced our commitment to focus on digital inclusion in 2021.

Highlights

I could not be prouder of my team within the Ministry of Health and the whole digital health community for what we have achieved this year.

The scale of what we had to do and the levels of engagement and support that we have had at the Ministry has been unbelievable.

Looking back at what we have had to build from scratch, it is mind blowing. We now have a National Contact Tracing Solution, a border register, and the NZ COVID Tracer App.

We have also had to stand up technology to support Managed Isolation and Quarantine Facilities as well as necessary swabbing, testing and results and data flows and management around those.

We have had excellent feedback from the sector about the Data and Digital team, their professionalism and responsiveness.

And amongst it all we have also had a bunch of business-as-usual work that we had to carry on doing.

A New Year

Next year is going to be pretty busy, with the new vaccine and immunisation system being a significant focus for us as COVID-19 vaccines become available.

We’ll continue to focus on the data and digital aspects of supporting other government priorities.

By March we will know the Transition Unit’s plan in response to the Health and Disability System Review, which should set out the Government’s agenda for reform.

I believe we need a strategy for transformation, not a transformation strategy, but rather a clearly defined execution approach for driving health and disability system transformation.